Waking Up Lost and Confused

Have you ever woken up lost and confused? In a strange place that you don’t recognize? Unable to remember how you got there?

Sometimes I have this experience. I wake up in a strange place and I don’t know where I am or how I got there. So far, I’ve always quickly remembered. But this moment tells us something important about memory, self, and awareness. We can also learn from this moment about the experience of having the type of memory failures associated with Alzheimer’s disease and other forms of dementia.

My moments of waking up lost and confused are most likely to occur when I travel. I find myself in a strange hotel room. When I look around, nothing is familiar. For a few moments, I don’t know where I am. I can’t remember how I got there. You have probably experienced something similar. When I ask my college students about it, almost all report that they’ve had a moment in which they’ve woken up and failed to recognize where they are or remember how they got there.

The experience of remembering yesterday is critical for solving these moments of being lost and confused. Usually, I quickly recall that I’ve traveled, I remember checking into the hotel, I remember what activity led me to travel. I remember. I then know where I am and how I got there.

But we don’t only have this experience while traveling. Instead, this is something we experience every morning. Fortunately, when we awaken in our own beds, this is simpler. I recognize immediately where I am. But many mornings I have to think for a few moments. What day is it? What do I have to do today? What did I do yesterday?

William James (1890) wrote about this experience more than 100 years ago. He noted that when we sleep, we have an interruption of self-awareness. Sleeping creates a gap in awareness. Last night we were awake and aware. We could remember the day leading up to that moment of going to sleep. Memory supports the awareness of a continuous self. Each morning we must reconnect. When we awake, we are immediately aware of the gap – we know that we have been asleep. We know we’ve had a gap in awareness – a time when we were not aware of the world around us, a time that we can’t remember. But once we remember the previous day, we no longer perceive the gap in awareness. We bridge the gap through memory.

But not everyone can bridge that gap with memory. Some people experience severe memory disruptions. In the later stages of Alzheimer’s disease, people have difficulty tracking one moment to the next. They can’t remember what they were doing before the present activity. People with this form of amnesia experience events, but often don’t remember the events even a few minutes later. This form of memory failure is called anterograde amnesia: a difficulty creating new memories. This can lead people with Alzheimer’s disease to display conversational loops, in which they repetitively recreate a conversation because they can’t recall that they’ve already had that conversation.

Interestingly, many people with anterograde amnesia describe their experience as feeling like they just woke up. HM, the most famous and frequently studied person with anterograde amnesia, described feeling like he just woke up. Clive Wearing, an individual with incredibly dense amnesia, regularly repeated that he had just woken up.

They describe their situation this way because they can’t remember what they were doing just prior to the current moment. They have an awareness of the current moment and no memory of what they were doing a few moments previously. As far as they know, they have just woken up. They have just started a new moment of awareness. They are unable to bridge their awareness back to the previous moment because that memory was never encoded.

When I go to visit my family member who has Alzheimer’s disease, I always start by asking how she is. She often states that I’ve just woken her up. She says she was napping just before I came in. Of course, that’s possible. I know that Alzheimer’s disrupts sleep patterns. So, no matter when I stop by, she may have been sleeping.

Other times I know she is mistaken. I see and talk with a member of the care team in the assisted living facility. They’ve just walked out of her room and we’ve talked about how my relative is doing. But when I walk in, my relative states that she just woke up. Bridging the gap to her previous activities and thoughts is often impossible. The lack of new memories leaves one forever with a feeling of waking up lost and confused.

I try to remember this when I work with my relative. I try to emphasize this when teaching my students about the ravages of anterograde amnesia. All of us have had a moment that is like the constant experience of amnesia. We’ve had that moment of waking up and not knowing where we are. It is very disorienting. It is confusing. It can be scary.

Having those experiences can inform us about the constant experience of living with anterograde amnesia, of developing the dense memory losses in Alzheimer’s disease. For these people, there is no ability to remember. They can’t bridge to their previous selves. That feeling of being lost when you just wake up? That’s their experience almost every moment of every day. Knowing this can increase our empathy for them.