The essential features of confusional arousals are mental confusion or confusional behavior during or following arousals from sleep, typically from deep non-rapid eye movement (NREM) or slow-wave sleep (SWS) in the first part of the night, but also upon attempted awakening from sleep in the morning. The notion of confusional arousals in children has received less attention overall compared with that concerning adults. The impression gained in adults is that, especially in response to forced awakenings, the behavioral disturbance in adult episodes is more forceful, vigorous and resistive, sometimes leading to violent behavior. Childhood confusional arousals do not usually require treatment, only advice to parents that they can be considered to be a passing phase. The same cannot necessarily be said of confusional arousals in adult life when they have more of a tendency to persist, depending on their etiology and relationship to other sleep disorders.

The current evidence that aging is associated with a significant increase in sleep-wake cycle complaints has individual, social, and economic consequences. These age-related changes occur as early as the middle years of life, with over 35% of the population in their forties to sixties reporting sleep difficulties. Age effects on non-rapid eye movement (NREM) sleep electroencephalogram (EEG) differ between brain topographical sites in parallel with age-related changes in gray matter density of the brain. A precise interaction between the homeostatic and circadian processes is required for optimal sleep and vigilance. Age-related increase in wakefulness during sleep may be associated with a phase angle change between the signal from the circadian clock and sleep-wake cycles. Age-related changes in the neural correlates of NREM sleep oscillations may also underlie changes in memory and brain plasticity. There is need to determine the consequences of age-dependent changes to the sleep-wake cycle in middle-aged individuals.