What Are Night Terrors?

What Are Night Terrors?

Night terrors, also known as sleep terrors, are episodes of intense fear that occur during sleep and are often characterized by agitated movements and vocalizations. They tend to be more common in young children, but they can also be experienced by adults.

Night terrors often last between one to 10 minutes, but can last longer. They also tend to occur most frequently at night and not during daytime napping. While they can be very upsetting for the person who experiences the night terror as well as family members who witness such episodes, they are usually considered relatively benign. 

Symptoms

Signs of a night terror can include:

• Screaming or yelling
• Rapid breathing
• Racing heartbeat
• Excessive sweating
• Sitting up or getting out of bed
• Being difficult to wake
• Open, staring eyes but lack of response to environmental stimuli
• Confusion upon waking
• No memory of the night terror upon waking
• Aggressive behavior

Night terrors are a type of non-rapid eye movement sleep arousal disorder in which a person who is sleeping appears to wake in a terrified state. A person's eyes may be open, they may cry out or scream, and make agitated or aggressive movements.

While a person might appear to be awake, they will be confused and not able to communicate with others. Just as people often do not remember their dreams once they wake up, people usually do not have any memory of these night terror episodes.

Diagnosis

Night terrors are known as sleep terrors in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 is the manual that is used by most doctors and mental health professionals to diagnose different types of mental health conditions.

Sleep Arousal Disorder

Sleep terrors are one of the two types of non-rapid eye movement sleep arousal disorders that are recognized in the DSM-5. The DSM-5 defines a sleep terror as a repeated sudden, partial awakening from a deep sleep that is accompanied by autonomic arousal and behaviors reflecting intense fear.

Difficult to Diagnose

Night terrors can be difficult to diagnose for a number of reasons, particularly when it comes to receiving a diagnosis as an adult for two main reasons:

If there is a reason to suspect that you might be having night terrors, your doctor may perform a physical exam, ask you a number of different questions, and ask you or a loved one to keep a sleep diary.

Exams and Lab Tests

In addition to a physical exam, lab tests may be performed to help rule out any potential medical conditions that might be causing or contributing to your symptoms.

Your doctor may also order other tests if health problems or a sleep disorder are suspected. Such tests might include a sleep study (polysomnography) or an electroencephalogram (EEG) to look at electrical activity in the brain.

Your doctor will also ask you a number of questions. For example, you might be asked:

• Whether you currently take any medications
• How often you consume alcohol
• Whether you take any other substances
• What your stress levels are like
• Whether you have been diagnosed with another mental health condition
• What mental health symptoms you might be experiencing
• Whether you take any sleep medications or natural sleep aids
• If you have ever had another type of sleep disorder
• Whether any of your family members have had symptoms or been diagnosed with a sleep disorder
• If you have symptoms of a breathing-related sleep problem

Causes

During sleep, the brain goes through a series of stages that are marked by different patterns of activity. The first three stages of sleep are known as non-rapid eye movement (NREM) sleep and the fourth is known as rapid eye movement (REM) sleep.

Night terrors most commonly occur as people move from one stage of sleep to the next. During this time, they may awaken slightly, which may contribute to the arousal that is seen during a night terror.

The exact causes of night terrors are not known, although there is evidence that the condition tends to run in families, although further research is needed to better understand possible genetic links. 

Some factors may increase the risk of night terrors in adults. These factors include:

• Sleep disruptions
• Fatigue
• Illness
• Medications including antidepressants
• Restless leg syndrome
• Stressful events
• Alcohol use or the use of another central nervous system (CNS) depressant
• Trauma
• Mental health conditions, particularly in adults
• Underlying neurological conditions

Research also suggests that children and teens who experience night terrors are also more likely to report experiencing migraine headaches.

In one study looking at kids between the ages of 10 and 19, those who experienced sleep terrors were significantly more likely to experience either episodic or chronic migraines.

Prevalence

Night terrors typically begin during early childhood and usually resolve on their own as children age, although some adults may continue to experience sleep terrors.

Night terrors are not uncommon in children between the ages of four and 12. Night terrors affect approximately 2% to 7% of children and tend to occur most frequently between the ages of four and seven.

The condition is also believed to occur in approximately 3% of adults, although exact numbers are difficult to estimate since many people do not remember these episodes after waking. Sleep terrors in adults often seem similar to the experience of a daytime panic attack.

Night Terrors vs. Nightmares

Bad nightmares may sometimes seem similar to a night terror, but there are differences between the two. Some of these key differences include:

• People usually waken fully and quickly from a nightmare. During a night terror, people do not fully wake—they seem confused and unable to communicate.
• People usually remember at least part of their nightmare once they wake. In some cases, they may recall the nightmare in vivid detail. Night terrors are not frequently remembered. When they are recalled, people may only remember incomplete fragments.

Treatment

While night terrors can be distressing, they usually resolve on their own without intervention and have no lasting effects. However, there might be times when it is appropriate to seek treatment:

• If you or your child's night terrors are causing other family members significant distress
• If agitation or aggression experienced during a night terror, such as kicking, thrashing, or jumping out of bed, poses a risk of injury
• If the night terrors are making it difficult to function normally during the day
• If you or your child are experiencing signs of fatigue or sleep deprivation
• If night terrors are putting a strain on your relationship with your partner or other members of your household
• If the episodes are frequent
• If they are accompanied by other sleep issues
• If they begin in adolescence or adulthood

Some approaches that might be recommended as treatment for sleep terrors include one or a combination of the following options.

Psychotherapy

Approaches such as cognitive-behavioral therapy (CBT) may be helpful for improving sleep hygiene. While the available research is limited, some evidence suggests that psychotherapy may be helpful for reducing or eliminating night terrors in children and adults.

Stress Management

Because people are more likely to experience night terrors when they are overstressed, a therapy that addresses stress may be helpful. Relaxation therapy may help reduce symptoms, but other techniques such as hypnosis or biofeedback might also be recommended.

Treating Other Conditions

If there are any related conditions that may be contributing to night terrors, treating these underlying disorders may be beneficial. Depression, anxiety, and other sleep disorders may also play a role in contributing to night terrors, so seeking treatment for those other conditions may help reduce or eliminate night terror symptoms. 

Medications

There is no medication specifically indicated for night terrors, but sometimes certain prescription drugs may be helpful. Antidepressants and anti-anxiety medications may be helpful in some cases.

Coping

There are also things that you can do that may help manage night terrors. Treatments for night terrors are often centered on improving sleep hygiene and reducing stress, so positive changes in your daily habits may help reduce or even eliminate symptoms of this condition.

Some steps you can take to cope with night terrors:

Establish Good Sleep Habits

Sleep deprivation and fatigue can increase the likelihood of experiencing a sleep terror, so getting on a regular sleep schedule can help improve the quality and amount of sleep that you are getting. 

• Go to bed at the same time each night and wake up at the same time each morning
• Avoid eating in the evening
• Avoid caffeine in the afternoon and evening
• Avoid looking at your phone or devices in bed
• Make sure your sleep environment is comfortable

Use Relaxation Strategies

Because stress can increase the risk of having a night terror, finding ways to get your stress levels under control can be an effective self-help strategy. This might involve identifying sources of stress and then finding ways to relax, whether that involves something like yoga, massage, deep breathing, or meditation.

It can sometimes be difficult for kids to identify or articulate their worries, so focus on making sure that your child has plenty of reassurance, support, and opportunity to talk about their concerns.

Try Scheduled Wakening

Look for patterns and try to notice if night terrors occur around the same time each night. If you spot any discernible patterns, you can try a technique that relies on waking someone up at a scheduled time each night.

You can have your partner wake you or set an alarm to rouse you from sleep. Parents can try waking their child briefly at a specific time before night terrors typically occur, usually around 10 to 15 minutes before the sleep terrors usually take place. 

Research has shown that this approach can significantly reduce or even completely eliminate sleep terrors. While scheduled wakening is considered low-risk, it may be difficult to use if the individual or if other members of the household are struggling with sleep deprivation.

If your partner experiences night terrors, you can help by providing reassurance and keeping them safe. Remove hard or sharp objects from the bedroom to prevent accidental injuries. Avoid trying to wake someone when they are experiencing a night terror, which can make the episode worse and even result in physical injuries if the other person is confused, upset, or agitated.

How Parents Can Help Kids