It is estimated that 25% of the population suffers from some type of sleep disorder. According to the Diagnostic Statistical Manual of Mental Disorders IV-TR, sleep disorders are divided into two main types: dyssomnias and parasomnias. Dyssomnias are more common, and they are characterized by abnormal sleep quality and difficulties with sleep initiation, maintenance, and duration. Examples of dyssomnias include insomnia and narcolepsy. Parasomnias are characterized by abnormal behavioral and arousal disruptions, the most common of which are nightmares, sleepwalking, and sleep terror disorders.
Sleep terror disorder, also called “night terrors,” are episodes of intense fear during sleep. Sleepers having night terrors experience sudden, partial awakening from sleep. They are likely to be in a terrified state and may bolt up in bed, scream, flail their arms and legs, and appear confused and unable to communicate. Their breathing is labored, their eyes are open, and they are difficult to comfort and console.
Unlike nightmares, which occur during the dream stage of sleep (REM), night terrors occur when a person is in a deep sleep (stages 3 or 4—slow wave sleep). These episodes occur during the first third of the night and can last anywhere from a few minutes to 30 minutes. Once they subside, the person usually goes back to sleep and will not recall the experience in the morning.
Night terrors are more common in children than they are in adults. The Diagnostic Statistical Manual of Mental Disorders IV-TR estimates that between 1% and 6% of children and less than 1% of adults experience night terror episodes. Night terrors in children are often short-lived, occurring over several days or weeks, and are usually outgrown by adolescence. As such, treatment is not generally required.
In both children and adults, certain events or situations can trigger night terrors. These include unresolved psychological conflicts, stress, sleep deprivation, fatigue, and traumatic events. For children, seeing a scary movie or hearing their parents fight can trigger a terror episode. Sleep disturbances can be provoked in adults by alcohol and drug abuse or by the use of some prescription medications. The most common prescription drugs responsible for sleep disturbance include antihistamines, decongestants, and antidepressants. Withdrawal from addictive drugs can also provoke sleep disturbance.
Children who experience frequent episodes that do not subside after a few weeks should be seen by their doctors to determine if other medical or psychological conditions are the cause. In severe cases of night terrors, the child’s doctor may prescribe an antidepressant to help relieve nervousness or tension.
While night terrors are typically short-lived in children, there are a few things parents can do to help reduce severity and frequency. Because fatigue and stress are common triggers for children, allowing for more sleep time and eliminating stresses in a child’s life can help. In addition, a parent can attempt to stop a night terror before it begins. Using this technique, the parent determines when to awaken the child by observing what time the terrors usually begin. The parent would then awaken the child about 15 minutes before the episode occurs. After 4 or 5 minutes, the child can return to sleep. The waking is discontinued once the terrors stop, which in most circumstances occurs within a week.
Night terrors in adults are more difficult to treat, as they don’t typically vanish as easily as they do for children. The goal for adults is to reduce stress as much as possible and to create a calm, relaxed state right before bed. Some helpful techniques include regular massages, physical exercise, and making the routine before bedtime as serene and peaceful as possible.
Because phobias, anxiety, and past emotional traumas have been found to be linked to this sleep disturbance, counseling is recommended. Talking with a therapist could help uncover a person’s concerns and problems associated with underlying issues, and the resultant healing could lead to a reduction of episodes. In severe cases, medications such as the antidepressant Tofranil or benzodiazepine drugs such as Klonopin or Valium have been prescribed.
We all know the benefits of a good night’s sleep, and lack of good sleep can adversely affect a person’s work performance, cognitive functioning, and mental and physical well-being. A person who often wakes up feeling tired due to interrupted and tense slumber should seek professional medical advice. Adults who are having frequent night terror episodes may also consider seeing a sleep specialist.
While there is no cure for night terrors, the goal is to achieve a calm state of sleep to reduce the frequency of episodes. Relaxation techniques, counseling, and good sleep hygiene are the first steps. If you think you or a loved one may be having night terrors, please visit the Cleveland Clinic Website for more information.