Sleep terrors (night terrors) – Symptoms and causes

Overview

Sleep terrors are episodes of screaming, intense fear and flailing while still asleep. Also known as night terrors, sleep terrors often are paired with sleepwalking. Like sleepwalking, sleep terrors are considered a parasomnia — an undesired occurrence during sleep. A sleep terror episode usually lasts from seconds to a few minutes, but episodes may last longer.

Sleep terrors affect almost 40 percent of children and a much smaller percentage of adults. However frightening, sleep terrors aren’t usually a cause for concern. Most children outgrow sleep terrors by their teenage years.

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

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Symptoms

Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don’t remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors.

Sleep terrors generally occur in the first third to first half of the night, and rarely during naps. A sleep terror may lead to sleepwalking.

During a sleep terror episode, a person may:

• Begin with a frightening scream or shout
• Sit up in bed and appear frightened
• Stare wide-eyed
• Sweat, breathe heavily, and have a racing pulse, flushed face and dilated pupils
• Kick and thrash
• Be hard to awaken, and be confused if awakened
• Be inconsolable
• 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 restrained

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. However, consult your doctor if sleep terrors:

• Become more frequent
• Routinely disrupt the sleep of the person with sleep terrors or other family members
• Lead to safety concerns or injury
• Result in daytime symptoms of excessive sleepiness or problems functioning
• Continue beyond the teen years or start in adulthood

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Causes

Sleep terrors are classified as a parasomnia — an undesirable behavior or experience during sleep. Sleep terrors are a disorder of arousal, meaning they occur during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleepwalking, which can occur together with sleep terrors.

Various factors can contribute to sleep terrors, such as:

• Sleep deprivation and extreme tiredness
• Stress
• Sleep schedule disruptions, travel or sleep interruptions
• Fever

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

• Sleep-disordered breathing — a group of disorders that include abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea
• Restless legs syndrome
• Some medications
• Mood disorders, such as depression and anxiety
• In adults, alcohol use

Risk factors

Sleep terrors are more common if family members have a history of sleep terrors or sleepwalking. In children, sleep terrors are more common in females.

Complications

Some complications that may result from experiencing sleep terrors include:

• Excessive daytime sleepiness, which can lead to difficulties at school or work, or problems with everyday tasks
• Disturbed sleep
• Embarrassment about the sleep terrors or problems with relationships
• Injury to oneself or rarely to someone nearby