What could cause someone to wake up confused about their surroundings?
There are a few potential reasons why someone might wake up disoriented and not recognize where they are:
Sleepwalking
Sleepwalking, also known as somnambulism, involves getting up and walking around while still being asleep. Most sleepwalkers have no memory of their activities while sleepwalking. Waking up in an unfamiliar place after an episode of sleepwalking can be very confusing and disorienting. Approximately 10-15% of kids and up to 4% of adults sleepwalk occasionally. Sleepwalking tends to run in families. Factors like lack of sleep, fever, sleep apnea, medications, or alcohol can trigger sleepwalking episodes.
Sleep terrors
Sleep terrors are episodes of intense panic and fear during sleep, often accompanied by screaming or crying out. They usually happen early in the night during deep non-REM sleep. The person will seem wide awake but is actually still asleep and have no memory of the event. For this reason, someone experiencing a sleep terror may be very confused about their surroundings upon waking up. Sleep terrors affect around 3% of adults and over 15% of children. Stress, fever, lack of sleep, or certain medications can bring them on.
Disorientation upon waking
It’s quite common to feel momentarily confused about where you are when you first wake up, especially if you’ve been tossed out of deep sleep. This transitional disorientation upon waking typically passes within a minute or two. Certain medications, medical conditions, or sleeping in an unfamiliar environment can prolong this temporary confusion.
REM sleep behavior disorder
REM sleep behavior disorder (RBD) involves acting out vivid dreams during REM sleep due to a lack of normal muscle paralysis. People with RBD will physically move around while dreaming, sometimes violently, and can end up in unlikely locations. As dreams are not usually remembered, waking up in an unfamiliar place can be baffling. RBD becomes more common with age but affects less than 1% of the general population.
Confusional arousals
Confusional arousals are episodes of confused, disoriented behavior upon waking up from sleep, typically lasting seconds to minutes. The person is awake but remains sluggish, confused, and amnesic about the event. Underlying medical conditions like dementia, seizure disorders, or Parkinson’s disease can trigger confusional arousals. They affect approximately 5% of adults but are more common in the elderly.
Sleep drunkenness
Sleep drunkenness, also called sleep inertia, produces a transitional state of lowered performance and impaired cognition for a period after waking up. Coming out of deep non-REM or REM sleep can lead to substantial sleep inertia, with associated grogginess, confusion, and disorientation lasting up to 30 minutes. Sleep deprivation tends to worsen these after-effects. About 1 in 4 people regularly experience moderate to severe sleep inertia.
Night terrors
Night terrors are episodes of extreme panic that happen during deep non-REM sleep, usually in the first third of the night. The person may scream, thrash around wildly, or be inconsolable. They don’t usually get out of bed but have no memory of the event the next day. Night terrors are more common in children, affecting up to 6.5% of kids, but do occur in some adults as well. Stress or sleep deprivation can trigger night terrors.
Parasomnias
Parasomnias are a category of undesirable sleep-related events involving abnormal physical movements, emotions, perceptions, and dreams. Confusional arousals, sleepwalking, sleep terrors, night terrors, and REM sleep behavior disorder are all considered parasomnias. These overlapping conditions can all lead to waking up disoriented and not knowing where you are. Parasomnias tend to run in families and occur more often in children.
Sleep apnea
Sleep apnea causes repeated pauses in breathing during sleep due to airway obstruction. This leads to frequent awakening out of deep sleep in order to breathe. The frequent partial arousals out of deep sleep often impair thinking and judgment. Severe sleep apnea increases the risk of waking up confused about your location. Sleep apnea affects around 10% of adults but up to 30% of the elderly. Obesity is the biggest risk factor.
Sundowning
Sundowning refers to worsening confusion, disorientation, and agitation that can occur in those with dementia later in the day. Sundowning symptoms often arise upon waking from sleep as well. Deterioration of the circadian rhythm is believed to play a role. Sundowning affects around 20% of those with Alzheimer’s disease and up to 66% of people with other dementias. It can cause them to wake up and not recognize where they are.
Delirium
Delirium is an abrupt change in cognition and awareness that can fluctuate throughout the day. It often develops due to infections, drug effects, organ failure, or other medical conditions. Delirium can involve disorientation, confusion, and memory issues upon waking. Rates are around 1-2% in the general population but up to 60% hospitalized elderly experience delirium during their stay. The disorder usually resolves once the underlying medical problem improves.
What conditions or circumstances make it more likely?
Certain circumstances and medical conditions can increase the likelihood of someone waking up feeling confused and not knowing where they are:
- Sleeping in an unfamiliar environment – This could include a hotel room, hospital room, camping lodgings, or a friend/relative’s house.
- Changes in sleep schedule – Jet lag from traveling or switching from day to night shift work can impair orientation.
- Sleep deprivation – Lack of sufficient sleep is linked to next-day cognitive deficits.
- Sleep disorders – Conditions like sleep apnea, narcolepsy, or restless legs syndrome lead to poor sleep quality.
- Medications – Some prescription drugs, over-the-counter medicines, and supplements can cause disorientation.
- Alcohol consumption – Drinking alcohol before bed makes it more likely to wake up confused.
- Neurodegenerative diseases – Dementia, Parkinson’s disease, and multiple sclerosis increase disorientation.
- Mental illness – Psychiatric disorders like schizophrenia, PTSD, and severe depression can contribute.
- Traumatic brain injury – Damage to the brain can impair thinking and judgment.
- Metabolic disturbances – Issues like low blood sugar, kidney disease, or vitamin deficiencies affect cognition.
- Infections – Fevers from infections like urinary tract infections (UTIs) increase confusion.
- Cardiovascular disease – Poor blood flow to the brain (ischemia) can cause befuddlement.
- Epilepsy – Seizures originating in sleep can lead to waking confusion.
- Young age – Toddlers and children commonly experience night terrors and sleepwalking.
So in summary, anything that interrupts normal sleep architecture or deprives the brain of oxygen can make a person more likely to awaken feeling disoriented about their surroundings and location. Elderly individuals are also at greater risk due to aging brain changes.
What should you do if it happens to you?
If you wake up one morning confused about where you are, the following tips may help:
- Try to stay calm and clear your mind. Take some deep breaths.
- Look around the room for clues about your location – photos, decor, window views.
- Check the time. Is it morning or nighttime based on the lighting?
- Slowly retrace the previous day’s events for context clues.
- Reach for your phone and check your location or text messages.
- Splash your face with water or take a shower to help feel more alert.
- Ask anyone nearby where you are and how you got there.
- Give yourself 10-15 minutes before fully panicking to see if it passes.
- Try going back to sleep for a short nap if still very early.
- Get something to eat and drink water to provide energy.
- Avoid driving if you still feel very disoriented.
If the confusion and disorientation persists for more than 15 minutes or causes you distress, seek medical attention, as it could signal an underlying physical or mental health issue requiring diagnosis. Let your doctor know about any recent illnesses, prescription medication changes, stress, or sleep problems you’ve experienced lately. They can evaluate potential contributing factors.
Sudden onset of confusion upon awakening can sometimes be a medical emergency requiring prompt evaluation, especially for the elderly or those with chronic medical conditions. Call emergency services if the confusion is accompanied by:
- Severe headache
- Vision changes or loss of coordination
- Chest pain
- Trouble speaking or walking
- Unusual behaviors
- Hallucinations or paranoia
These red flag symptoms could indicate a stroke, seizure, delirium, blood clot, or brain infection requiring immediate treatment. Don’t write it off as normal grogginess if the situation seems serious.
When to see a doctor
Consult your physician promptly if waking up confused about your surroundings happens frequently or persists over time. Chronic or recurrent episodes of awakening disorientation may be tied to an underlying medical issue that needs evaluation.
See your doctor right away if this feeling of confusion upon waking is accompanied by:
- Memory lapses or declining cognitive function
- Mood changes like depression or irritability
- Difficulty concentrating or communicating
- Feeling drowsy and fatigued during the daytime
- Acting out dreams while asleep
- Difficulty sleeping or frequent nighttime awakenings
- Headaches upon waking
These associated symptoms can be indicative of sleep disorders like sleep apnea, circadian rhythm disorders, or parasomnias. Neurodegenerative disorders, mental illness, stroke risk, metabolic abnormalities, prescription medication effects, and other medical conditions may underlie persistent disorientation upon waking as well.
Keeping a sleep diary tracking symptoms and talking to family members can help identify patterns useful for diagnosis. Overnight sleep studies, bloodwork, cognitive testing, neuroimaging, and EEGs are tools doctors can utilize to get to the bottom of troublesome orientation difficulties that regularly affect awakening. Targeted treatment based on the cause then improves quality of sleep and next-day clarity.
Conclusion
Brief confusion or a “foggy” feeling upon first awakening is common and usually passes quickly as you become alert. However, frequently waking up extremely disoriented about your location can signal issues with sleep quality, medications, or health that require medical investigation. Neurodegenerative disease, mental illness, sleep disorders, and other medical conditions may be factors, especially in the elderly. See a doctor if it happens persistently and impairs function during the day. With proper diagnosis and treatment of underlying causes, disruptive awakening disorientation can often be remedied.
