Precipitating factors include sleep deprivation, use of hypnotics or tranquilisers before bedtime, and sudden awakening from sleep (e.g., telephone ringing, alarm clock). In the ICSD-2 alcohol intake had been considered as a precipitating factor of confusional arousals. In the ICSD-3 the relation between alcohol use and disorder or arousal have been excluded. Moreover, the alcohol blackout has been added as a differential diagnosis. These changes have important implications for forensic cases.