Night Terrors

Introduction

Night terrors (or sleep terrors) are events or experiences of intense fear, resulting in screaming and physically flailing – all while still asleep. These often occur in conjunction with sleepwalking. Like sleepwalking, night terrors are considered a form of parasomnia — which is defined as an undesirable occurrence while sleeping. A sleep terror incident can normally last from a few seconds to several minutes, though episodes have been formally recorded that can last longer.

What are Night Terrors?

Night terrors are a type of parasomnia, which is classified as an arousal disorder that typically happens during your non-REM sleep cycle. 

A person encountering this affliction will suddenly begin showing signs of both terror and panic while sleeping – with these intense feelings accompanying screaming or kicking. 

These actions are usually followed by other symptoms like rapid breathing and an elevated heart rate, excessive sweating, and tensing of the muscles. Although the sufferer may have their eyes open and show intense fear, they are generally not responsive to anyone attempting to wake them up or to provide comfort. Sufferers of night terrors have been reported to fight or escape, resulting in accidental injury to themselves or concerned loved ones.

After an episode, the person often resumes their deep sleep and typically has no memory of the night terror ever occurring the very next morning.

The frequency of night terrors is not predictable. Sufferers may experience an episode rarely, while others can experience one or two night terrors per month.

Are Night Terrors Worse than Nightmares?

Being suddenly awoken to hear the sounds of your child screaming is a frightening and upsetting experience for any parent, particularly when all attempts to comfort and console your child are met with a blank but fearful facial expression and thrashing limbs. This terrible situation is not a nightmare – it is a night terror.

Nightmares are either repulsive or scary dreams that provoke emotional discomfort in the individual who has endured them. Unlike night terrors, nightmares regularly occur during the REM sleeping cycle and generally do not involve any physical or vocal responses. It is quite normal to remember the vivid circumstances or feelings after experiencing a nightmare, whereas with a night terror episode, there is no recollection at all.

What Triggers Night Terrors?

As with other parasomnias, there are studies with empirical evidence that sufferers of night terrors have a genetic predisposition for these events to occur, specifically via a confirmed family history of parasomnia.

Additionally, night terror sufferers may also experience several other sleep disorders such as obstructive sleep apnoea, gastroesophageal reflux, and/or restless leg syndrome. It is appropriate to note that obstructive sleep apnoea is present in more than 50% of children who have been referred to specialists for sleep terrors.

To date, there is no significant or notable medical association between night terrors and any psychological disorders. While the conditions described previously can influence someone to experience parasomnias, several important factors have been noted to trigger an episode:

• Periods of emotional distress or conflict,
• Fever from sickness or illness,
• Separation anxiety in children,
• Major disruption to sleep schedules,
• Extended sleep deprivation,
• Specific types of medications,
• Migraines and headaches,
• Significant head injuries.

Photo by Annie Spratt on Unsplash

Are there any Remedies for Night Terrors?

Medical practitioners always check if there is an underlying cause that requires treatment before directly treating any episodes. Studies have shown that snoring, sleep apnea, and even periodic limb movements can accelerate sleep terrors, and naturally, these sleeping issues will be treated in the first place.

Treatment has been formally proven to eradicate this ailment completely. Even if a sufferer has no other notable conditions, additional medical steps may be required, including hypnotherapy, which has been proven to be effective.

Medication has also shown promising results in combating these occurrences, especially if the effects are extremely distressing and persistent or if a child’s behaviour during the day becomes negatively impacted, resulting in overall poor performance.

It is important to note that sleep disorders are very common in childhood, and typically, there are no underlying or apparent medical conditions present.

Who is More Likely to Suffer from Night Terrors?

Night terrors affect people of any age but are more common in younger children than both adults and adolescents.

Children and Night Terrors

Nightmares and similar incidents originate in childhood. It is approximated that 20 – 50% of children between the ages of two to six have experienced a nightmare so severe it disturbed their parents or caregivers. One study found that up to 40% of children under the age of six have experienced at least 1 night terror incident.

Adolescents and Night Terrors

Unfortunately, detailed peer-reviewed evidence is lacking in this age group. However, the prevalence of these episodes occurring in children over the age of 12 seems low. Most adolescents who do experience night terrors would have first encountered them when they were much younger and tend to outgrow these experiences as they move towards adulthood. 

One formal study has described that only 4% of parasomnias, like sleep terrors, will continue past puberty or adolescence. The onset of these events within teenagers is likely to be related to a recent significant traumatic event or a developing psychiatric disorder.

Within this age group and in certain social contexts, like school camps or sleepovers, a teenager with a known history of experiencing night terrors may feel anxious or apprehensive.

Adults and Night Terrors

Adults who experience these events will be considerably less frequent than young children. Less than 2% of adults have formally reported (via their GP) experiencing sleep terrors. Also, there are very few reported cases (less than 1%) of people over the age of 65 who have described having night terrors.

As with adolescents, those adults who had a childhood history of experiencing night terrors may have the odd recurrence. These could be triggered by sleep deprivation, stress, or the onset of another sleep disorder. 

Night terrors in adults are a distinct concern due to the elevated risk of injury occurring to either themself or their partner. Especially if violent behaviour occurs throughout the episode. As with children, both adolescents and adults will not recall any details of the event ever happening.

Conclusion

This problem is a serious sleep disorder that can cause significant injuries to the sufferer and their carers or partners. Attempts to escape from the bedroom, or even fight, can result in potential harm to everyone involved. Sleep terrors can cause acute embarrassment, and they can greatly affect interpersonal relationships with others. 

However, both direct and indirect treatments are available for sufferers of night terrors. These treatment options have successfully proven to cease all future episodes from occurring and reduce both their severity and frequency.