Night Terrors

Night Terrors or Nightmares? How to Tell the Difference

You are getting ready for bed when you hear a blood curdling scream coming from your child’s room. When you run into the room, you see him sitting straight up in bed, eyes wide open and shaking violently. As you calm him, your son lies down and goes back to sleep. Although you are now wide awake, he sleeps through the rest of the night and has no memory of the event the next morning. What just happened? Nightmare? Or night terror?

Definition

What are Night Terrors?

Night Terrors are officially called Sleep Terrors. The disorder is also called pavor nocturnus in children or incubus attack in adults. Sleep Terrors is one of the sleep disorders recognized by the American Academy of Sleep Medicine in “The International Classification of Sleep Disorders (ICSD)”. In this classification, sleep terror disorder is categorized as a parasomnia associated with being aroused from a very deep sleep. In this disorder, the person with night terrors is neither fully asleep nor fully awake.

The ICSD defines sleep terrors as being “characterized by a sudden arousal from slow-wave sleep with a piercing scream or cry, accompanied by autonomic and behavioral manifestations of intense fear”.

If you or your child suffer from night or sleep terrors, you know the sensations associated with the disorder: fast, pounding heart, rapid breathing, and sweating. You may find your child sitting up in bed, confused as to how and why the symptoms are happening. The attack can last from a few seconds to a few minutes.

Statistics

Night Terrors Statistics

Night or Sleep Terrors occur most often in children from the age of 4 through 12. Usually, the child will outgrow the syndrome by the teenage years.

The disorder occurs in about 3% of all children and may occur in about 1% of all adults. In adults, night terrors occur primarily between the ages of 20 and 30. After that age, there are very few reports of the syndrome. In all age groups, males are slightly more likely to experience night terrors.

There does seem to be a familial tendency to the disorder and sleep terrors often occur in several members of a family. A study done on twins for the American Academy of Pediatrics showed that there was an inherited tendency toward sleep terrors and that the syndrome occurred more commonly in identical twins where one had the disorder.

It has been estimated that as many as 80% of children with night terrors have at least one family member with the disorder. It is also not uncommon for someone with night terrors to also have other sleep disorders including sleep apnea, sleep paralysis, and sleep walking or talking.

Diagnosis

Nightmare or Night Terrors: How the Disorder is Diagnosed

Because of the similarity to nightmares, your healthcare provider will ask you or your child detailed questions about your memories during and immediately after the episodes. It is not uncommon that the memory, or lack of memory, of the events may be the only way your doctor can diagnose the syndrome.

Most commonly, victims of sleep terrors do not remember anything about the episode. This amnesia is one of the major differences between night terrors and nightmares. Almost everyone has had a nightmare — and the memory of the event is typically very vivid. Not so, for the night terror.

Nightmares typically occur during the last part of the night; sleep terrors usually occur during the beginning of the night’s sleep. The victim of night terrors may be hard to awaken and may be impossible to console; with nightmares, you can usually be awakened and calmed relatively quickly.

Physical disorders such as epilepsy and sleep apnea should be ruled out before a diagnosis is made since similar symptoms can occur with those diseases. Your doctor may order an electroencephalogram (EEG) to rule out epileptic seizures.

You may also be sent to a sleep lab for a polysomnograph that will show that the episodes occur during the first part of the night during non-REM stage 3 or stage 4 sleep. Nightmares, on the other hand, occur later in the sleep cycle during REM sleep.

Causes

Causes and Effects of Night Terrors

Possible Causes of Night Terrors

The cause of night terrors is really not known, but some researchers suspect that there may be a chemical reaction in the brain that might be responsible. However, there are several things that seem to trigger a sleep terror episode in many people.

  • stress
  • anxiety
  • depression
  • fear
  • fever
  • migraines

These episodes seem to occur most frequently if you are overtired or sleep deprived. Stress, anxiety and depression can also contribute to an episode. Fear is a common trigger, particularly in children. Sometimes, simply sleeping in an unfamiliar place may be enough to trigger night terrors.

There are several medical conditions that can be associated with sleep terrors. Some of these conditions include other sleep disorders like sleep apnea and sleep paralysis. Fever, particularly in children, may be enough to cause sleep terrors. Migraines may affect your sleep patterns and lead to an episode of night terrors.

In adults, some prescription, over-the-counter, and illegal drugs may trigger an episode. These drugs include alcohol, antihistamines, decongestants, and some beta blockers. Withdrawal from addictive drugs including both illegal and prescription medications can be a cause of sleep terrors.

Possible Effects of Night Terrors

The major direct effect of sleep terrors occurs when the victim gets out of bed and hurts himself in his panic. There is also the possibility of hurting someone else during the episode; however, this is rare.

Sleep disruption during the terror event can cause sleepiness during the day. This daytime sleepiness can result in decreased school or job performance. If the sleep disruption is severe enough and lasts long enough, you may develop a “sleep debt” that can cause other more serious health problems.

Treatment

Prevention and Treatment of Night Terrors

Children

Night terrors in children will usually disappear without treatment as the central nervous system develops. What can a parent do until this maturation happens?

Obviously, it is best to try to prevent the night terror from happening in the first place. If the night terrors seem to occur most often when your child is overtired, try developing a better sleep schedule that allows him to sleep longer during the night. Because fever or another physical disease may trigger an attack, it is important to promptly treat an illness in children who are prone to sleep terrors.

Stress is known to trigger night terrors in some children, so it is important to reduce stress as much as possible — particularly before bed time. Turn off the television a couple of hours before bed and develop a soothing bedtime routine. Start with a warm bath and gentle back rub. Read a good book to your child, but avoid books with frightening or violent themes. Provide a small, indirect night light if it helps your child be less afraid at bedtime.

If you can determine at what point in the night the sleep terrors occur, you might try waking your child up for a few minutes BEFORE the episode usually happens. For example, if your child often experiences the terror an hour after going to sleep, try waking him up 45 minutes after going to bed. For some people, the simple act of disrupting the sleep pattern prior to the episode may be enough to prevent the night terror. Once your child stops having the attacks, you can stop waking him up.

During an active attack, you should sit quietly with your child — speaking calmly and gently hugging or stroking the child may help calm him. Most of the time, your child will simply turn over and go back to sleep after the initial panic passes.

Adults

For adults, many of the same treatments can be applied:

  • reduce stress
  • try to get more sleep
  • control your sleep environment
  • avoid the use of alcohol and illegal drugs
  • speak with your doctor about any medications you are taking to ensure they are not triggering your attacks

When night terrors are very severe in adults, your doctor may prescribe certain medications. Some drugs that may be useful in control of the syndrome include antidepressants and anti-anxiety medications.

St. John’s Wort has been shown to be somewhat effective for some people in relieving depression and anxiety. Before starting treatment with any over-the-counter medication, be sure to check with your doctor to ensure that these drugs will not interact with other medications you are taking. In addition, none of these medications are usually recommended for use in children.

An adult with sleep terrors can also try Cognitive Behavior Therapy (CBT), meditation or yoga, relaxation techniques, or hypnosis to try to help prevent these events or minimize their effects.

For both children and adult sufferers, the most important thing you can do is ensure that the sleeping environment is safe. Since victims of the syndrome often get out of bed, the bedroom should be uncluttered and stairways should be blocked. Obviously, a child with night terrors should never sleep in the top bunk of a bunk bed. Lock the doors to the outside to ensure your child doesn’t go outside.

Providing a safe environment will keep you or your child safe until the sleep terrors stop.

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