Scared Sleepless

A reader writes:

Dear Dr. Rosen,

I've read your article about sleep talking and wanted to share my recent experience with you because I'm quite confused.

I started dating a man 3 months ago. At that time, he told me that he sometimes talks in his sleep. 

Everything was going fine until recently. He would indeed talk in his sleep every now and then, mostly about things that had happened to him during the day, or about other ordinary topics.

This changed several nights ago. He stood up while still in bed, turned his head towards me (I couldn't see if his eyes were open because it was dark) and he asked me “Who the hell are you?” He repeated this 3-4 times, all the while looking right at me. I didn't say anything, mainly because I was frightened.

My question is: Could this be a sign of a more serious problem than just some regular sleep talking? Is it normal that people actually LOOK at you while they are asleep? What is the best thing to do in such situations? 

Thank you in advance,

Yours faithfully,

Sleepless in Stockholm

Dear Sleepless,

What you’re describing sounds like a confusional arousal (albeit a disturbing one). Confusional arousals usually occur in the first portion of the night, when the drive to sleep is strongest. Normally, we all cycle through the different stages of sleep, shifting from deep to light to REM (rapid eye movement) sleep and even awakening briefly now and then before quickly returning to sleep.

Occasionally, however, part of our brain awakens while other parts remain fast asleep. When this occurs, strange things happen: sleep walking, sleep eating, night terrors, and sleep talking. It’s not uncommon for people to carry on conversations with people who aren’t there, or to speak of things wholly unrelated to what is happening around them. Invariably, there is no recollection of this the following morning.

While the vast majority of confusional arousals result in no harm to the person experiencing them, or to those who witness them, they do sometimes result in injury, such as when a person sleepwalks out of a window, or wanders away from the house on a cold winter’s night. Therefore, the most important thing to do is make sure that the person experiencing the confusional arousal is safe. If they tend to sleep walk, for example, it is important to prevent them from banging into furniture, falling down stairs, etc. There is no need to try an awaken them: the best is to simply guide them back to bed where they’ll be safe, and to let them fall completely back to sleep.

There have been isolated reports of physical and sexual assaults being committed by people in a fugue-like state of confusional arousal. However, these are very rare. Still, if you are concerned, it may be a good idea for your boyfriend to consider discussing this with his doctor, as there are medicines which can decrease the likelihood of confusional arousals from occurring in the first place. In parallel to this, keeping to a regular schedule, getting enough sleep, and stress relief prior to sleep may also help to reduce their incidence, and to help you both get a better night’s sleep.

________________

Dennis Rosen, M.D.

Help your child get a great night's sleep with: 

Successful Sleep Strategies for Kids (a Harvard Medical School Guide)