Being unable to wake up from sleep can be a frightening experience. There are a few different terms that describe the inability to awaken during sleep. Let’s explore what’s happening when you find yourself stuck in a sleeping state.
Understanding Sleep Stages
To understand what’s happening when you can’t wake up, it helps to know that sleep occurs in cycles made up of different stages:
| Stage | Description |
|---|---|
| Stage 1 | Light sleep; easy to awaken |
| Stage 2 | Light to moderate sleep |
| Stages 3 & 4 | Deep sleep; difficult to awaken |
| REM sleep | Dreaming sleep |
During light stages of sleep like stages 1 and 2, it’s relatively easy to wake up. As you progress into deeper stages like slow-wave sleep, it becomes more challenging to rouse yourself.
When you can’t seem to wake up, it’s likely because you’re stuck in a deep stage of non-REM sleep or are in the middle of a REM cycle. Let’s look closely at a few terms that describe this phenomenon.
Sleep Inertia
Sleep inertia refers to that groggy feeling you experience after you’re abruptly awakened from a deep sleep. You may feel disoriented, confused, and unable to fully wake up and function normally.
Sleep inertia occurs when your sleep is disrupted during slow-wave sleep or right after a REM cycle. Your brain and body are suddenly jarred out of deeper sleep and struggle to become rapidly alert.
While frustrating, sleep inertia is usually temporary. Within 5-30 minutes, your brain activity and alertness levels should return to normal.
Sleep Drunkenness
Sleep drunkenness is very similar to sleep inertia. It describes extreme grogginess and impaired cognitive and motor skills upon sudden awakening.
Some signs of sleep drunkenness include:
- Slurred speech
- Confusion
- Lack of coordination
- Unusual behavior
Episodes of sleep drunkenness typically resolve within 30 minutes, though some people may experience lingering drowsiness.
Sleep Paralysis
Sleep paralysis is a frightening experience in which you briefly lose muscle function when waking up or falling asleep. It leads to temporary full-body paralysis, meaning you’re aware but unable to move or speak.
Sleep paralysis tends to happen as you are falling asleep or waking up from REM sleep. While inability to move can last up to several minutes, most episodes of sleep paralysis are brief.
Though harmless, being conscious but immobilized can be extremely scary. Some people also hallucinate sights or sounds, exacerbating fear and panic.
Confusional Arousals
A confusional arousal is a state of being partly awake and asleep at the same time. You may sit up in bed appearing awake but remain confused, unable to respond normally to external stimuli.
Confusional arousals arise during slow-wave sleep. The brain produces dream-like mentation while the body partly emerges into a waking state. This discordance leads to disorientation.
Most confusional arousals clear within 5-15 minutes. Some episodes may persist for up to half an hour before full alertness takes over.
Hypnopompic Hallucinations
As you transition from sleep into wakefulness, you may experience vivid hallucinations. These hypnopompic hallucinations occur as REM sleep and waking states overlap.
Hallucinations can involve any of the senses but are primarily visual. You may see people, animals, objects, or flashing lights that aren’t really there. These visions are often described as frightening.
Hypnopompic hallucinations usually disappear quickly once you fully awaken. But the uneasiness they provoke can make it hard to wake up completely for a few minutes.
Narcolepsy
Narcolepsy is a chronic neurological disorder that impacts the sleep-wake cycle. It can cause sleep paralysis, hypnopompic hallucinations, and an inability to stay awake during the day.
People with narcolepsy frequently enter REM sleep rapidly at sleep onset. They may awaken unable to move or talk if REM sleep continues into waking life. Narcolepsy also leads to broken, inconsistent quality of sleep.
Excessive daytime sleepiness is the most common symptom. People have irresistible urges to sleep throughout the day. Episodes can occur anytime, lasting from a few seconds to over an hour.
Non-24-Hour Sleep-Wake Disorder
Non-24 is a circadian rhythm disorder causing your internal 24-hour sleep-wake cycle to drift. It most often affects people who are totally blind. Light and dark signals that keep your body clock synchronized fade away.
Without these cues, your body follows its own rhythm that exceeds 24 hours. You go to bed later each day as your cycle gradually delays. The mismatch between the non-24-hour cycle and day-night schedule leads to impaired sleep and function.
Attempting to follow a normal schedule can leave you groggy and unable to fully awaken at desired times. The constant state of semiconsciousness and fatigue greatly impacts quality of life.
Delayed Sleep-Wake Phase Disorder
People with delayed sleep phase experience an extreme inability to fall asleep until very late at night. Their circadian cycle is significantly shifted or delayed compared to conventional day-night schedules.
Attempting to sleep and wake up earlier than preferred times leads to difficulty falling asleep, frequent awakenings, and inability to get out of bed. This delayed rhythm disrupts sleep as well as work, school, and social life.
Lingering drowsiness upon awakening is a hallmark symptom. Medications, bright light therapy, and gradual changes to sleep timing help manage this chronic disorder.
Sleep Apnea
Obstructive sleep apnea (OSA) is a common sleep disorder in which breathing repeatedly stops and starts during sleep. Periods where air cannot flow into the lungs are called apneas.
These lapses in breathing are due to airway blockage. Breathing pauses last at least 10 seconds but may persist for a minute or longer. They can occur up to hundreds of times per night.
Frequent apneas lead to loud snoring, choking, and gasping sounds as you struggle to breathe. Dangerously low oxygen levels occur. Fragmented sleep makes those with OSA often feel tired upon awakening.
Some people have trouble waking up enough to realize they are not breathing and resume normal respiration during episodes of apnea.
Kleine-Levin Syndrome
Kleine-Levin syndrome is an exceptionally rare sleep disorder. It mainly affects adolescent males. Individuals experience periods of hypersomnia separated by symptom-free intervals.
During hypersomnia episodes, a person needs to sleep extensively – up to 20 hours per day or more. Despite excessive sleep, patients still struggle to wake up and can remain drowsy all day.
Cognitive changes also occur. Brain fog, childlike behavior, confusion, irritability, and lack of energy are common during episodes. Most symptoms disappear after the hypersomnia period ends. Episodes may recur every few weeks or months, sometimes for a decade or more.
Fatal Familial Insomnia
Fatal familial insomnia is an extremely rare genetic prion disease. It leads to worsening insomnia and ultimately complete sleep loss. Progressive brain deterioration occurs.
Inability to sleep is accompanied by a range of neurological symptoms – confusion, hallucinations, phobias, jerky movements. As the disease advances over months to years, autonomic dysfunction results in unstable blood pressure and body temperature.
Fatal familial insomnia is always fatal, usually within 18 months of symptom onset. There are currently no treatments only palliative care.
Treatment Options
Treatment for an inability to fully awaken depends on the underlying cause:
- Sleep inertia and drunkenness: Gradually waking up improves these temporary states. Caffeine and exposure to bright light also help overcome grogginess.
- Sleep paralysis: Getting enough nightly sleep, managing stress, and avoiding sleep disruptions can reduce episodes.
- Confusional arousals: Maintaining a regular sleep-wake schedule and winding down before bedtime helps prevent these.
- Hypnopompic hallucinations: These often go away on their own with time but may be treated with medications in severe cases.
- Narcolepsy: Stimulant medications help control sleepiness and scheduled napping reduces fatigue.
- Non-24 and DSPD: Light therapy, melatonin, and behavioral interventions aim to synchronize circadian rhythms with external day-night cycles.
- Sleep apnea: PAP therapy uses pressure to keep airways open during sleep. Mouthpieces also help.
- Kleine-Levin syndrome: Stimulant drugs alleviate symptoms during episodes. Lithium prevents recurrence.
- Fatal familial insomnia: No cure exists, but sedatives and physical therapy provide comfort.
If inability to wake up regularly impairs your functioning, make an appointment with your doctor. They can help uncover the underlying problem and recommend appropriate treatment.
When to Seek Medical Help
Occasional difficulty waking up is normal, especially if you are sleep deprived or waking up during deep non-REM or REM sleep. But recurrent episodes of impaired alertness upon awakening may indicate an underlying disorder.
See your doctor if you regularly:
- Require an excessive amount of sleep
- Have trouble waking up most mornings
- Feel very disoriented upon awakening
- Fall asleep involuntarily during the day
- Feel unable to move (sleep paralysis) when waking up
Sudden inability to wake up could stem from a serious health condition requiring prompt medical care. Seek emergency help if symptoms are accompanied by:
- Chest pain
- Severe headache
- Vision changes
- Difficulty breathing
- Loss of consciousness
Conclusion
Inability to fully wake up can occur due to deep, uninterrupted sleep or disorders like sleep apnea and narcolepsy. Short-lived states like sleep inertia and confusional arousals are common and typically resolve quickly. But recurring difficulty waking up may indicate an underlying problem necessitating medical care. See your doctor if you regularly struggle to awaken to address any health issues and improve your sleep.