Also known as sleep terrors, night terrors are episodes of intense fear, screaming, and flailing while you are still asleep.
These terrors are also sometimes paired with sleepwalking and other parasomnias. Episodes can last anywhere from a few seconds to a few minutes, and the patient usually has little to no memory of the event in the morning.
Night terrors are most common in children, affecting roughly 40% of all children and a much smaller percentage of adults at least once during their lives.
Most children outgrow night terrors, but treatment may be required if they are causing a significant sleep disturbance or if they pose a safety risk to the child or others.
In this article, we’ll explore the topic of night terrors in depth, providing an overview of what they are, what symptoms they produce, and how they differ from nightmares.
We’ll also provide information about diagnosis and treatment options.
What Are Night Terrors?
Everyone has experienced at last one nightmare, a dream that invokes feelings of fear or terror. In some cases, you may wake with a full memory of the dream, or you may have nothing more than a vague feeling of unease that you can’t seem to shake. Night terrors take those feelings to the extreme.
A night terror is a sleep disturbance that is similar to a nightmare but is far more dramatic.
These episodes typically induce feelings of terror or panic in the dreamer, causing them to shout, scream, or thrash around in bed – it may also lead to episodes of sleepwalking or other behaviors in which the patient is acting out the dream.
Night terrors are sometimes caused by post-traumatic stress disorder (PTSD), though they can also result from extended periods of sleep deprivation, chronic stress, and various sleep disorders.
The primary difference between night terrors and nightmares is that the dreamer remains asleep during a night terror. Night terrors typically occur during non-REM (NREM) sleep, particularly during the early part of the night.
This is another factor that differentiates night terrors from nightmares, as nightmares typically occur closer to the end of the night.
What Are the Symptoms of Night Terrors?
Sleep terrors can occur at any age, but they are more common in children than adults. Estimates vary greatly, but experts suggest that up to 15% of younger children experience recurrent night terrors.
These episodes are most frequently seen in children between the ages of 2 and 6 years old and they can be very distressing for parents.
A night terror can last anywhere from a few seconds to a few minutes, but the typical duration is between 5 minutes and 30 minutes.
During this time period, persons experiencing night terrors may be seen to bolt upright in bed with their eyes open, a look of sheer terror or panic plastered across their face.
Some people scream or cry and many exhibit additional symptoms like sweating, rapid breathing, and fast heart rate.
Night terrors typically occur during NREM sleep during the first one-third to one-half of the night, and they rarely occur during naps.
During a sleep terror episode, the patient may exhibit the following symptoms or behaviors:
- Screaming or shouting
- Sitting upright in bed looking frightened
- Staring wide-eyed while still asleep
- Sweating and breathing heavily
- Rapid heart rate and flushed face
- Kicking and thrashing
- Dilated pupils and increased muscle tone
- Being difficult to awaken
- Awakening with confusion
- Being inconsolable
- Having little to no memory the next day
- Getting out of bed, sleep walking or behaving aggressively
As is true for people who experience sleep walking and other insomnias, being woken during the episode can cause the patient to become very confused.
Some people become very agitated and may even act aggressively. In most cases, it is better not to wake the person and to simply make sure they are safely returned to bed instead.
Night terrors themselves are not inherently dangerous. In cases where the patient gets out of bed and moves around, however, there is a risk for injury.
For patients experiencing recurrent night terrors, it may be wise to take safety precautions such as locking exterior doors and windows.
If the night terrors occur at roughly the same time each night, it may also help to have a sleeping partner or parent wake the patient 15 to 30 minutes before the even typically occurs in hopes of preventing it.
What Causes Night Terrors?
Again, night terrors can occur at any age, but they are more common in children than adults. This condition has been identified most frequently in children who:
- Are overtired or stressed
- Started taking a new medication
- Are physically ill, especially with fever
- Fail to get enough sleep on a regular basis
- Are sleeping in a new environment
- Have been drinking too much caffeine
Night terrors typically affect children between the ages of 2 and 6, but they have been observed in babies as young as 18 months. This condition seems to be more common in boys than in girls, and there also appears to be a genetic link. About 80% of children who experience regular night terrors have a family member who also experienced them or who has another sleep disorder such as sleep walking.
Technically speaking, night terrors are a type of parasomnia – an undesirable behavior or experience that occurs involuntarily during sleep.
Night terrors are also classified as a disorder of arousal which simply means that they occur during the deepest stage of NREM sleep.
Sleep walking is another example of an NREM disorder, so it should come as no surprise that the two conditions often occur together.
There are a number of factors which are thought to contribute to sleep terrors. They include:
- Chronic stress
- Sleep deprivation
- Overfull bladder
- Sleeping somewhere unfamiliar
- Genetic factors
- Migraine headaches
- Emotional stress
- Physical injury or stress
- Substance abuse
- Premenstrual period
- Encephalitis (brain swelling)
Sleep terrors have also been linked to various underlying conditions such as sleep apnea, restless leg syndrome, and Parkinson’s disease.
The link between night terrors and sleepwalking may also indicate that the patient has difficulty maintaining slow-wave (NREM) sleep – this increases their susceptibility to parasomnias and quick arousals.
Damage or dysfunction to the thalamus in the brain may also be involved, but brain lesions are a very unlikely cause of night terrors.
Night terrors only affect about 2% of adults, and it is very rare in people over the age of 65.
In adults, sleep terrors are also commonly linked to mental health disorders such as post-traumatic stress disorder, bipolar disorder, depression, and anxiety.
Sleep terrors may affect adults differently than children as well. For example, they may occur at any time during the sleep cycle and adults are more likely to remember the dream upon waking.
How Are Night Terrors Diagnosed?
Generally speaking, night terrors do not require treatment. When they occur in children, the condition usually resolves as the child gets older.
If you suddenly start having sleep terrors as an adult, however, it may be cause for concern.
You should also talk to your doctor if the following things apply:
- Your sleep terrors are becoming more frequent
- The condition disrupts sleep for you or your family
- Your sleep terrors put you at risk for injury
- You experience excessive daytime sleepiness
- Sleep terrors continue from childhood into the teen years
Though sleep terrors are an easily identifiable occurrence, they are not technically regarded as a diagnosable condition, according to the Diagnostic and Statistical Manual fifth edition (DSM-V).
Rather, it is classified as an NREM sleep arousal disorder, the diagnostic criteria for which are as follows:
- Recurrent episodes of abrupt terror arousals, typically starting with a panicked scream
- Intense fear and signs of autonomic arousal during the episode
- Relative unresponsiveness to comforting attempts during the episode
- Little to no recall of dream imagery upon waking
- Significant distress or impairment in occupational, social, and other areas of function
- Symptoms cannot be explained by another mental disorder or medical condition
The diagnosis of sleep terrors is usually made based on the patient’s history of symptoms and by excluding other possibilities.
Your doctor may also ask you to keep a sleep diary for a few weeks to track your symptoms and to gather information about your sleep habits.
In some cases, polysomnography may be required to gather clinical evidence about your bodily function during sleep and during sleep terror episodes – you may also need an EEG if your doctor suspects nocturnal seizures.
In addition to collecting information about your symptoms, your doctor will want to know about any complications you may be experiencing.
For example, frequent night terrors may result in a significant sleep disturbance which can contribute to excessive daytime sleepiness.
Daytime fatigue may impair your ability to concentrate or function properly at work, in school, or in social situations.
There is also a risk for injury to yourself or others during episodes and embarrassment about the condition can affect the patient’s romantic and social relationships.
What Are the Treatment Options for Night Terrors?
As it has already been mentioned, night terrors typically do not require treatment.
Particularly in children, they tend to resolve on their own over time.
When the condition becomes particularly disturbing or dangerous for the patient or other members of the family, however, treatment may be recommended.
Treatment usually focuses on improving safety and eliminating triggers.
Here are some of the treatment options for night terrors:
- Treating underlying medical conditions such as mental health problems and concurrent sleep disorders like sleep apnea or restless leg syndrome.
- Improving stress levels by engaging in cognitive behavioral therapy, hypnosis, biofeedback therapy, or relaxation exercises.
- Waking the patient about 15 to 30 minutes before the event is expected to occur – this is known as anticipatory awakening.
- In rare cases, pharmaceutical medications such as benzodiazepines or antidepressants may help to reduce sleep terrors.
If you experience mild or infrequent night terrors, you may not need treatment, but there are still lifestyle changes and management strategies which could be beneficial. Here are a few different strategies you can try:
- Develop and stick to a regular sleep schedule. Fatigue and sleep deprivation can trigger night terrors, so try to go to bed and get up at the same times each day.
- Create a relaxing bedtime routine. Doing a quiet, calming activity before bed (such as reading a book or soaking in a hot bath) can help you fall asleep and stay asleep.
- Make your bedroom a haven for sleep. Keep your bedroom cool, dark, and quiet to promote healthy and restful sleep.
- Reduce daily stress levels with stress-relieving activities. Try meditation, yoga, or other relaxation exercises to reduce your chronic stress.
- Make the environment safe. Prevent injury during sleep terrors and episodes of sleep walking by closing and locking all exterior doors and windows – you can also put alarms on them.
- Comfort the person experiencing night terrors. Do not try to wake the person but you can offer comfort measures such as soothing words or gentle physical touch.
You may also want to keep a sleep diary to identify any patterns that may exist. If you find that the sleep terrors occur at the same time each night, you can use anticipatory awakenings to prevent them.
You may also find that the sleep terrors occur in conjunction with some kind of trigger that you can control to reduce them or prevent them entirely.
As is true for any sleep disorder, the biggest danger associated with night terrors is sleep disturbance.
If they occur frequently, it can cause a significant disruption of sleep which can contribute to daytime sleepiness.
This can affect your ability to function or focus which, in turn, affects your quality of life. Talk to your doctor if you’re concerned about your night terrors.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment. Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.