They are common terms to define episodes that cause fear at night and great fear when sleeping, especially in children.
They are different from nightmares . They can be distressing for the person who has them and for their family.
While people talk about “night terrors,” this is not, in fact, a diagnosable condition, according to the Diagnostic and Statistical Manual Fifth Edition (DSM-V).
It contains elements of the conditions known as Nightmare Disorder, REM Sleep Conduct Disorder, and Non-Rapid Eye Movement (NREM) Sleep Disorder.
Although nighttime episodes can be terrifying, night terrors are not usually a sign of something more serious. They tend to end as abruptly as they begin.
During night terrors, a person may stare wide-eyed in fear, even though they are asleep. The person may flap their limbs and scream.
Night terrors are more common in children, but adults can get them too. A normal attack typically lasts between 30 seconds and 3 minutes, but can be substantially longer.
Night terrors are unpleasant, but they are generally not a cause for medical concern.
It is estimated that they affect 40 percent of children and a smaller number of adults.
Symptoms of night terrors
Night terrors differ from nightmares. In a nightmare, the dreamer may wake up, but during night terrors they usually fall asleep.
This difference is probably due to the sleep phase in which the night terrors occur.
Nightmares tend to occur during rapid eye movement (REM) sleep, towards the end of the night’s sleep.
In contrast, night terrors occur during the first third of the night during deep sleep, also known as slow wave sleep or non-REM sleep.
Signs of a night terror episode can include:
- Sit in bed or sleepwalking.
- Kick and hit the limbs.
- Heavy breathing, racing pulse, and profuse sweating.
- Dilated pupils and increased muscle tone.
- Difficulty waking up.
- Confusion in wakefulness.
- Look with wide eyes, as if awake, but not responding to stimuli.
- Aggressive behavior (especially in adults).
- Forgetting the event.
If the person remembers the dream, it probably involves something very scary to them.
Causes of night terrors
Several factors can contribute to night terrors.
- Fever, especially in children.
- Stress .
- Sleep deprivation.
- Light or noise.
- Full bladder.
- Spend the night in some unfamiliar place.
- Possibly genetic factors.
- Migraine headaches.
- Physical or emotional stress.
- Use or abuse of some medications or alcohol.
In 2014, a study of nearly 7,000 children between the ages of 8 and 10, with a follow-up around 13 years, showed that those who were bullied were more than twice as likely to experience night terrors.
Also, night terrors are often associated with other underlying conditions, such as breathing problems while sleeping, for example:
- Head injuries
- Restless Leg Syndrome.
- Certain medications
A study that evaluated 661 people with Parkinson’s disease, ages 43 to 89, reported that 3.9 percent had night terrors. Additionally, 17.2 percent had nightmares and 1.8 percent experienced sleepwalking.
The following factors may also play a role.
Night terrors and sleepwalking appear to be associated. Both occur during slow wave sleep, the deepest stages of sleep, which occur in the early part of the night.
Some researchers believe that people who experience sleepwalking or night terrors may have a difficult time maintaining slow wave sleep. This makes them susceptible to rapid awakenings, and increases the chances of parasomnias.
Brain injuries are an unlikely cause of night terrors. In some cases, however, damage or dysfunction of the thalamus has been linked to this phenomenon.
In one study, a woman began having regular night terrors at the age of 48.
She underwent observation in a sleep laboratory to investigate the cause. The tests showed an increased signal coming from the thalamus. This seemed to cause the micro-awakenings that suggest night terrors.
The thalamus is believed to play a key role in maintaining sleep-wake cycles. It also works to dampen the signals that normally come from the senses, including the ears, while we sleep.
Most of the information our brain receives from the outside world passes through the thalamus before it is sent to the parts of the brain that allow us to see or hear, for example.
When we sleep, the thalamus is less inclined to send this information to the rest of the brain.
As a result, when we sleep, we are less aware of the tactile stimuli and sounds around us.
People who have night terrors or who sleep often have a family member who does this too.
In 1980, a small study found that 80 percent of sleepwalkers and 96 percent of people who have night terrors have at least one other close relative who has one or both of the conditions.
Other research that focused on identical and non-identical twins supported this finding.
The researchers found that a person is significantly more likely to experience night terrors if their identical twin does. In non-identical twins, the chance of this happening is less.
A long-term study of 1,940 children, published in 2015, found that those whose parents had walked in their sleep were more likely to have night terrors and that these night terrors were more likely to persist longer.
The maximum age for night terrors in childhood was 18 months. At this age, parents reported that 34.4 percent of children had night terrors. Up to a third of children who experience night terrors develop sleepwalking habits later in childhood.
Tests and Diagnosis
A doctor will ask a patient and, if appropriate, their family members about any signs of nightmares. They can also run tests to look for other possible factors, which can be physical or psychological.
A sleep study may be recommended.
A sleep study, or polysomnogram, involves spending the night in a sleep laboratory and taking various measurements while you sleep.
Brain waves, blood oxygen levels, heart rate, breathing, and eye and leg movements are measured throughout the night and the patient is filmed.
The physician will review the recording and evaluate different aspects of the individual’s sleep behavior.
The film may reveal irregular breathing, possibly suggesting apnea, or other reasons for disturbed sleep, such as restless legs syndrome.
Treatment of night terrors
Medication is not usually necessary for night terrors.
Although night terrors seem distressing to children, permanent damage is unlikely to occur and usually passes without intervention.
Holding the child’s hand and speaking calmly can help shorten an episode.
Treatment is usually necessary only if the episodes have a significant negative effect on the safety of the person or their family, or if the problem is affecting their ability to function during the day.
If treatment is necessary, three types of intervention are possible:
- Treatment of an underlying condition : It could be sleep apnea or a mental health problem.
- Improved sleeping conditions: if lack of sleep is a factor, change sleeping habits or sleeping environment.
- Medications – Medications are rarely used, but benzodiazepines and serotonin reuptake inhibitors (SSRIs) can help in some cases.
Home remedies and simple solutions
Several simple interventions can help relieve night terrors.
- Safe sleeping environment: close all doors and windows at night.
- Eliminate tripping hazards and dispose of fragile and dangerous objects.
- Stress – Identify any sources of stress and ways to relieve them. If a child experiences night terrors, ask them to tell you something that bothers them and talk about it.
- Get more sleep – Sleep deprivation can be a factor, so try going to bed earlier or napping in the afternoon. Having a relaxation routine before bed can also help, for example taking a warm bath or reading the light before bed.
- Avoid screen time for at least an hour before bedtime.
- Look for patterns : Keep a sleep diary and note how often terrors occur and what time they start.
If night terrors are bothersome, and they occur at a regular time, a suggestion is to wake your child 15 minutes before they occur, keep them awake for 5 minutes, and then let them go back to sleep.
Night terrors in adults
Night terrors are more common in children, but they can affect adults as well. An adult can have night terrors at any time during the sleep cycle, and they are more likely to remember the dream than children.
Adults are more likely to have night terrors if they have a history of:
- Bipolar disorder.
- Depression .
Sometimes night terrors can lead to injury to the person or other people, especially if they stagger or become sleepwalking as well. An adult is more likely to display aggressive behavior than a child during night terrors.
Adults can also be ashamed of their behavior during sleep, and this can affect relationships.
Anyone worried about night terrors might consider visiting a sleep specialist.