Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness.
The transition from sleep to wake is marked by sleep inertia, a distinct state that is measurably different from wakefulness and manifests as performance impairments and sleepiness. Although the precise substrate of sleep inertia is unknown, electroencephalographic, evoked potential, and neuroimaging studies suggest the persistence of some features of sleep beyond the point of awakening. Forced desynchrony studies have demonstrated that sleep inertia impacts cognition differently than do homeostatic and circadian drives and that sleep inertia is most intense during awakenings from the biological night. Recovery sleep after sleep deprivation also amplifies sleep inertia, although the effects of deep sleep vary based on task and timing. In patients with hypersomnolence disorders, especially but not exclusively idiopathic hypersomnia, a more pronounced period of confusion and sleepiness upon awakening, known as "sleep drunkenness", is common and problematic. Optimal treatment of sleep drunkenness is unknown, although several medications have been used with benefit in small case series. Difficulty with awakening is also commonly endorsed by individuals with mood disorders, disproportionately to the general population. This may represent an important treatment target, but evidence-based treatment guidance is not yet available.
Emory Sleep Center and Department of Neurology, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA 30329, USA. Electronic address: Lbecke2@emory.edu.
Lynn M
LM
Trotti
D006801:Humans; D020447:Parasomnias / Q000503:physiopathology*; D012890:Sleep / Q000502:physiology*
Idiopathic hypersomnia; Mood disorders; Narcolepsy; Sleep drunkenness; Sleep inertia
Neuroscience. 2011 Mar 10;176:308-17
21167917
Aviat Space Environ Med. 2000 Mar;71(3):225-9
10716166
Sleep Med Rev. 2001 Oct;5(5):363-364
12531001
Neurology. 1998 Feb;50(2 Suppl 1):S37-42
9484422
Brain. 1997 Aug;120 ( Pt 8):1423-35
9278632
Cognit Ther Res. 2015 Oct;39(5):601-612
26451063
J Affect Disord. 2013 May;147(1-3):431-6
23200737
Eur J Appl Physiol. 2014 May;114(5):1049-56
24509892
Chronobiol Int. 2008 Sep;25(5):725-44
18780200
J Psychopharmacol. 2014 Jul;28(7):703-6
24554692
Clin Neurophysiol. 2002 Aug;113(8):1183-90
12139996
Sleep. 2006 Jun;29(6):831-40
16796222
Behav Neurosci. 2008 Aug;122(4):928-35
18729646
J Sleep Res. 2011 Jun;20(2):275-8
21518064
Science. 1968 Mar 8;159(3819):1070-8
4865791
Exp Brain Res. 2014 Mar;232(3):811-20
24337231
J Affect Disord. 2009 May;115(1-2):87-99
18947882
Sleep. 2014 Aug 01;37(8):1337-47
25083014
Percept Mot Skills. 1992 Aug;75(1):291-302
1528684
Sleep. 2007 Oct;30(10):1274-81
17969461
Psychophysiology. 2000 Jul;37(4):440-6
10934902
J Sleep Res. 2015 Aug;24(4):364-371
25773686
Behav Neurosci. 2011 Apr;125(2):252-60
21463024
Sleep Med Rev. 2000 Aug;4(4):341-353
12531174
Neurosci Biobehav Rev. 2010 Sep;35(1):97-103
20026350
Percept Mot Skills. 2006 Apr;102(2):339-51
16826655
J Sleep Res. 2002 Sep;11(3):213-8
12220317
Sleep. 2001 Nov 1;24(7):813-9
11683484
Sleep. 2009 Jun;32(6):753-9
19544751
J Sleep Res. 2010 Sep;19(3):425-35
20408928
Sleep Med Rev. 2016 Oct;29:23-33
26599679
J Sleep Res. 2003 Sep;12(3):189-206
12941058
Sleep. 1994 Feb;17(1):11-9
7910702
Chronobiol Int. 2002 Jul;19(4):709-20
12182498
Electroencephalogr Clin Neurophysiol. 1997 Feb;102(2):125-31
9060863
Sleep Med. 2015 Jul;16(7):883-90
26004680
Sleep Med. 2003 Jan;4(1):7-12
14592354
Sci Transl Med. 2012 Nov 21;4(161):161ra151
23175709
J Biol Rhythms. 2008 Aug;23(4):353-61
18663242
Rev Saude Publica. 2004 Dec;38 Suppl:32-7
15608912
PLoS One. 2013 Nov 18;8(11):e79688
24260280
Biol Psychol. 2008 Mar;77(3):337-42
18162282
Percept Mot Skills. 2013 Feb;116(1):280-93
23829154
Brain Res Bull. 2006 Dec 11;71(1-3):270-8
17113956
J Sleep Res. 2010 Sep;19(3):436-43
20374446
J Affect Disord. 2002 May;69(1-3):231-6
12103471
Aten Primaria. 2014 Nov;46 Suppl 5:191-4
25476060
Sleep Med. 2014 Oct;15(10):1264-8
25156750
Brain Connect. 2012;2(4):177-90
22817652
Exp Brain Res. 2007 Apr;178(2):228-39
17051381
Sleep. 1986;9(1 Pt 2):200-4
3704443
Schweiz Arch Neurol Neurochir Psychiatr. 1981;129(2):209-22
7323773
Eur J Neurosci. 2004 Jun;19(11):3099-104
15182318
Brain Res Cogn Brain Res. 2005 Mar;22(3):323-31
15722204
Arch Gen Psychiatry. 1972 May;26(5):456-62
5019884
Percept Mot Skills. 2003 Dec;97(3 Pt 2):1073-84
15002849
J Biol Rhythms. 2003 Feb;18(1):80-90
12568247
J Sleep Res. 2009 Mar;18(1):11-9
19250171
J Sleep Res. 2010 Dec;19(4):525-34
20408941
Int Rev Neurobiol. 2010;93:129-51
20970004
J Clin Sleep Med. 2010 Feb 15;6(1):77-8
20191943
J Nerv Ment Dis. 2000 Jun;188(6):340-8
10890342
Sleep. 2001 May 1;24(3):293-300
11322712
Int J Occup Saf Ergon. 2003;9(4):479-90
14675520
JAMA. 2006 Jan 11;295(2):163-4
16403927
Sleep. 2003 Aug 1;26(5):573-7
12938810
Neurology. 2014 Aug 26;83(9):834-41
25156346
Brain. 2002 Oct;125(Pt 10):2308-19
12244087
Neuroimage. 2014 Nov 15;102 Pt 2:894-903
25067818
J Sleep Res. 2004 Jun;13(2):121-7
15175091
Sleep. 2007 Jan;30(1):104-8
17310871
J Neural Transm (Vienna). 2012 Oct;119(10):1173-84
22903311
Physiol Behav. 2006 Jan 30;87(1):177-84
16303153
Electroencephalogr Clin Neurophysiol. 1980 Feb;48(2):230-2
6153339
Accid Anal Prev. 2017 Feb;99(Pt B):411-415
26589387
Sleep. 2000 Sep 15;23(6):801-11
11007447
Chronobiol Int. 2010 Jul;27(5):1031-44
20636214
Physiol Behav. 2011 May 3;103(2):197-202
21281656
Eur J Paediatr Neurol. 2011 Jul;15(4):320-5
21345702
Sleep Med. 2016 Jan;17:38-44
26847972
J Geriatr Phys Ther. 2016 Jan-Mar;39(1):14-9
25695469
Acta Psychiatr Scand. 1993 Jul;88(1):67-71
8372698
Neurosci Lett. 2001 Sep 14;310(2-3):145-8
11585588
Sleep Med Rev. 2011 Apr;15(2):123-35
20970361
J Sleep Res. 2002 Sep;11(3):219-27
12220318
Ann Emerg Med. 2006 Nov;48(5):596-604, 604.e1-3
17052562
Chronobiol Int. 2012 Jul;29(6):769-79
22734577
Sleep. 2016 Mar 01;39(3):675-85
26715234
J Sleep Res. 2010 Jun;19(2):317-22
20050996
Neuroimage. 2015 Dec;123:229-44
26220744
Psychophysiology. 1997 Nov;34(6):721-5
9401427
Sleep. 1994 Feb;17(1):69-76
8191205
Behav Brain Res. 2006 Feb 28;167(2):237-44
16242789
Neurophysiol Clin. 2013 Jun;43(3):171-9
23856173
Med Clin (Barc). 2007 Mar 17;128(10):361-4
17386240
Chronobiol Int. 2010 Jul;27(6):1219-41
20653451
Am J Psychiatry. 1977 Feb;134(2):183-5
189623