Night terrors or sleep terrors are common terms for episodes that cause anxiety at night, especially in children. They are different from nightmares. They can be stressful for the person who has them and for their family.
While people speak of “night terrors,” according to the Diagnostics and Statistics Manual, Fifth Edition (DSM-V), this is actually not a diagnosable condition.
It contains elements of conditions known as nightmare disorder, REM sleep behavior disorder, and non-rapid eye movement disorder (NREM).
While nighttime episodes can be terrifying, night terrors are usually not a sign of anything more serious. They tend to end as abruptly as they begin.
Night terrors are nocturnal episodes that cause great anxiety while you sleep. The person can wag their limbs and scream and scream.
Night terrors are most common in children, but adults can suffer too. A normal attack usually lasts between 30 seconds and 3 minutes, but can be significantly longer.
Night terrors are uncomfortable, but usually not a cause for medical concern.
It is estimated that they affect around 40% of children and a smaller number of adults.
Night terrors are different from nightmares. In a nightmare, the dreamer may wake up, but during the night terrors he will usually be asleep.
This difference is most likely due to the sleep phase when night terrors occur.
Nightmares usually occur during Rapid Eye Movement Sleep (REM) towards the end of the night.
In contrast, night terrors occur during the first third of the night during deeper sleep, also known as slow-wave sleep or non-REM sleep.
The signs of a night terror episode can be:
- scream and scream
- sit in bed or sleepwalk
- Kicking and hitting the limbs
- difficult breathing, racing pulse, and profuse sweating
- dilated pupils and increased muscle tone
- difficult to wake up
- Confusion on waking up
- wide-eyed stare as if awake but not responding to stimuli
- aggressive behavior, especially in adults)
- do not remember the event
If the person remembers the dream, it is likely that it will bring something very scary for them.
A number of factors can contribute to night terrors.
- Fever, especially in children
- sleep deprivation
- Light or noise
- an overflowing bladder
- Spend the night in an unfamiliar place
- possibly genetic factors
- Migraine headache
- physical or emotional stress
- Use or abuse of some drugs or alcohol
In 2014, a study of nearly 7,000 children ages 8 to 10, with a follow-up visit around 13 years of age, showed that those who were bullied were more than twice as likely to experience night terrors.
In addition, night anxiety is often associated with other underlying illnesses, such as breathing problems while sleeping such as sleep apnea, migraines, head injuries, restless legs syndrome, and certain medications.
A study that looked at 661 Parkinson’s patients, ages 43 to 89, reported that 3.9% had night terrors. In addition, 17.2% had nightmares and 1.8% had sleepwalking.
The following factors can also play a role.
Night terrors and sleepwalking seem to be linked. Both occur during slow wave sleep, the deepest phase of sleep that occurs early in the night.
Some researchers believe that people who suffer from sleepwalking or night terrors may have difficulty maintaining slow sleep. This makes them prone to quick awakenings and increases the likelihood of parasomnias.
Brain lesions are an unlikely cause of night terrors. However, in some cases damage or dysfunction of the thalamus has been linked to this phenomenon.
In one study, a woman started 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 from the thalamus. This seemed to be causing the micro-excitations that indicated night terrors.
The thalamus is believed to play a key role in maintaining the sleep-wake rhythm. It also attenuates the signals that normally come from the senses, including those from hearing, while we sleep.
Most of the information our brain receives from the outside world passes through the thalamus before being sent to the parts of the brain that allow us to see or hear, for example.
When we sleep, the thalamus is less apt to send this information to the rest of the brain.
As a result, when we sleep, we become less aware of tactile stimuli and the sounds around us.
People with night terrors or sleep walks often have a family member who does this too.
In 1980, a small study found that 80% of sleepwalkers and 96% of people with night terrors have at least one other close family member who has one or both of these conditions.
Another study, focused on identical and non-identical twins, supported this finding.
The researchers found that if their identical twin did so, a person was significantly more likely to experience night terrors. This is less likely to happen with non-identical twins.
A long-term study of 1,940 children published in 2015 found that those whose parents walked in their sleep were more likely to have night terrors and that night terrors were more likely to last longer.
The maximum age for night terrors in childhood was 18 months. At that age, the parents of 34.4% of the children reported having night terrors. Up to a third of children who have experienced night terrors develop sleepwalking habits later in childhood.
A doctor will ask a patient and family members, if any, about signs of night terrors. You can also take tests to look for other possible factors, which could be physical or psychological.
A sleep study can be recommended.
A sleep study or polysomnography involves spending the night in a sleep laboratory and taking various measurements while you sleep.
During the night, brain waves, blood oxygen levels, heart rate, breathing as well as eye and leg movements are measured and the patient is filmed.
The doctor will review the recording and assess various aspects of the person’s sleep behavior.
The film can reveal irregular breathing, which may indicate apnea, or other causes of disturbed sleep, such as restless legs syndrome.
Medication is usually not required for night terrors.
While night terrors seem excruciating to children, permanent damage is unlikely and they usually pass without intervention.
Hold the child’s hand and speak calmly to shorten an episode.
Treatment is usually only needed if the episodes have a significant negative impact on the safety of the person or family, or if the problem affects their ability to function during the day.
When treatment is required, three types of interventions are possible.
- Treating an underlying condition such as sleep apnea or a mental health problem.
- Improving sleep conditions by changing sleeping habits or the sleeping environment.
- Medications like benzodiazepines and serotonin reuptake inhibitors (SSRIs) can help in some cases.
- Coping with stress, for example through therapy or counseling.
Home remedies and simple solutions
A number of simple procedures can help alleviate night terrors.
Safe sleeping environment
Close and lock all doors and windows at night. Consider alerting them. Eliminate trip hazards and remove fragile and dangerous objects.
Identify sources of stress and ways to alleviate them. If a child is terrified of the night, ask them to tell you about anything that is bothering them and discuss them.
Sleep deprivation can be a factor, so try to go to bed earlier or take an afternoon nap. A relaxing routine before bed can also help, such as a warm bath or light reading before bed. Avoid screen time for at least an hour before bed.
Search for patterns
Keep a sleep diary and note how often the horrors occur and when they start. If the nighttime horrors are bothersome and they occur at a regular time, wake your child 15 minutes before they are likely to occur, keep them awake for 5 minutes, and then let them go back to sleep.
Night terrors are most common in children, but can also affect adults. An adult may experience night terrors at any time during the sleep cycle and is more likely to remember the dream than children.
Adults are more likely to be night scared if they have a history of:
Sometimes night terrors can injure the person or others, especially if they are fighting or sleepwalking. An adult is more likely to be aggressive than a child when it comes to night terrors.
Adults can also feel ashamed of their sleep patterns, which can affect relationships.
Anyone worried about night terrors might consider seeing a sleep specialist.
To learn more about sleep, visit our dedicated hub page.