January 2021 | Reviewed by: Virginia Skiba, MD and Anne M. Morse, DO
What are sleep terrors?
Sleep terrors, also called night terrors, is a parasomnia. A parasomnia involves undesired events that come along with sleep.
In a typical episode, you will sit up in bed and scream or shout. This scream can include kicking and thrashing. You may say or shout things that others are unable to understand. You will also have a look of intense fear with eyes wide open and heart racing. You may also sweat, breathe heavily, and be very tense. At times, you may even bolt out of bed and run around your home. This response is more common in adults. It may also lead to violent actions. It is sometimes difficult to distinguish these types of events from REM sleep behavior disorder.
During an episode of sleep terrors, you will not respond appropriately to voices and can be hard to wake up. Once you do wake up, you will be very confused. You may not know where you are or what is going on. Most often, you will not have any memory of what took place. At times, you may recall brief bits of a dream. The dream may involve great danger or fright. It can take a long time to feel comforted once the episode is over.
These episodes occur most often in the first third of the time that you are asleep. This is during slow-wave sleep or stage N3 of sleep. Episodes in adults can occur at any time in the sleep cycle. Adults are also more likely to recall a dream that was a part of the event.
Serious or even deadly injury can occur with sleep terrors, such as attempts of leaving the house or driving. Attempts to escape from bed or to fight can result in harm to you or others. You may be embarrassed by the sleep terrors. This can greatly affect your relationships.
What are symptoms of sleep terrors?
During an episode of sleep terrors, you might:
- Sit up in bed
- Scream or shout
- Perform dangerous actions
- Be hard to awaken
- Be confused when awoken
- Not remember what took place
What are risk factors for sleep terrors?
Sleep terrors is more common in children and affects males and females equally. It may affect as many as 6.5% of all children. It tends to begin when a child is four to 12 years old. Children with sleep terrors will often talk in their sleep and sleepwalk.
In rare cases, it can begin in adulthood. Overall, only about 2.2% of adults have it. Very few people over the age of 65 have sleep terrors.
There is a strong genetic and family link. It can occur in several members of the same family.
Many adults who have sleep terrors are also likely to have a history of one of the following:
- Bipolar disorder
- Some depressive disorders
- Anxiety disorders
It is unclear how closely it may be linked to these mental disorders in adults. In children, there does not seem to be any connection between mental disorders and sleep terrors.
Episodes of sleep terrors and sleepwalking share many of the same causes. These include the following:
- Sleep deprivation
- Hyperthyroidism (overproduction of thyroid hormones)
- Migraine headaches
- Head injury
- Encephalitis (brain swelling)
- Stroke
- The premenstrual period
- Bloated stomach
- Physical or emotional stress
- Sleep apnea
- Other sleep-related disorders or events
- Travel
- Sleeping in unfamiliar surroundings
- Some medications
- Alcohol use and abuse
- Noise or light
- Fevers in children
How to diagnose sleep terrors?
Sleep terrors are more common in children. Medications are not typically needed. Parents should keep track of the child’s sleep wake schedule and the timing and characteristics of the sleep terror events. This can be helpful in distinguishing the type of event and be used in constructing a treatment plan. A sleep evaluation to look for other sleep problems that may be interfering with the child’s ability to get the right number of hours or quality of sleep is necessary. In some cases, a sleep study may be recommended.
An adult who continues or begins to have sleep terrors should be evaluated for other sleep disorders. In these cases, talk to your medical provider.
A sleep doctor will often ask you to complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. She might also ask you to rate your sleep using a simple questionnaire. This will help show how your sleep is affecting your daily life. The doctor will need to know your complete medical history. Be sure to inform her of any past or present drug and medication use. Also, tell the doctor if you or a relative have ever had a sleep disorder.
A sleep doctor will try to determine if there is something else that is causing your sleep terrors or making the symptoms worse, such as:
- Another sleep disorder
- A medical condition
- Medication use
- A mental health disorder, like PTSD
- Substance abuse, including alcohol abuse
The sleep doctor may want to examine your sleep using a sleep study. Also known as a polysomnography, a sleep study charts your brain waves, heartrate and breathing as you sleep. It also looks at how your arms and legs move and records your behavior during sleep on video. This will help show if you get out of bed and do anything unusual during your sleep study.
How to treat sleep terrors?
It is important to make sure that the bedroom environment is safe. Make sure there are no dangerous objects within reach. Pull furniture with sharp edges away from the bed.
If your child has another sleep disorder, it should be treated and this will likely decrease the frequency of their sleep terrors. Sleep terrors can occur when sleep is fragmented by other sleeping problems. Sleep apnea is a common medical problem that can lead to frequent arousals from sleep. This may increase the risk of parasomnias such as sleep terrors. Symptoms of sleep apnea include snoring, waking up gasping for air, and daytime sleepiness. Treatment of sleep apnea may improve sleep terrors.
If you witness sleep terrors in your child, you may feel very distressed and try to wake or console them during the event. This can have the opposite effect, causing worsening of the behaviors or a more prolonged event.
It is recommended to have your child maintain a regular sleep schedule 7 days a week and achieve age appropriate number of hours of sleep per night. In some children, sleep terrors may persist despite maintaining healthy sleep habits. If this occurs, it may be advantageous to gently wake your child about 15 minutes prior to the typical timing of the sleep terror. This may stop the event from occurring. If the events continue and are distressing to the family, the doctor may suggest medications. Fortunately, sleep terrors tend to go away on its own as children enter the teen years.