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Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. (2013). 9780890425558, American Psychiatric Association. ISBN 9780890425558 Sleep terror is classified in the category of NREM-related in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.
Sleep terrors usually begin in childhood and usually decrease as age increases. Factors that may lead to sleep terrors are young age, sleep deprivation, medications, stress, fever, and intrinsic sleep disorders. The frequency and severity differ among individuals; the interval between episodes can be as long as weeks and as short as minutes or hours. This has created a situation in which any type of nocturnal attack or nightmare may be confused with and reported as a night terror.
Night terrors tend to happen during periods of arousal from delta sleep, or slow-wave sleep. Delta sleep occurs most often during the first half of a sleep cycle, which indicates that people with more delta-sleep activity are more prone to night terrors. However, they can also occur during daytime naps. (2025). 9780890420256, American Psychiatric Press. ISBN 9780890420256 Night terrors can often be mistaken for confusional arousal.
While nightmares (bad dreams during REM sleep that cause feelings of horror or fear) are relatively common during childhood, night terrors occur less frequently. The prevalence of sleep terrors in general is unknown. The number of small children who experience sleep terror (distinct from sleep terror , which is recurrent and causes distress or impairment) are estimated at 36.9% at 18 months of age and at 19.7% at 30 months. In adults, the prevalence is lower, at only 2.2%. Night terrors have been known since ancient times, although it was impossible to differentiate them from nightmares until rapid eye movement was studied.
During polysomnography, individuals with night terrors are known to have very high voltages of electroencephalography (EEG) Delta wave activity, an increase in muscle tone, and a doubled or faster heart rate. Brain activities during a typical episode show Theta wave and Alpha wave activity when monitored with an EEG. Episodes can include tachycardia. Night terrors are also associated with intense autonomic discharge of tachypnea, flushing, diaphoresis, and mydriasis—that is, unconscious or involuntary rapid breathing, reddening of the skin, profuse sweating, and dilation of the pupils. Abrupt but calmer arousal from non-rapid eye movement sleep, short of a full night terror episode, is also common.
In children with night terrors, there is no increased occurrence of psychiatric diagnoses. However, in adults with night terrors, there is a close association with psychopathology and . There may be an increased occurrence of night terrors—particularly among those with post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). It is also likely that some personality disorders may occur in individuals with night terrors, such as dependent, schizoid, and borderline personality disorders. There have been some symptoms of depression and anxiety that have increased in individuals that have frequent night terrors. Hypoglycemia is associated with both pediatric and adult night terrors.Blog from Fountia, "Things You Didn't Know About Night Terrors" A study of adults with thalamic lesions of the brain and brainstem have been occasionally associated with night terrors. Night terrors are closely linked to sleepwalking and frontal lobe epilepsy.
When a night terror happens, it is typical for a person to wake up yelling and kicking and to be able to recognize what they are saying. The person may even run out of the house (more common among adults), which can then lead to violent actions. It has been found that some adults who have been on a long-term intrathecal clonidine therapy show side effects of night terrors, such as feelings of terror early in the sleep cycle. This is due to the possible alteration of cervical/brain clonidine concentration. In adults, night terrors can be symptomatic of neurological disease and can be further investigated through an MRI procedure.
Also, older children and adults provide highly detailed and descriptive images associated with their sleep terrors compared to younger children, who either cannot recall or only vaguely remember. Sleep terrors in children are also more likely to occur in males than females; in adults, the ratio between sexes is equal. A longitudinal study examined twins, both identical and fraternal, and found that a significantly higher concordance rate of night terror was found in identical twins than in fraternal.
Though the symptoms of night terrors in adolescents and adults are similar, their causes, Prognosis, and treatments are qualitatively different. There is some evidence that suggests that night terrors can occur if the individual does not eat a proper diet, does not get the appropriate amount or quality of sleep (e.g., because of sleep apnea), or is enduring stressful events. Adults who have experienced sexual abuse are more likely to receive a diagnosis of sleep disorders, including night terrors. Overall, though, adult night terrors are much less common and often respond best to treatments that rectify causes of poor quality or quantity of sleep.
A distinction between night terrors and epileptic seizure is required. Indeed, an epileptic seizure could happen during the night but also during the day. To make the difference between both of them, an EEG can be done and if there are some anomalies on it, it would rather be an epileptic seizure.
Additionally, a home video might be helpful for a proper diagnosis. A polysomnography in the sleep laboratory is recommended for ruling out other disorders, however, sleep terrors occur less frequently in the sleep laboratory than at home and a polysomnography can therefore be unsuccessful at recording the sleep terror episode.
The duration of one episode is mostly brief but it may last longer if parents try to wake up the child. Awakening the child may make their agitation stronger. For all these reasons, it is important to let the sleep terror episode fade away and to just be vigilant in order for them not to fall to the ground.
Considering an episode could be violent, it may be advisable to secure the environment in which the child sleeps. Windows should be closed and potentially dangerous items should be removed from the bedroom, and additionally, alarms can be installed and the child placed in a downstairs bedroom.
There is some evidence to suggest that night terrors can result from lack of sleep or poor sleeping habits. In these cases, it can be helpful to improve the amount and quality of sleep which the child is getting. It is also important to have a good sleep hygiene, if a child has night terrors parents could try to change their sleep hygiene. Another option could be to adapt child's naps so that they are not too long or too short. Then, excessive stress or conflicts in a child's life could also have an impact on their sleep too, so to have some strategies to cope with stress combined with psychotherapy could decrease the frequency of the episodes.Van Horn, N. L., & Street, M. (2019). Night Terrors. In StatPearls Internet. StatPearls Publishing. A polysomnography can be recommended if the child continues to have a lot of night terror episodes.
Hypnosis could be efficient. Sleepers could become less sensitive to their sleep terrors.
One technique is to wake up just before the sleep terrors begin. When they appear regularly, this method can prevent their appearance.
Psychotherapy or counseling might be helpful in some cases.
If all these methods are not enough, (such as diazepam) or tricyclic antidepressants may be used; however, medication is only recommended in extreme cases. Widening the nasal airway by surgical removal of the adenoid was previously considered and demonstrated to be effective; nowadays, however, invasive treatments are generally avoided.
Another small trial found benefit with L-5-hydroxytryptophan (L-5-HTP).
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