Introduction

Night terrors are episodes of intense fear that are experienced when one is asleep. Due to a partial wakefulness state, the individual will have actual fear responses such as screaming, kicking, and an increased heart rate. Night terrors are caused by a flaw in the slow-wave sleep and an over-excitement of the central nervous system (CNS). They can be triggered by mental disorders, hereditary factors, and other health conditions. In most cases, they are experienced during childhood and early adolescence. The individuals with the disorder eventually grow out of them and never experience night terrors later in life. However, they can cause sleep disturbances that can lead to other complications, such as excessive daytime sleepiness, narcolepsy, and hypersomnia. They often do not require any treatment but in severe cases, they can be suppressed using medication that prevents the excitement of the CNS.

Symptoms

Night terrors mainly affect children between the ages of five and thirteen. They occur at night during a sleeping episode when one is asleep but partially awake. They are commonly experienced within the first two hours of falling asleep, a stage known as the slow-wave sleep. The individuals who experience night terrors have no memory of the occurrence when they awaken. It is difficult to wake the individual or calm them down during an episode of night terrors since they cause extreme fear. The disorder is associated with many panic reactions including:

  • Screaming
  • Extreme distress
  • Kicking
  • Mumbling
  • Rapid heartbeat
  • Increased blood pressure
  • Erratic movement
  • Sweating
  • Increased breathing rate

Other major symptoms of night terrors include:

1. Sleepwalking

Night terrors are commonly associated with sleepwalking whereby the individual walks and performs other activities while in the sleep state. The person is usually confused, disengaged, frigid, and unresponsive. It is also difficult to rouse the person from the sleepwalking state. People that experience sleepwalking will have little to no memory of the episode after waking up.

2. Excessive daytime sleepiness

Night terrors usually disrupt a person’s night time sleep. These sleep disturbances cause daytime fatigue and often individuals require naps during the day. A person who has excessive daytime sleepiness lacks energy and has poor concentration. Children with night terrors are highly affected by daytime sleepiness especially in school where concentration is required.

Causes of night terrors

1. Delay in CNS maturation

Most cases of night terrors are reported in children and young adolescents who, usually, outgrow the episodes and do not experience them when they are older. The occurrence of night terrors in childhood indicates that the CNS is not fully developed, and this causes faults in its awakening. Those with underdeveloped CNS, therefore, wakes up partially at night due to the faulty activation of the CNS.

2. Genetic factors

In many cases, the individuals who experience night terrors have a family history of the condition. The causal genetic factors that are inherited impair the development process of one’s CNS. This delayed development causes faults in the function of the CNS in childhood. The affected child, therefore, develops night terrors since their underdeveloped CNS is activated while asleep.

3. Irregular sleep schedules

A regular sleep schedule enables the person to sleep throughout the night and only wake up when they have had adequate sleep. Thus, irregular sleep schedules can contribute to night terrors since they can affect the normal sleep-wake cycles. One can wake up partially during the poorly defined sleeping episodes, thus experience vivid dreams which are terrifying and cause significant panic reactions.

4. Alcohol intoxication

Night terror cases in adults have been associated with the consumption of alcohol before going to sleep. Alcohol causes an individual to have vivid dreams, which are more colorful and intense. It also accelerates the onset of sleep because it is a sedative agent. However, it can also lead to stimulation and awakening at night. Thus, alcohol alters one’s sleep patterns and affects when they wake up naturally. Hence, when an alcoholic in an intense dreamful state awakens partially at night, they can experience night terrors.

5. Febrile illnesses (Fever)

Febrile illnesses have been commonly associated with cases of night terrors. Many individuals begin to experience night terrors when they have or are recovering from such illnesses. The illnesses cause a sudden rise in body temperature which can last between two and seven days. The persistent fever causes sleep fragmentation and reduces the total sleep time. The effects of elevated temperatures cause flaws in the awakening of an individual during the slow-wave sleep and, hence, they can lead to night terrors.

6. Psychopathological disorders

Night terrors experienced in adulthood can indicate the presence of a psychopathological disorder.  The common disorders associated with night terrors include:

  • Anxiety disorders
  • Depressive disorder
  • Schizophrenia
  • Dementia

Individuals with histories of psychopathological disorders have a higher risk of experiencing night terrors and sleepwalking episodes.

7. Medications

Some medications cause night terrors as a side effect. The medications associated with night terrors in adults normally act on the brain. They may signal the brain to be more active, thus causing partial arousal when asleep.  Some of the medications that cause night terrors include:

  • Antidepressants
  • Stimulants
  • Steroids
  • Narcotics
  • Blood pressure medications

Diagnosis

A doctor will gather information from the patient to diagnose night terrors. Most cases of night terrors are reported in children and, therefore, the parents or guardians provide the information needed for diagnosis. Parents or guardians, thus, must monitor their children and keep a record of their sleep habits to give the doctor useful information to enable proper diagnosis. The doctor uses this information to determine the seriousness of the night terrors. There are several methods that the doctor can use to diagnose night terrors. They include the following.

1. Sleep diary

A sleep diary is a recording of a person’s sleeping habits. It contains a lot of information about one’s sleep, including:

  • The condition of the sleeping environment
  • The sleep and wake times
  • The time taken to fall asleep
  • The length of naps during the day
  • Wake times during the night

This information is recorded for up to two weeks and is used by the doctor to diagnose the condition. A case of the night terrors can be confirmed if doctors find prolonged sleeping habits that are associated with the condition.

2. Polysomnography

Polysomnography is a nocturnal sleep study in which the individual undergoes overnight evaluation. The test checks for any breathing complications that may be disturbing a person’s sleep. These disturbances affect a person’s ability to remain asleep throughout the night. The individual is observed while asleep and a recording is kept on the physiological parameters that are related to sleep and wakefulness, including:

  • Brain activity
  • Blood oxygen levels
  • Heart rate
  • Eye movements
  • Respiratory rate
  • Muscle activity
  • Snoring
  • Body position

The data from the study can help doctors diagnose night terrors using the above symptoms that a patient may manifest.

3. Electroencephalography (EEG)

The EEG is a test used to measure a person’s brain activity when asleep. It is a device that is attached to the head using wires and takes measurements when one is asleep. A person who has night terrors shows a slow localized spike in brain wave activity when asleep. They have generalized bursts of high voltages accompanied by slow delta activity.  The spike in brain activity is caused by faulty CNS arousal during a sleeping episode.

4. Family history

Night terrors can be inherited genetically as has been found in many cases. The condition runs in families with genetics influencing their occurrences. The doctor, therefore, studies a person’s family history to determine whether there have been cases of night terrors within the family in the past. An individual whose family has a history of night terrors is at a higher risk of experiencing the condition. Genetic and environmental factors also interact and cause or worsen the occurrence of night terrors.

5. Reviewing the medical history

Underlying health conditions can cause sleep disturbances that lead to night terrors, especially in adults. The doctor reviews the individual’s medical history to identify any health conditions that can cause night terrors. Febrile illnesses are commonly associated with night terrors because they cause a significant increase in body temperature and can cause partial awakening during sleep. Likewise, psychopathological disorders such as anxiety disorders, depression, schizophrenia, and dementia can also lead to night terrors.

Treatment

Most cases of night terrors do not require any treatment because the condition resolves on its own. Children and young adolescents usually outgrow the condition and never experience the condition again. Treatment is, however, necessary when the night terrors disrupt one’s sleep or have a potential for injury. The treatment methods involve eliminating the triggers of the night terrors and protecting the individual from potential harm. The treatment options for night terrors include:

1. Treating the underlying health condition

When the night terrors are associated with an underlying medical or mental condition, the doctor prescribes medication for the causal condition. Eliminating or suppressing the underlying health condition reduces the occurrence of night terror episodes.

2 Medication

Night terrors are rarely treated using medication. However, when the condition disrupts one’s quality of life, doctors can prescribe several medications including:

a. Benzodiazepines

These are psychoactive drugs that act on the gamma-aminobutyric acid-A receptors. They depress the central nervous system and have a sedative effect. Benzodiazepines are used to manage night terrors because the condition is caused by the over-excitement of the CNS. They reduce the activity of the CNS, thus enabling the individual to sleep soundly without waking in the middle of the night. The common benzodiazepines available in the market include Xanax, Klonopin, Librium, Valium, Ativan, and Valium.

b. Tricyclic antidepressants

Tricyclic antidepressants are used to treat many health conditions, including clinical depression, anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder. Some tricyclic antidepressants exhibit a sedative mechanism that helps suppress the activity of the CNS when a person is asleep. The individual can sleep throughout the night without experiencing night terrors.

c. Serotonin Re-Uptake Inhibitors (SSRIs)

SSRIs are used to prevent the reuptake of the serotonin, which is responsible for excitement. They have also been found to improve an individual’s sleep quality. SSRIs are sometimes used together with trazodone, which improves sleep efficiency and decreases sleep onset latency. Improving sleep quality reduces the occurrence of night terrors.

3. Sleep supplements

Since the condition is caused by awakening during sleep, OTC sleep supplements like melatonin pills can help reduce its occurrence. Melatonin specifically strengthens the body’s sleep-wake cycles thus can prevent partial wakefulness during a sleeping episode. Melatonin is a natural ingredient that is also a hormone naturally occurring in our bodies.

4. Alternative treatment options for night terrors

 

a. Regular sleep schedule

Night terrors are commonly associated with sleep deprivation and irregular sleep schedules. Having a fixed sleep schedule can help alleviate the occurrence of night terrors and improve the individual’s sleep quality. When an individual follows a fixed sleep routine, the body gets accustomed to sleeping and waking at specific times, thus they do not wake up during non-wakeful periods.

b. Avoiding alcohol

Alcohol intoxication is associated with night terrors in adults. Avoiding alcohol before going to sleep can ensure that one sleeps without experiencing vivid dreams or potential partial awakening during dreams. Thus, not taking alcohol before bedtime is proper sleep hygiene that can also curb night terrors.

c. Support System

Most cases of night terrors occur in children and, therefore, parents and guardians should care for them. Family members should familiarize themselves with night terrors and learn how to take care of a young one when the episodes occur. They should comfort the affected child when the night terrors occur since the condition can cause overwhelming fear reactions. Further, they should ensure that the child cannot injure themselves during the panic reactions that come with night terrors. Hence, the child’s bedroom should be kept safe with no objects or hazards that can cause injury during an episode. The safety of the affected is very important when dealing with night terrors because the body movements are greatly increased while the person remains asleep. Lastly, the room should also be kept dark and quiet to prevent disturbances that may cause awakening and the onset of the condition.

Conclusion

Night terrors are terrifying experiences that occur when a person is asleep but partially awake. They cause significant fear responses, such as screaming, kicking, and squirming. Night terrors mainly occur during childhood and early adolescence. In most cases, the person outgrows them and never experiences them again later in life.

A family history of night terrors increases the risk of an individual getting the disorder. Genetic factors interact with the environmental factors leading to the expression of night terrors. Underlying health conditions also contribute to the occurrence of night terrors. The condition is diagnosed using the information on a person’s sleep habits and a review of their medical history.

Night terrors rarely require medication because the condition resolves on its own with time. It can, however, be managed using prescribed medication or OTC sleep supplements.

 

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