![]() Mechanistically, it has been hypothesized that awakening may occur before adenosine is fully cleared, resulting in sleep inertia. Sleep inertia is thus hypothesized to reflect the contradictory needs of maintaining sleep and allowing behavioral responsiveness or the brain’s need for a more gradual awakening process due to its complexity. Despite this, worsened cognitive performance after even some awakenings is still potentially problematic. To some extent, the potential harm of slow transitions to cognitive baseline may be mitigated by changes in sleep inertia intensity based on sleep timing, composition, and duration (see below), such that there are times when a sudden awakening impairs cognition to a lesser extent. Neurophysiology and neuroimaging of sleep inertiaįrom an evolutionary standpoint, sleep inertia is counterintuitive, as sudden transitions to wakefulness seem clearly more adaptive. Reference lists were reviewed to identify additional manuscripts. ![]() The former two terms were also queried at. įor this review, PubMed was searched for “sleep inertia”, “sleep drunkenness”, “sleep-wake transition”, “sleep-wake transitions”, “wake up”, “wake-up”, “waking up”, “waking-up”, “awaken”, “awakening”, “neural inertia”, “sleep offset”, and “sleep-offset”. Difficulty awakening is also common in people with mood disorders and may be an important treatment target. ![]() Such pronounced sleep inertia is a core feature of idiopathic hypersomnia (IH), a potential consequence of delayed sleep phase syndrome (DSPS), and a contributor to non-REM (NREM) arousal parasomnia severity. In some disease states, a transitional period akin to markedly pronounced sleep inertia is present and is sometimes referred to as “sleep drunkenness”. Sleep inertia is a normal phenomenon, but one with potentially dangerous ramifications, e.g., in health care workers or military personnel who are woken abruptly in the night and required to make cognitively-taxing decisions. The intensity and duration of sleep inertia vary based on situational factors, but its effects may last minutes to several hours. “Sleep inertia” refers to the transitional state between sleep and wake, marked by impaired performance, reduced vigilance, and a desire to return to sleep. This may represent an important treatment target, but evidence-based treatment guidance is not yet available. Difficulty with awakening is also commonly endorsed by individuals with mood disorders, disproportionately to the general population. Optimal treatment of sleep drunkenness is unknown, although several medications have been used with benefit in small case series. 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. Recovery sleep after sleep deprivation also amplifies sleep inertia, although the effects of deep sleep vary based on task and timing. 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. 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. 1, 2017.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. Approach to treating panic disorder with or without agoraphobia in adults. Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. Efficacy of two cognitive-behavioral treatment modalities for panic disorder with nocturnal panic attacks. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. Arlington, Va.: American Psychiatric Association 2013. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. ![]() Nightmares and nightmare disorder in adults. ![]()
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