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During the course of a normal night of sleep, the human brain switches between deep and light sleep, and dreaming sleep (REM), several times. Confusional arousals occur when the brain becomes divided, literally, between sleeping and waking. Part of the brain wakes up, but another part remains deeply asleep.

During a confusional arousal, a sleeper may sit up in bed, talk, scream, or even leave the bed and wander around-the proverbial "sleepwalking." A sleepwalker's behavior may be calm or it may be agitated. Occasionally it can be violent. If a sleep-walker risks injuring him or herself, treatment for the disorder should be sought immediately from a specialist in sleep medicine.

When children experience confusional arousals, they typically awaken frightened and confused, and often scream in terror at an invisible threat. As a rule, children remain distant and unresponsive to a parent's attempt to wake or calm them.

A confusional arousal may last as long as twenty minutes, but usually is briefer. As a rule, the sufferer of a confusional arousal returns to sleep without a full awakening-and will have no recollection of the arousal the following day.

Confusional arousals are believed to be a normal feature of the development of the brain sleep-stage switching mechanism, provided that they occur roughly three times a year or less, and are out-grown by early adulthood. Because development of the sleep-stage switching mechanism occurs during the period from infancy to about 10 years, confusional arousals are most common in this age group.

Current research confirms the validity of popular lore about sleepwalkers, that one should not attempt to awaken them. Despite the open eyes, despite the calm walking around the house, sleepwalkers actually are deeply asleep. The recommended strategy is to prevent them from leaving the house, and to protect them from other harm, (furniture, stairways) while gently coaxing them back to bed. Keeping a soft light on in a sleeper's room who is prone to arousals may also help prevent the events. In the morning, the sleeper will not remember their episode.

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