Sleep terrors (night terrors)

Definition

Sleep terrors are episodes of fear, flailing and screaming while asleep. Also known as night terrors, sleep terrors often are paired with sleepwalking.

Although sleep terrors are more common in children, they can affect adults. A sleep terror episode usually lasts from seconds to a few minutes.

Sleep terrors are relatively rare, affecting only a small percentage of children — often between ages 4 and 12 — and a smaller percentage of adults. However frightening, sleep terrors aren't usually a cause for concern. Most children outgrow sleep terrors by adolescence.

Symptoms

Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and remembers details, but a person who has a sleep terror episode remains asleep. Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors.

Like sleepwalking and nightmares, sleep terrors are a parasomnia — an undesired occurrence during sleep. Sleep terrors usually occur during the first third of the sleep period.

During a sleep terror episode, a person might:

• Sit up in bed
• Scream or shout
• Kick and thrash
• Sweat, breathe heavily and have a racing pulse
• Be hard to awaken
• Be inconsolable
• Get out of bed and run around the house
• Engage in violent behavior (more common in adults)
• Stare wide-eyed

When to see a doctor
Occasional sleep terrors aren't usually a cause for concern. If your child has sleep terrors, you can simply mention them at a routine well-child exam.

Consult your doctor if your or your child's sleep terrors:

• Become more frequent
• Routinely disrupt sleep or the sleep of other family members
• Cause you or your child to fear going to sleep
• Lead to dangerous behavior or injury
• Appear to follow the same pattern each time

Causes

Various factors can contribute to sleep terrors, including:

• Sleep deprivation
• Fatigue
• Stress
• Anxiety
• Fever (in children)
• Sleeping in unfamiliar surroundings
• Lights or noise

Sleep terrors sometimes are associated with underlying conditions that affect sleep, such as:

• Sleep-disordered breathing — a group of disorders characterized by abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea
• Migraines
• Head injuries

In other cases, use of alcohol, illegal drugs or certain medications — including some antihistamines, sedatives and sleeping pills — can trigger sleep terror episodes.

Risk factors

Sleep terrors tend to run in families. Some adults who have sleep terrors may have a history of depressive or anxiety disorders, although most don't have a mental health condition.

Complications

Sleep terrors aren't necessarily a concern, but regularly disrupted sleep can be. It can cause excessive daytime sleepiness, which can lead to difficulties at school or work, or problems with everyday tasks such as driving.

Harming oneself or others is another possible, rare complication during sleep terrors.

Preparing for your appointment

For children, sleep terrors tend to decrease by the time they're adolescents. However, if you have concerns about safety or underlying conditions for you or your child, you may want to consult your or your child's doctor, who may refer you to a sleep specialist.

It's a good idea to prepare for your appointment. Here's some information to help you.

What you can do

• Keep a sleep diary. Keeping a sleep diary for two weeks before your appointment can help your doctor understand what's causing the sleep terrors. In the morning, you record as much as you know of your or your child's bedtime ritual, quality of sleep, and so on. At the end of the day, you record behaviors that may affect your or your child's sleep, such as caffeine consumption and any medications taken.
• Write down any symptoms you or your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you or your child is taking.
• Bring a family member or friend along, if possible. Someone who accompanies you can help you remember what the doctor says.
• Write down questions to ask your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. For sleep terrors, some basic questions to ask your doctor include:

• What is likely causing my or my child's symptoms or condition?
• Other than the most likely cause, what are other possible causes for the symptoms or condition?
• What kinds of tests are needed?
• Is the condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• Are there any restrictions that that need to be followed?
• Do you recommend seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:

• When did the sleep terrors begin?
• How often do the sleep terrors occur?
• Have there been sleep problems in the past?
• Does anyone else in your family have sleep problems?

Tests and diagnosis

Sleep terrors are usually self-diagnosed. Your doctor may do a physical or psychological exam to identify any conditions that may be contributing to the sleep terrors. In some cases, a sleep study in an overnight sleep lab may be recommended.

Sleep studies
To participate in a sleep study, also known as a polysomnogram, usually requires spending the night in a sleep lab. Sensors that send electrical signals are placed on various parts of the body, and a chip will be attached to a finger. A video camera will record your sleep. Throughout the night, the sensors will record your:

• Heartbeat
• Brain waves
• Breathing
• Eye movements
• Leg movements
• Muscle tension
• Blood oxygen level

Your doctor will review the information to determine whether you or your child have any sleep disorders.

Treatments and drugs

Treatment for sleep terrors isn't usually necessary. If your child has a sleep terror, simply wait it out. You might gently restrain your child and try to get him or her back into bed. Speak softly and calmly. Shaking your child or shouting may make things worse.

If the sleep terrors are associated with an underlying medical or mental health condition or another sleep disorder, treatment is aimed at the underlying problem. If stress or anxiety seems to be contributing to the sleep terrors, your doctor may suggest meeting with a therapist or counselor. Cognitive behavior therapy, hypnosis, biofeedback and relaxation therapy may help.

Medication is rarely used to treat sleep terrors, particularly for children. If necessary, however, use of benzodiazepines or some antidepressants may help reduce sleep terrors.

Lifestyle and home remedies

If sleep terrors are a problem for you or your child, here are some things to try:

• Make the environment safe. To help prevent injury, close and lock all windows and exterior doors at night. You might even lock interior doors or place alarms or bells on the doors. Block doorways or stairways with a gate, and move electrical cords or other objects that pose a tripping hazard. If your child has sleep terrors, don't let him or her sleep in a bunk bed. Place any sharp or fragile objects out of reach.
• Get more sleep. Fatigue can contribute to sleep terrors. Try an earlier bedtime or a more regular sleep schedule.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed. Meditation or relaxation exercises may help, too.
• Put stress in its place. Identify the things that stress you out, and brainstorm possible ways to handle the stress. If your child seems anxious or stressed, talk about what's bothering him or her.
• Look for a pattern. If your child has sleep terrors, keep a sleep diary. For several nights, note how many minutes after bedtime a sleep terror episode occurs. If the timing is fairly consistent, wake your child about 15 minutes before you expect a sleep terror episode. Keep your child awake for five minutes, and then let him or her fall asleep again.

Above all, be positive. However disruptive, sleep terrors aren't a serious condition - and they usually go away on their own.