Sleep terror disorder



Sleep Terror Disorder 859
Photo by: Scott Griessel

Definition

Sleep terror disorder is defined as repeated temporary arousal from sleep, during which the affected person appears and acts extremely frightened.

Description

Sleep terror disorder is sometimes referred to as pavor nocturnus when it occurs in children, and incubus when it occurs in adults. Sleep terrors are also sometimes called night terrors, though sleep terror is the preferred term, as episodes can occur during daytime naps as well as at night. Sleep terror is a disorder that primarily affects children, although a small number of adults are affected as well.

Causes and symptoms

Causes

The causes of sleep terror are for the most part unknown. Some researchers suggest that sleep terrors are caused by a delay in the maturation of the child's central nervous system. Such factors as sleep deprivation, psychological stress , and fever may also trigger episodes of sleep terror.

Symptoms

The symptoms of sleep terror are very similar to the physical symptoms of extreme fear. These include rapid heartbeat, sweating, and rapid breathing (hyperventilation). The heart rate can increase up to two to four times the person's regular rate. Sleep terrors cause people to be jolted into motion, often sitting up suddenly in bed. People sometimes scream or cry. The person's facial expression may be fearful.

People experiencing sleep terror disorder sometimes get out of bed and act as if they are fighting or fleeing something. During this time injuries can occur. Cases have been reported of people falling out of windows or falling down stairs during episodes of sleep terror.

People experiencing sleep terror are not fully awake. They are nearly impossible to bring to consciousness or comfort, and sometimes respond violently to attempts to console or restrain them. In many cases, once the episode is over the person returns to sleep without ever waking fully. People often do not have any recollection of the episode after later awaking normally, although they may recall a sense of fear.

Episodes of sleep terror usually occur during the first third of a person's night sleep, although they can occur even during naps taken in the daytime. The average sleep terror episode lasts less than 15 minutes. Usually only one episode occurs per night, but in some cases terror episodes occur in clusters. It is unusual for a person to have many episodes in a single night, although upwards of 40 have been reported. Most persons with the disorder have only one occurrence per week, or just a few per month.

Demographics

Sleep terror disorder is much more common in children than it is in adults. It is estimated that approximately 1%–6% of children in the United States experience sleep terror at some point in their childhood. For most children, sleep terrors begin between the ages of four and 12. The problem usually disappears during adolescence. Sleep terror disorder appears to be more common in boys than in girls; some studies have reported that preadolescent boys are the group most commonly affected. No figures are available for the rates of the disorder in different racial or ethnic groups. Sleep terrors in children are not associated with any psychological disorders.

Fewer than 1% of adults have sleep terror disorder. For most adults, sleep terrors begin in their 20s or 30s, although it is possible for someone to suffer from episodes of sleep terror from childhood onward. In the adult population, sleep terrors affect both sexes equally. They are, however, often associated with psychological disorders, most commonly anxiety, personality, or post-traumatic disorders. People who have a family history of sleep terrors or sleepwalking disorder are about 10 times more likely to develop sleep terror disorder than those who do not.

Diagnosis

Sleep terror is diagnosed most often in children when parents express concern to the child's pediatrician. A fact sheet from the American Academy of Child and Adolescent Psychiatry suggests that parents consult a child psychiatrist if the child has several episodes of sleep terror each night, if the episodes occur every night for weeks at a time, or if they interfere with the child's daytime activities. The diagnosis is usually made on the basis of the child's and parents' description of the symptoms. There are no laboratory tests for sleep terror disorder. In adults, the disorder is usually self-reported to the patient's family doctor. Again, the diagnosis is usually based on the patient's description of the symptoms.

Sleep terror is characterized by an abrupt arousal from sleep followed by symptoms of extreme fear. The symptoms often include screams, rapid heartbeat, heavy breathing, and sweating, as well as a subjective feeling of terror. According to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision ( DSM-IV-TR ), which is the standard reference work used by mental health professionals to diagnose mental disorders, people with sleep terror disorder do not respond to attempts to comfort or awaken them. In order to meet criteria for the diagnosis, the patients must not be able to recall their dreams, and they must not remember the episode itself. In addition, the episodes may not be attributed to a medical condition or drug use.

Sleep terror disorder is frequently confused with nightmare disorder . The two are similar in the sense that both are related to bad dreams. Nightmare disorder, however, involves a significantly smaller amount of physical movement than does sleep terror. Normally, people experiencing nightmare disorder do not get out of bed.

Moreover, people experiencing nightmare disorder often have problems going back to sleep because of the nature of their dream. Most people experiencing sleep terrors, however, go back to deep sleep without ever having fully awakened. People experiencing nightmares can generally remember their dreams and some of the events in the dream leading up to their awakening. People often awake from nightmares just as they are about to experience the most frightening part of a disturbing dream. People experiencing sleep terrors, however, can sometimes recall a sense of profound fear, but often do not remember the episode at all.

Treatments

If sleep terror episodes are infrequent, then treatment may not be necessary as long as the episodes are not interfering significantly with the person's life. Some people may want to rearrange their bedroom furniture to minimize the possibility of hurting themselves or others if they get out of bed during a sleep terror episode. To keep children from becoming overly worried about their sleep terrors, experts suggest that parents avoid placing unnecessary emphasis on the episodes. Psychotherapy is often helpful for adults concerned about the specific triggers of sleep terror episodes.

Several different medications have been used to treat sleep terror disorder, with varying degrees of success. One of the most common is diazepam (Valium). Diazepam is a hypnotic (sleep-inducing medication), and is thought to be useful in the prevention of sleep terror episodes because it acts as a nervous system depressant. There are many different types of hypnotics, and choosing one for a patient depends on other drugs that the patient may be taking, any medical or psychological conditions, and other health factors. Most studies of medications as treatments for sleep terror disorder have been done on adult patients; there is little information available on the use of medications to treat the disorder in children.

Prognosis

In most children, sleep terror disorder resolves before or during adolescence without any treatment. Adults often respond well to diazepam or another hypnotic. Psychotherapy and avoidance of stressors that may precipitate terror episodes may be helpful as well. Episodes of sleep terrors often decrease with age. This decrease is due to the fact that the amount of slow-wave sleep, which is the sleep phase during which terror episodes usually occur, declines with age.

Resources

BOOKS

Aldrich, Michael S. Sleep Medicines. New York: Oxford University Press,1999.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revised. Washington DC: American Psychiatric Association, 2000.

Chokroverty, Susan, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston: Butterworth-Heinemann, 1999.

Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.

Thorpy, Michael J, ed. Handbook of Sleep Disorders. New York: Marcel Dekker Inc., 1990.

PERIODICALS

Owens, Judith A., Richard P. Millman, Anthony Spirito. "Sleep Terrors in a 5-Year-Old Girl." Pediatrics & Adolescent Medicine 153, no. 3 (March 1999).

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. <www.aacap.org> .

American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. (507) 287-6006. <www.asda.org> .

OTHER

American Academy of Child & Adolescent Psychiatry (AACAP). "Children's Sleep Problems." AACAP Facts For Families Pamphlet #34. Washington, DC: American Academy of Child & Adolescent Psychiatry, 2000.

Tish Davidson, A.M.



User Contributions:

Anuska
Report this comment as inappropriate
Jul 24, 2007 @ 7:07 am
My son who is two and a half years suddenly wakes and screams blue murder. He seems to be in a dream state with a glazed look in his eyes, but seems to be awake though. He asks for things like tea and milk or sometimes he needs to use the toilet. As a mother i am most concerned about this and hope that it will settle down. What can i do to minimise this. He has one or two episodes every night and they seem to last longer and longer each time. sometimes he falls asleep and sometimes it lasts for hours. It occurs at more or less the same time, between 1 and 2a.m every night. Is he watching too much TV and can scary movies make this worse. He insists on watching movies that contain a few violent episodes. Please help me, im desperate!
Karen
Report this comment as inappropriate
Jun 20, 2008 @ 11:23 pm
My son is 8 years old. He was sick with chickenpox. During the chickenpox he had a high fever and would come downstairs (after being in bed asleep for one hour), in a panic but not fully awake. He would say his tongue hurt from pins and needles and he was sweating but cold and his heart is racing. He would calm down after about 5 minutes then go back to bed and sleep though the night. The chickenpox are gone and now and he still comes downstairs in a panic (still not really awake)and is scared, you can see the fear and his heart racing and then he calms down in about 5 minutes and then we put him back to bed and he sleeps though the rest of the night. This happens about every two days. He wakes in the morning and does not remember getting out of his bed the night before or what scared him. He never had this before the chickenpox and I was wondering if the chickenpox might have triggered the sleep terrors and will they disappear or need to be treated? I am worried.
Kelley Jensen
Report this comment as inappropriate
Jun 23, 2008 @ 7:19 pm
My husband and I are confused about whether or not our daughter is having night- terrors. Our daughter seems to follow some of the symptoms such as, waking histerically and doing so usually about 1/2 hour to an hour or later after falling asleep. All my kids were like this from infancy through their toddler years, but I sometimes think its stomach cramps from gas or something. It is very hard to decipher because all three of my children have had collic symptoms (gas and constipation as infants). My daughter is 2 1/2 years old with two older brothers 7 and 6. Her 6 yr. old brother has had night- terrors to the degree of running through our house at night screaming. My husband and I also have a family history of sleep disorders including night- terrors and sleepwalking, so I know my daughter is predisposed. When my daughter wakes up at night she is unconsoleable and screaming hysterically. It sounds like she is screaming "help me" and "hold me", but when I try to comfort her she pulls my hair, kicks me, and seems stuck in a state of hysteria. My husband and I are conflicted on how to handle her like this. I just endure her screaming as I try to figure out how to calm her down. My husband treats it more as a behavior and demands her to stop screaming and removes her from our bed. Once removed and out of our room, my husband sternly demands that she calm down if she is to return to our bed. As harsh as this sounds it is the only thing that seems to snap her out of it. My tactics to sing to her and hold her only seem to get her more aggressive, more upset, and more stuck. We're very confused especially because sometimes our daughters actions during these episodes seem deliberate and conscious. However, my insticts tell me they are nigh-terrors and driven by something out of her control. To complicate matters her older brothers both have special needs (ADHD with OCD tendencies), so she may have some of there traits.
We are loving parents and want to do what is best for our daughter. Please give us any feedback to help us better understand what is happing to our daughter, so we can handle it the right way. Is she having night-terrors?
chaoco
Report this comment as inappropriate
May 30, 2010 @ 2:02 am
This disease can become persistent with chronic schizophrenia and therefore debilitating.
Ambien does a wonderful job of stopping these sleep panic attacks also known as sleep terror disorder, but only work for about four or five hours during a night. I have schizophrenia with auditory and visual hallucinations and the characters that live unilateral to me inside of my head whom cause these hallucinations also cause my sleep terror disorder. Also, I leave the television on while asleep and it changes the dreams I have to follow what is on the tv, but the insane dreams I do have if I run out of ambien are very stong and annoying they cause me to wake up or remain in a constant dream that lasts all night and I do not actually get any sleep unless I take the full doesgae of ten mg Ambien, if I take this medication and stay awake as the neurotransmitters in my brain are so active sleeping pills only make me slightly tired for about thirty minutes, if I do stay awake the voices in my head fall asleep themselves and only respond to things that I say to them ad do not create so many hallucinations and do not respond as often, but they are still slightly awake and cause persistent sexual arousal disorder. I am allergic to seroquel and it causes me to remain awake and feel as though I am on fire and am also freezing and also cause serious neurological problems drive me more insane than the schizophrenia does all day. If they could develop a hypnotic sedative I can take during the day that does not cause outward visual hallcuinations such as the wood grain on a wall becoming people and they make out and they rowboat and do all sorts of crazy crap that would be the greatest medicine I have ever taken, as the Ambien is effective for my schizophrenia up to like seventy five percent, rather than the highest does of Lithium only like ten to twenty percent effective then you could get rid of the words, schizophrenia medication is effective in twentyfive percent of cases and change it to seventy five percent effective, also hypertension drugs stop a lot of postural hypertension and can lessen any anger you will have towards the schizophrenia (skitzophrenia) bacteria, outdated dna, brain damage, drug use, multiple personalities (meeps), child trauma protector personalities (now jackasses), disassociative amneisa causing, or whatever else they will say schizophrenia is caused by problems. PLEASE DEVELOP A HYPNOTIC SEDATIVE I CAN TAKE DURING THE DAY TIME THAT DOES NOT CAUSE HALLUCINATIONS AND MAKES THE SCHIZOPHRENIA FALL ASLEEP SCIENTISTS WHO WILL READ THIS YEARS FROM NOW.
Report this comment as inappropriate
Jun 21, 2010 @ 12:00 am
My 7 year old son has generally 3-5 of these a night. His therapist telling me that this is quite common amongst children who have ADHD or ADD. She is telling me that often times this is another way of ADHD manifesting itself. Whether I believe that or not I am not quite sure of yet. He wakes up within the first 3 hours of sleeping running through the house screaming, as if life itself is about to end. A fear that is indescribable. He used to have these episodes and for about 2 months he stopped and not a one of them. Now again began them a couple of weeks ago. For those who truly do have sleep terrors this is scary to watch your child go through this. We see the psychiatrist this week and we'll see what she has to say.
DEDE
Report this comment as inappropriate
Sep 3, 2010 @ 8:20 pm
I hope I can help someone out there, my son had sleep terror when he was 2.5 years old, it was crazy, I found the solution in one of my sleep books and it worked. you need to shift the child's bead time by half an hour, he needs more sleep and more regular sleep, mine was regular but that extra half an hour helped and the episodes disappeared, the other component is sweets, for us it happened around Halloween when they started to give out treats to the kids on daily bases. For us a rule is no sugar for the kids, if any then monitored.
D.
david
Report this comment as inappropriate
Feb 2, 2012 @ 6:18 pm
my son whos is five year old wakes up in a state of terror most nights usually in the first hour of sleep sometimes the episodes are so bad , his heart racing the fear in his eyes .he dos not
recognize anyone when hes in this state. its making me scared incase he hurts himself . it last about 10 to 15 min then he gos back to bed and is sleeping within 5 secs he has no recollection of this in morning at the begining when they started they were 1 every 2 weeks now it mostly everynite . the terror varys from nite to nite . hes a normal child, no social disfuntions or anything that would make him scared or worried hes a very happy child during the day with no indication anything has happened .
Amanda
Report this comment as inappropriate
Aug 13, 2012 @ 12:12 pm
Night terrors are the most frightening thing in the world they normally only happen to me when I'm very stressed out or going thru something hard to cope with I'll fall a sleep and spring up screaming and jump out of bed yelling someone's in the room and try and turn on the light sometimes I won't remember but at times when they're really bad I will they started to scare my boyfriend so I would let him go to sleep first and try and stay up because I felt bad and didn't want to freak him out later I talked to mom and I guess she has the same issue and it also only happens when she's really stressed out I would say if a loved one is having these just make sure to try and calm them and if they say they see something just act like you saw it bc my boyfriend says I get upset if he said he didn't see it
Raccinia
Report this comment as inappropriate
Aug 14, 2012 @ 4:04 am
I am a 32 year old female.For the past 2 1/2 weeks I wake up after 2 to 3 hrs of sleep sweating heart racing and jumping out of bed.the only thing thing different was I had a mirena iud with hormone removed 22 days ago. Before this this this has never happened to me.Dr.s dont seem to know why and say snxiety.i neef to lnoe whats wrong witj me im going crazy and can't sleep.
Robyn
Report this comment as inappropriate
Aug 16, 2013 @ 8:08 am
My Daughter has suffered regular Night Terrors from the age of 3.5yrs, we have a diagnosis of Aspergiers however just enough to qualify, wharever that means because honestly id be glad to hand it back and have some "normalacy" if it exists. I have seen her Night/sleep Terrors go through waves sometimes we get 5 aweek or on good weeks just 1 or 2, the Dr gave us Catapres but somehow I think it needs a reveiw, some people and information Ive read has made me attempt some forms of intervention, but honestly just ake sure your child is safe and secure when having them and they wont remember a thing in the morning. I believe that Anxiety is a huge contributor to sleep distrubances.
Chris
Report this comment as inappropriate
Apr 22, 2014 @ 5:05 am
My 3 1/2 year old son has been having long crying fits in his sleep, tossing and turning and sometimes sitting up. He will be stop for a few mins then start whining in his sleep and then start crying again, some times saying jibberish. This will go on and off again every couple hours some times. I can't wake him up or comfort him in any way, it's heartbreaking. Has any one experienced this?

Comment about this article, ask questions, or add new information about this topic:

CAPTCHA