Waking up confused and anxious (Why?)

In this guide, we will discuss what it means to wake up confused and anxious, possible causes such as confusional arousals, what does confusional arousal mean, potential causes for confusional arousals, risk factors that may be associated, treatment options, and what are panic attacks plus some of their symptoms.  

Waking up confused and anxious: Why?

If you have been waking up confused and anxious in the middle of the night it is possible you may be experiencing confusional arousals, also known as sleep drunkenness, which is a sleep disorder that causes you to act in a strange and confusing way as soon as you wake up or moments after waking.

You may feel disoriented not knowing where you are of what you are doing. 

Have you noticed how you seem to hit the snooze button repeatedly, going back to sleep without really waking up?

Well, when you wake up your brain doesn’t necessarily ‘wake up’ immediately. If you want to wake up and start your day calm, find out the best alarm clocks for anxiety.

It goes through a process called ‘sleep inertia’ which can explain what you experience as grogginess, confusion and difficulty getting out of bed.

As indicated by Kristeen Cherney from healthline.com, “Sleep drunkenness bypasses the sleep inertia phase, so your brain and body don’t get the opportunity to transition into the awakened phase.”

In contrast, you could also be experiencing a nocturnal panic attack but you could have an idea of which one could be if you pay

attention to the symptoms since they are both very different conditions. Moreover, consider it could also be related to an undiagnosed or undetected anxiety disorder that started to manifest recently.

Whichever option might be, make sure to pay a visit to a physician to get assessed and some additional testing to determine the reason why you have started to wake up confused and anxious.

What are confusional arousals?

As indicated by sleepeducation.org, “Confusional arousals is a sleep disorder that causes you to act in a very strange and confused way as you wake up or just after waking.

It may appear that you don’t know where you are or what you are doing. Your behavior may include the following:

  • Slow speech
  • Confused thinking
  • Poor memory
  • Blunt responses to questions or requests”

When this type of episode occurs, you may seem to be awake but very confused with a ‘foggy’ state of mind.

These often start when someone tries to wake you up if they have seen you sleepwalking or shouting.

Many people with confusional arousals tend to have no memory of what happened or the episode itself.

Confusional arousals are considered a parasomnia, which is classed as a sleep disorder that involves unwanted experiences that happen when we are falling asleep, while sleeping or waking up.

As indicated by sleepeducation.org: “Confusional arousals tend to occur as you wake from slow-wave sleep.

This sleep stage is most common in the first third of the night. In some cases, these episodes may occur later in the night or during a daytime nap.”

What causes confusional arousals?

There are some potential causes associated with confusional arousals such as having sleep apnea or being sleep deprived.

Another potential cause could be having restless leg syndrome, which can affect your quality of sleep.

Some of the other related factors include:

  • Having an anxiety disorder.
  • Alcohol abuse.
  • Changes in your mood and/or bipolar disorder.
  • Your work schedule (constant changes in your shifts)
  • Being stressed and worried, especially at night

Moreover, as indicated by Kristeen Cherney, “According to Cleveland Clinic, sleep drunkenness may also be caused by getting either too little or too much sleep.

In fact, some estimates indicate that 15 percent of sleep drunkenness is linked to getting nine hours of sleep per night, while 20 percent of reported cases are linked to getting less than six hours.”

Risk factors of confusional arousals

There is not just one particular cause or risk factor associated with confusional arousals, instead, scientific evidence and researchers have identified the following as possible risk factors:

  • Having a mental health illness. 
  • Antidepressant medication.
  • Being sleep deprived or getting too little sleep on a regular basis.
  • Sleeping too much.
  • Hypersomnia.
  • Having a relative or family history of parasomnias such as sleepwalking, restless leg syndrome, or sleep apnea.

Diagnosing confusional arousals

The suspicion may start when a friend, relative, or even your partner complains about you acting strangely upon waking up but you may have no recall of what happened.

Just having one or two episodes is not something to be alarmed about but if it becomes frequent, for instance, once a week, it is important to go to pay a visit to your doctor. 

Moreover, your doctor will ask some questions about your meical history, family history, symptoms, etc., so they can start narrowing down the possibilities. If they reach to the conclusion it might be confusional arousal they may order a sleep study. 

Is there a treatment?

There isn’t actually a treatment for confusional arousal but most professionals will recommend making some changes or adjustments to your habits and lifestyle such as:

  • Avoiding alcohol intake, especially before going to sleep.
  • Establishing a sleep routine and getting a full night’s sleep.
  • Avoiding napping during the day.
  • Following your doctor’s instructions if you are taking antidepressant medication.
  • Following your doctor’s instructions on sleep medication, which may be prescribed in severe cases.

On the other hand, some experts consider that the treatment for confusional arousal hinges on treating the underlying sleep problems or conditions, where the symptoms seem to subside. 

Panic attacks

As we have mentioned, panic attacks can also be responsible for waking up confused and anxious.

However, they differ from confusional arousals in their core symptomatology.

Moreover, if you are familiar with panic attacks, you have a history or you have been diagnosed with panic disorder then it would be easier to explain what is happening. 

In contrast to confusional arousals, panic attacks usually come suddenly without a warning with an intense feeling of losing control, going crazy or about to die.

Moreover, they are experienced with intense fear and can be very exhausting. On average, they can last between 10 up to 30 mins but there are some panic attacks that can take longer, it depends. Some of the symptoms include:

  • Rapid heart rate or heart palpitations
  • Increased breathing rate
  • Chest pain
  • Sweating
  • Trembling
  • Numbness or tingling sensation
  • Feeling like choking
  • Feeling as having a heart attack

If you notice, both conditions are totally different when we compare the symptoms experienced.

However, if you are still confused don’t hesitate to pay a visit to your doctor and get answers about any questions you may have differentiating each condition and determining what is happening to you or a loved one.

Why is this blog about Waking up confused and anxious important?

This blog about waking up confused and anxious is very useful if you have been having this type of episode.

However, there are many things to consider when determining if you are suffering from confusional arousals or nocturnal panic attacks. As we have seen, the symptoms differ from one condition to the other. 

However, in the case of confusional arousals you are not going to remember anything related to the episode or how you behaved. During panic attacks, you are experiencing intense fear and you are able to remember the episode.

It is recommended to pay a visit to your doctor to determine whether you experience one or the other condition and receive treatment.

Please feel free to leave any comments or thoughts about the content of this article!

Frequently Asked Questions (FAQs) about Waking up confused and anxious

Why do I wake up scared and confused?

If you wake up scared and confused it is possible you have been having a nightmare which consists of waking up frightened or terrified after a disturbing dream, night terrors where you could be waking up with an unresponsive look and act fearful or aggressive or it could also be confusional arousal which is a sleep disorder that consists of waking up confused or disoriented also known as ‘sleep drunkenness”.

Can confusion be caused by anxiety?

Yes, anxiety, stress, or depression can cause confusion, difficulties concentrating, and other problems that may disrupt your day to day activities.

Subsequently, you may feel confused if you experience high levels of anxiety throughout the day or during specific times of the day (i.e. waking up or when going to sleep).

What causes morning anxiety?

Morning anxiety can be caused by several factors. For instance, if you drink coffee with sugar as soon as you wake up it can increase anxiety symptoms or it could also be due to low blood sugar due to skipping breakfast can also make anxiety worse.

However, if you go to sleep worried with anxious thoughts, it increases the chance of morning anxiety.

How can I stop waking up with anxiety?

If you would like to stop waking up with anxiety consider getting more sleep (better quality), establish a morning routine where you could start by exercising or doing some meditation, stop using your snooze button, keep a journal where you could start by writing some of the worrying thoughts and transforming them into positive affirmations, stretch or practice some yoga in the morning, etc. If you’re open to trying yoga for anxiety and stress relief, check out these top Yoga DVDs.

What is Sexsomnia?

Sexsomnia is also known as sleep sex and it is considered a form of parasomnia or abnormal activity that happens while you are sleeping.

It is characterized by the fact that an individual engages in sexual acts while they are in the non-rapid eye movement (NREM) sleep. Upon waking up, the person experiencing this type of parasomnia is not able to remember the episode or their behavior.


Sleepeducation.org: “Confusional Arousals – Overview and Facts”

Cherney, K. (2018, Dec.) What Is Sleep Drunkenness? Retrieved from healthline.com.

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