night terrors

Night Terrors 

Definition

Night terrors are a sleep disorder characterized by anxiety episodes with extreme panic, often accompanied by screaming, flailing, fast breathing, and sweating and that usually occur within a few hours after going to sleep.

Description

Night terrors occur most commonly in children between the ages of four and 12 but can also occur at all ages. Affected individuals usually suffer these episodes within a few hours after going to sleep. They appear to bolt up suddenly, and wake up screaming, sweating and panicked. The episode may last anywhere from five to 20 minutes. During this time, the individual is actually asleep, although the eyes may open. Quite often, nothing can be done to comfort the affected person. Very often, the person has no memory of the episode upon waking the next day.

Night terrors are differentiated from nightmares in that they have been shown to occur during Stage 4 of sleep, or in REM sleep, while nightmares can occur anytime throughout the sleep cycle.

Causes and symptoms

Suffering from night terrors seems to run in families. Extreme tension or stress can increase the incidence of the episodes. In adults, the use of alcohol also contributes to an increased incidence of night terrors. Episodes sometimes occur after an accident involving head injury. Other factors thought to contribute to episodic night terrors, but not actually cause them, include:

• medications
• excessive tiredness at bedtime
• eating a heavy meal prior to bedtime
• drug abuse

Diagnosis

Night terrors are primarily diagnosed by observing the person suffering from an episode. The following symptoms are characteristic of a person suffering from a night terror:

• panic
• sweating
• gasping, moaning, crying or screaming during sleep
• little or no recollection of the episode upon awakening

Treatment

In most cases, the individual will still be asleep as the night terror episode happens and will prove difficult to awaken. The goal should be to help the affected person go back into a calm state of sleep. The lights should be turned on, and soothing comments should be directed at the person, avoiding brusque gestures such as shaking the person or shouting to startle them out of the episode. Any form of stress should be avoided.

Individuals affected by night terrors should be evaluated by a physician if they are really severe and occur frequently. A physician can recommend the best treatment for the particular circumstances of the night terrors. In some severe cases, the physician may prescribe a benzodiazepine tranquilizer, such as Diazepam, known to suppress Stage 4 of sleep. The physician may also refer the affected person for further evaluation by a sleep disorder specialist. It should be noted that episodic night terrors in children are normal and do not suggest the presence of psychological problems. In adults, night terrors are more likely to be related to a significant stress-related or emotional problem.

Prognosis

In children, night terror episodes in children usually end by the age of 12.

Prevention

If a child seems to have a regular pattern of night terror episodes, he should be gently awakened about 15 minutes before the episode usually happens. The child should be kept awake and out of the bed for a short period of time and then allowed to return to bed.

Since sleep deprivation is a strong trigger for night terror episodes, children should not be allowed to become overtired. Having children take a nap during the day may be useful.

Adults affected by night terror episodes should avoid stress, the consumption of alcohol and stimulants before going to sleep.

Resources

Periodicals

American Academy of Family Physicians. "Nightmares and Night Terrors in Children." October 2000.

Laberge, Luc, et al. "Development of Parasomnias from Childhood to Early Adolescence." Pediatrics July 2000: 67-74.

Organizations

American Sleep Disorders Association, 6301 Bandel Road Suite 101, Rochester, MN 55901. (507) 287-6008. http://www.asda.org.

National Foundation for Sleep and Related Disorders in Children. 4200 W. Peterson Suite 109, Chicago, IL 60646. (708) 971-1086.

Key terms

Benzodiazepines — A class of drugs that suppresses Stage 4 of sleep.

REM sleep — Rapid Eye Movement phase of sleep, a mentally active period during which dreaming occurs.

Sleep disorder — Any disorder that keep a person from falling asleep or staying asleep.

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terror /ter·ror/ (ter´er) intense fright.

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night terrors  pavor nocturnus.

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night terrors

n.

A state of intense fear and agitation, usually occurring in children, that causes the person to wake up screaming with fear and to remain distressed during a period of semiconsciousness.

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night terrors

Etymology: AS, niht + L, terrour

a form of dissociated sleep, usually in children, in which there may be repeated episodes of abrupt awakening from sleep with signs of panic and anxiety. The subject may have only fragmentary dream images of a threatening nature. See also pavor nocturnus, sleep terror disorder.