Sleep terrors (night terrors)

Overview

Sleep terrors are times of screaming or crying, intense fear, and sometimes waving arms and legs when not fully awake. Also known as night terrors, sleep terrors may lead to sleepwalking. Like sleepwalking, sleep terrors are a type of parasomnia. Parasomnias are disturbing or strange behaviors or experiences during sleep. A sleep terror usually lasts from seconds to a few minutes, but it may last longer.

Sleep terrors may happen in children between the ages of 1 and 12 years. They happen much less often in adults. Although sleep terrors can be frightening to those around the person with sleep terrors, they aren't usually a cause for concern. Most children outgrow sleep terrors by their teenage years.

Sleep terrors may need treatment if they cause problems with getting enough sleep or cause a safety risk.

Symptoms

Sleep terrors differ from nightmares. A nightmare is a bad dream. The person who has a nightmare wakes up from the dream and may remember details. A person who has a sleep terror remains asleep. Children usually don't remember anything about their sleep terrors in the morning. Adults may recall part of a dream they had during the sleep terrors.

Sleep terrors generally happen in the first part of sleep time, and rarely during naps. A sleep terror may lead to sleepwalking.

During a sleep terror, a person may:

• Start by screaming, shouting or crying.
• Sit up in bed and look scared.
• Stare wide-eyed.
• Sweat, breathe heavily, and have a racing pulse, flushed face and enlarged pupils.
• Kick and thrash.
• Be hard to wake up and be confused if awakened.
• Not be comforted or soothed.
• Have no or little memory of the event the next morning.
• Possibly, get out of bed and run around the house or have aggressive behavior if blocked or held back.

When to see a doctor

Occasional sleep terrors aren't usually a cause for concern. If your child has sleep terrors, you can simply mention them at a routine well-child exam. But if you have concerns for you or your child, talk to your doctor or other healthcare professional sooner, especially if sleep terrors:

• Happen more often.
• Regularly disrupt the sleep of the person with sleep terrors or other family members.
• Lead to safety concerns or injury.
• Result in daytime symptoms of extreme sleepiness or problems with daily activities.
• Continue beyond the teen years or start as an adult.

Causes

Sleep terrors are a type of parasomnia. A parasomnia is a disturbing or strange behavior or experience during sleep. People who have sleep terrors don't completely wake up from sleep during the episodes. Their appearance may suggest they are awake, but they remain partially asleep.

Several issues can contribute to sleep terrors, such as:

• Serious lack of sleep and extreme tiredness.
• Stress.
• Sleep schedule changes, travel or sleep interruptions.
• Fever.

Sleep terrors sometimes can be triggered by conditions that interfere with sleep, such as:

• Sleep-disordered breathing — a group of disorders that include breathing patterns that are not typical during sleep. The most common type of sleep-disordered breathing is obstructive sleep apnea.
• Restless legs syndrome.
• Some medicines.
• Mood disorders, such as depression and anxiety.
• Alcohol use.

Risk factors

Sleep terrors are more common if family members have a history of sleep terrors or sleepwalking.

Complications

Some complications that may result from sleep terrors include:

• Being too sleepy during the day, which can lead to problems at school or work or with everyday tasks.
• Disturbed sleep.
• Embarrassment about the sleep terrors or problems with relationships.
• Injury to the person having a sleep terror or, rarely, to someone nearby.

Diagnosis

To diagnose sleep terrors, your doctor or other healthcare professional may:

• Talk about your medical history. Your healthcare professional will likely discuss your medical history. You may have a physical exam to identify any conditions that may be part of the reason for your sleep terrors. You may be asked about your family history of sleep problems.
• Talk about your symptoms. Sleep terrors are usually diagnosed based on your description of the events. The health professional also may ask you or your bed partner some questions about your sleep behaviors. A video of a sleep terror episode can be helpful.
• Recommend an overnight sleep study. In some cases, your health professional may recommend an overnight study in a sleep lab. Sensors placed on your body record and monitor brain waves, the oxygen level in your blood, heart rate and breathing during sleep. The sensors also record eye and leg movements while you sleep. You may be videotaped to document your behavior during sleep cycles.

Treatment

Treatment usually isn't needed for sleep terrors that happen rarely. Children typically outgrow sleep terrors.

Treatment may be needed if the sleep terrors cause a safety risk, interfere with sleep, don't go away with time or happen more often. Being embarrassed or disrupting the sleep of others may lead some people to seek treatment.

Treatment generally focuses on plans for safety and getting rid of causes or triggers for sleep terrors.

Treatment options may include:

• Treating any underlying condition. If the sleep terrors are linked with a medical or mental health condition or another sleep disorder, such as obstructive sleep apnea, treatment is aimed at the underlying problem.
• Addressing stress. If stress or anxiety seems to be part of the cause of the sleep terrors, your healthcare professional may suggest meeting with a sleep specialist. Cognitive behavioral therapy, hypnosis or relaxation therapy may help.
• Anticipatory awakening. This involves waking the person who has sleep terrors about 15 minutes before the person usually has the event. Then the person stays awake for a few minutes before falling asleep again.
• Medicine. Medicine is rarely used to treat sleep terrors, especially for children. But if needed, the healthcare professional may prescribe medicines that help with sleep, such as benzodiazepines or certain antidepressants.

Lifestyle and home remedies

If sleep terrors are a problem for you or your child, here are some tips:

• Get enough sleep. Extreme tiredness can contribute to sleep terrors. If you're not getting enough sleep, try an earlier bedtime and a more regular sleep schedule. Sometimes a short nap may help. If possible, avoid noises or other stimuli that could interrupt sleep.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities before bed. Read books, do puzzles or soak in a warm bath. Meditation or relaxation exercises may help too. Make the bedroom comfortable and quiet for sleep. Avoid caffeine close to bedtime.
• Make the area safe. To help prevent injury, close and lock all windows and outside doors at night. You might even lock inside doors or put alarms or bells on them. Block doorways or stairways with a gate. Move electrical cords or other objects that might be a tripping hazard. Don't use bunk beds, if possible. Place any sharp or fragile objects out of reach. Also, lock up all weapons.
• Put stress in its place. Identify the things that cause stress. Think of ways to handle the stress. If your child seems anxious or stressed, talk about what's bothering your child. A mental health professional can help.
• Offer comfort. If your child has a sleep terror, consider simply waiting it out. It may be upsetting to watch, but it won't harm your child. You might cuddle and gently soothe your child. Then try to get your child back into bed. Speak softly and calmly. Don't shout. Trying to wake your child or keep your child from moving may make things worse. Usually the event will shortly stop on its own.
• Look for a pattern. If your child has sleep terrors, keep a sleep diary. For a few weeks, note how many minutes after bedtime a sleep terror occurs. If the timing is fairly consistent, anticipatory awakenings may help.

Preparing for an appointment

Sleep terrors in children tend to go away by the time they're teenagers. But if you have concerns about safety or underlying conditions for you or your child, talk to your healthcare professional. Your health professional may refer you to a sleep specialist.

Keep a sleep diary for two weeks before the appointment. A sleep diary can help the healthcare professional understand more about the sleep schedule, issues that affect sleep and when sleep terrors happen. In the morning, record bedtime rituals, quality of sleep, and anything else you think is important. At the end of the day, record behaviors that may affect sleep, such as sleep schedule changes and any medicine taken.

You may want to take a family member or friend along, if possible, to provide more information.

What you can do

Before your appointment, make a list of:

• Any symptoms, including any that may not seem related to the reason for the appointment. Bring a sleep diary to the appointment, if possible. A video recording of the sleep terror can be helpful.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbs or other supplements being taken, and the doses.
• Questions to ask the healthcare professional to help make the most of your time together.

Some questions to ask include:

• What is likely causing these symptoms?
• What are other possible causes?
• What kinds of tests are needed?
• Is the condition likely to last a short time or a long time?
• What's the best course of action?
• What are other options to the primary actions you're suggesting?
• Do you recommend seeing a specialist?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor or other healthcare professional is likely to ask several questions, for example:

• When did the sleep terrors begin?
• How often do the sleep terrors occur?
• When during the night do the episodes occur?
• Can you describe a typical episode?
• Have there been sleep problems in the past?
• Does anyone else in your family have sleep problems?
• Have the episodes resulted in any injuries.

Be ready to answer questions so you have time to go over information you want to spend more time on.