Gina Johnson
Sleep arousal, also known as a disorder of arousal (DOA) or arousal disorder, is a parasomnia characterized by a partial awakening from deep sleep, during which the subject is partially or totally unconscious. Arousal disorders are more common in children, who may appear to be alert by crying, moving, or even running, while simultaneously appearing disoriented and confused. In adults, DOA is often associated with violent behaviors, such as sleepwalking, suspected suicide, and even homicide. Arousal during sleep is caused by a change in the pattern of brain wave activity, which can be measured by an EEG.
| Characteristics | Values |
|---|---|
| Definition | Arousal during sleep is a change in the pattern of brain wave activity, as measured by an EEG. |
| Arousal Disorders | Partial arousal from "slow wave sleep" or deep sleep. |
| Confusional Arousal | Children may appear awake by crying, moving, or running but seem confused and disoriented. |
| Occurrence | More common in the first part of the night. |
| Duration | Episodes may last from a few minutes to hours. |
| Frequency | Arousal disorders are common in children and tend to decrease with age. |
| Associated Disorders | Sleep-disordered-breathing, restless legs syndrome, nocturnal asthma, sleepwalking, sleep terrors, sleep paralysis, sleep-related hypermotor epilepsy, REM sleep behavior disorder, and more. |
| Risk Factors | Fever, abrupt sleep loss, migraine, irregular sleep-wake schedules, stress, anxiety, alcohol intake, sleep deprivation, etc. |
| Treatment | CBT-I, anxiety-focused treatments, avoiding caffeine, adjusting light, noise, temperature, etc. |
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What You'll Learn
Arousal disorders in children
Arousal disorders, or sleep disorders, are common in children. Arousal does not mean that the child wakes up. Instead, it refers to a partial arousal from deep, or "slow wave" sleep. During such an episode, the child may appear alert and move around, cry loudly, or even run. However, they are simultaneously confused and disoriented, and can be relatively unresponsive to their parents or other environmental factors. Typically, the child has little to no memory of the event the next morning or even 30 minutes later.
Arousal disorders can be triggered by other health problems, such as fever, sleep-disordered breathing, migraine, or irregular sleep-wake schedules. In older teenagers, alcohol intake and sleep deprivation may also be factors. Confusional arousals are the most common type of arousal disorder, and they can lead to sleepwalking or sleep terrors. These disorders are usually harmless in children but can be associated with violent behaviours in adults.
There is a link between arousal disorders and other sleep disorders, such as sleep-disordered breathing, restless leg syndrome, and nocturnal asthma. Comorbid sleep disorders such as periodic limb movement disorder and obstructive sleep apnea have also been found to co-occur with arousal disorders in children. One study found no significant differences between children with arousal disorders and typically developing children in terms of sleep onset latency, N2 latency, or SWS latency. However, there was an increase in REM sleep latency in the group with arousal disorders.
Nocturnal polysomnography is often recommended when a child presents with chronic abnormal behaviour during sleep, as it can help differentiate between a seizure disorder and a sleep disorder. Treatment of the associated sleep disorder has been shown to reduce or eliminate confusional behaviours.
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Arousal disorders in adults
Arousal disorders, or sleep disorders, are characterised by a partial awakening from deep sleep, during which the subject is partially or totally unconscious. Arousal does not mean that the sleeper wakes up. Instead, they transition from deep sleep to a mixture of very light sleep and/or partial wakefulness. This shift in sleep stage can lead to a confusional state, during which the sleeper may appear alert and be crying, moving, or running, but they will also seem disoriented and confused.
Arousal disorders are common in children, and they usually occur during the first part of the night. They are usually harmless and tend to disappear with age. However, arousal disorders in adults are often associated with injurious or violent behaviours. Driving motor vehicles, suspected suicide, and even homicide or attempted homicide have been described during sleepwalking episodes in adults. Therefore, it is important to differentiate adult arousal disorders from other sleep disorders such as Sleep-related Hypermotor Epilepsy or REM Sleep Behaviour Disorder.
Arousal disorders are NREM parasomnias, meaning they occur during non-rapid eye movement sleep. They are characterised by abnormal movements, long durations, and a low rate of same-night recurrence. Arousal disorders can be triggered by disruptions to sleep, such as health problems, travel, fever, sleep loss, migraine, or irregular sleep schedules. They can also be associated with other sleep disorders, such as sleep-disordered breathing, restless leg syndrome, or nocturnal asthma.
The diagnosis of arousal disorders is challenging due to the lack of objective and quantitative diagnostic criteria. However, recent advances in EEG analysis and the characterisation of DOA motor patterns have improved the definition of DOA diagnosis. Treatment options for arousal disorders may include cognitive-behavioural therapy, mindfulness-based cognitive therapy, sex therapy, relationship therapy, medication adjustments, and hormone therapy.
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Confusional arousals
Arousal disorders are common in children. Arousal does not mean that the child wakes up. Instead, it is a partial arousal from "deep" sleep, also called "slow-wave sleep". During such episodes, the child may appear awake and alert, crying, moving, or even running, but they are simultaneously disoriented and confused. They may also be relatively unresponsive to their parents or other environmental challenges. Typically, the child will have little to no memory of the episode the next morning or even 10 to 30 minutes later.
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Arousal and sleep disorders
Arousal disorders, or sleep disorders, are characterised by a partial awakening from deep sleep, during which the subject is partially or totally unconscious. This phenomenon is also known as 'slow-wave sleep'. During an episode, the subject may exhibit inappropriate or absent responsiveness to the efforts of others to intervene or redirect them.
Disorders of Arousal (DOA) are mental and motor behaviours arising from NREM sleep. They are characterised by a spectrum of manifestations of increasing intensity, from confusional arousals to sleep terrors to sleepwalking. DOA in childhood are usually harmless, but in adulthood, they are often associated with violent behaviours. According to the Third Edition of the International Classification of Sleep Disorders (ICSD-3), DOA includes confusional arousals, sleepwalking, and sleep terrors. These manifestations share a similar genetic and familial transmission and are linked to incomplete arousal from slow-wave sleep.
Arousal disorders are common in children. During an episode, a child may transition from deep sleep to a mixture of very light sleep and/or partial wakefulness. This stage shift commonly leads to a confusional state, during which the child may appear alert and be crying loudly, moving, or even running. However, the child may simultaneously appear disoriented and confused and may be relatively unresponsive to solicitations from parents or other environmental challenges. There is usually little to no recall of the arousal or any events that occurred during the episode.
Confusional arousals in children may be triggered by small disruptions to sleep, such as a health problem or travel, or by another sleep disorder, such as sleep-disordered breathing. In older teenagers, alcohol intake and sleep deprivation must also be considered as potential triggers. In adults, DOA must be differentiated from other sleep disorders such as Sleep-related Hypermotor Epilepsy or REM Sleep Behaviour Disorder.
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Arousal and brain activity
Arousal during sleep is an abrupt change in the pattern of brain wave activity. Brain waves can be used to assess an individual's level of consciousness or sleep stage, and thus can be used to measure arousal. Brain waves are typically recorded by an electroencephalogram (EEG) test. Arousal typically represents a shift in sleep states, such as a shift from deep to light sleep, or from sleep to a state of being awake.
Sleep occurs in two basic states: rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM). Normally, you have several cycles of these stages throughout a typical night of sleep. REM is a deep stage of sleep with intense brain activity in the forebrain and midbrain. It is characterised by dreaming and the absence of motor function, with the exception of the eye muscles and the diaphragm. Arousal occurs more often during states of NREM sleep, which consists of three separate stages: N1, N2, and N3. Each stage has distinct and recognisable electrical brain wave patterns, and arousal can occur during any of them.
Arousal systems can impact neocortical activity through projections to the thalamus, lateral hypothalamus, or basal forebrain, while others send direct projections to the cortex. The onset of sleep and its cycles involve a "constellation" of circuit nuclei and brain chemicals. Sleep is linked to preserving brain health and brain function, enhancing complex cognition, and maintaining attentional resources.
Disorders of Arousal (DOA) are NREM parasomnias characterised by partial awakening from deep sleep, in which individuals are partially or totally unconscious, with inappropriate or absent responsiveness to others' interventions. DOA can manifest in confusional arousals, sleepwalking, and sleep terrors. While DOA in childhood is usually harmless, in adulthood, it has been associated with violent behaviours.
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Frequently asked questions
Sleep arousal refers to a shift from deep to light sleep or from sleep to wakefulness. Arousal can occur during any stage of sleep, but it is more common during non-rapid eye movement (NREM) sleep.
During sleep arousal, a person becomes more alert and experiences a change in brain wave activity. This can be observed through electroencephalogram (EEG) tests, which measure brain wave activity.
Yes, sleep arousal disorders or parasomnias are characterised by behaviours or events that disrupt sleep. These include confusional arousals, sleepwalking, sleep terrors, and sleep paralysis.
Sleep arousal can be caused by various factors such as health problems, travel, fever, sleep deprivation, stress, and anxiety. Certain sleep disorders like sleep-disordered breathing and restless leg syndrome can also contribute to sleep arousal.
To reduce sleep arousal and improve sleep quality, it is recommended to avoid caffeine close to bedtime, create a comfortable sleeping environment, and engage in regular exercise.
