Night terror

Night Terror

Night terror, also known as sleep terror, is a sleep disorder causing feelings of panic or dread typically occurring during the first hours of stage 3-4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. They can last longer, especially in children. Sleep terrors are classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are defined as undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousal from sleep.

Signs and Symptoms

The universal feature of night terrors is inconsolability, very similar to that of a panic attack. During night terror bouts, people are usually described as "bolting upright" with their eyes wide open and a look of fear and panic on their faces. They will often scream. Furthermore, they will usually sweat, exhibit rapid breathing, and have a rapid heart rate (autonomic signs). In some cases, individuals are likely to have even more elaborate motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions. There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury.

Although people may seem to be awake during a night terror, they will appear confused, be inconsolable and/or unresponsive to attempts to communicate with them, and may not recognize others familiar to them. Occasionally, when a person with a night terror is awakened, they will lash out at the one awakening them, which can be dangerous to that individual. Most people who experience this do not remember the incident the next day, although brief dream images or hallucinations may occur and be recalled. Sleepwalking is also common during night-terror bouts, as sleepwalking and night terrors are different manifestations of the same parasomnia.

Causes

There is some evidence that a predisposition to night terrors and other parasomnias may be congenital. Individuals frequently report that past family members have had either episodes of sleep terrors or sleepwalking. In some studies, a ten-fold increase in the prevalence of night terrors in first-degree biological relatives has been observed—however, the exact link to inheritance is not known. Familial aggregation has been found suggesting that there is an autosomal mode of inheritance. In addition, some laboratory findings suggest that sleep deprivation and having a fever can increase the likelihood of a night terror episode occurring. Other contributing factors include nocturnal asthma, gastroesophageal reflux, and central nervous system medications. Special consideration must be used when the subject suffers from narcolepsy, as there may be a link. There have been no findings that show a cultural difference between manifestations of night terrors, though it is thought that the significance and cause of night terrors differ within cultures.

Diagnosis and Treatment

The diagnosis of sleep terror disorder requires the presence of recurrent periods where the individual abruptly but not completely wakes from sleep, usually occurring during the first third major period of sleep. The individual experiences intense fear with a panicky scream at the beginning and symptoms of autonomic arousal, such as increased heart rate, heavy breathing, and increased perspiration. The individual cannot be soothed or comforted during the episode. The episode is completely forgotten. The occurrence of the sleep terror episode causes clinically significant distress or impairment in the individual's functioning. The disturbance is not due to the effects of a substance, general medical condition, or medication. Coexisting mental or medical disorders do not explain the episodes of sleep terrors.

In most children, night terrors eventually subside and do not need to Night terror, also known as sleep terror, is a sleep disorder causing feelings of panic or dread typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. They can last longer, especially in children. Sleep terrors are then classified in the category of NREM-related parasomnias 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, within sleep, or during arousal from sleep.

Prevalence and Confusion with Nightmares

Sleep terrors usually begin in childhood and usually decrease with age. Factors which may lead to sleep terrors are young age, sleep deprivation, medications, stress, fever, and intrinsic sleep disorders. Though the frequency and severity differ between individuals, the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights or multiple times in one night. 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, also known as 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. 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 episodes (distinct from sleep terror disorder, 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.

Signs and Symptoms

The universal feature of night terrors is inconsolability, very similar to that of a panic attack. During night terror bouts, people are usually described as "bolting upright" with their eyes wide open and a look of fear and panic on their faces. They will often scream. Furthermore, they will usually sweat, exhibit rapid breathing, and have a rapid heart rate (autonomic signs). In some cases, individuals are likely to have even more elaborate motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions. There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury. Although people may seem to be awake during a night terror, they will appear confused, be inconsolable and/or unresponsive to attempts to communicate with them, and may not recognize others familiar to them. Occasionally, when a person with a night terror is awakened, they will lash out at the one awakening them, which can be dangerous to that individual. Most people who experience this do not remember the incident the next day, although brief dream images or hallucinations may occur and be recalled. Sleepwalking is also common during night-terror bouts, as sleepwalking and night terrors are different manifestations of the same parasomnia.

Causes, Diagnosis, and Treatment

There is some evidence that a predisposition to night terrors and other parasomnias may be congenital. Genetics, family history, and other factors may play a role in the development of night terrors. Additionally, external factors such as stress, anxiety, sleep deprivation, irregular sleep schedules, and the consumption of alcohol or caffeine can also contribute to the onset of night terrors. Some medical conditions, such as sleep apnea, restless leg syndrome, and certain medications, can increase the likelihood of experiencing night terrors.

Diagnosing night terrors can be challenging, as the symptoms may be confused with other sleep disorders or medical conditions. A thorough medical history, discussion of sleep habits, and possibly a sleep study (polysomnography) may be required to accurately diagnose night terrors.

Treatment for night terrors is usually not necessary, as most children outgrow them by adolescence. However, if night terrors are causing significant distress or pose a danger to the individual or others, treatment options may include:

• Establishing a regular sleep schedule and maintaining a consistent bedtime routine.
• Creating a relaxing sleep environment, free of distractions and stressors.
• Addressing underlying medical conditions or sleep disorders that may be contributing to the night terrors.
• Reducing stress and anxiety through relaxation techniques, such as meditation or deep-breathing exercises.
• Avoiding alcohol, caffeine, and stimulating activities close to bedtime.
• Medication may be prescribed in severe cases, but this is typically reserved for adults or when other interventions have not been successful.

In some cases, therapy, such as cognitive-behavioral therapy (CBT), may be helpful in addressing anxiety or stress-related issues that could be contributing to night terrors. It's essential to consult with a healthcare professional to determine the most appropriate treatment approach for each individual case.

Prevention and Management

Preventing night terrors can be challenging, as the underlying cause may not always be apparent. However, some general recommendations for reducing the risk of night terrors include:

• Ensuring a consistent sleep schedule and adequate sleep duration for the individual's age.
• Minimizing stress and anxiety through relaxation techniques and addressing any underlying emotional or psychological issues.
• Creating a calming bedtime routine and sleep environment.
• Avoiding alcohol, caffeine, and stimulating activities before bedtime.
• Treating any underlying sleep disorders or medical conditions that may contribute to night terrors.

During a night terror episode, it's important to remember that the individual is not awake and may not be responsive to attempts at communication. The primary goal should be to ensure their safety and the safety of others. This may include gently guiding them back to bed if they are sleepwalking or removing any potential hazards in their environment. In most cases, it's best not to wake the person experiencing a night terror, as this can lead to confusion and disorientation. Instead, provide comfort and reassurance until the episode resolves on its own.==See also==

• Ephialtes (illness)
• Horror and terror
• Sleep paralysis

External links

Classification	ICD-10: F51.4 ICD-9-CM: 307.46 MeSH: D020184
External resources	MedlinePlus: 000809

• Night Terror Resource Center
• National Institutes of Health, Medline Plus: Night Terrors
• National Library of Medicine - Medical Subject Headings: Night Terrors

Night terror Resources
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