Grouped alongside sleepwalking, night terrors are considered a parasomnia, which is an undesired occurrence during sleep. Night terrors – also referred to as sleep terrors – involve episodes of screaming and flailing while asleep, underpinned by intense fear.

Commonly mistaken for nightmares, night terrors are in fact very different. Night terrors occur during a different part of the sleep cycle to nightmares, making them very difficult to wake from, and almost always unremembered upon waking.

Much rarer among adults, night terrors most commonly affect children. While the actual number of those affected by night terrors is unknown, estimates range from 3% (1) to 15% (2) of children, and even as high at 40% (3). It is estimated around 2% of adults suffer from night terrors (4).

While they are not generally a cause for concern, sleep terrors can be extremely disturbing, both for those who experience them, and those who witness them. So, if you are affected by night terrors, what can you do to deal with them?

Whether you’re dealing with night terrors in a toddler, night terrors in children who are older, or night terrors in adults, in this guide, you can find out more about the signs and symptoms of night terrors, about what causes them, and what you can potentially do to prevent or relieve them.

WHAT ARE NIGHT TERRORS?

Lasting anywhere between a few seconds and a few minutes – and sometimes longer – night terrors occur when the sufferer seemingly wakes from sleep with an intense fear or feeling of foreboding. This may be accompanied by screaming, crying and thrashing around.

Someone experiencing a night terror may also get out of bed to walk or run around. Much like when sleep walking, the person who is experiencing the sleep terror remains in a sleep-like state, and can only be awoken with some difficulty.

After the night terror, the person experiencing it may fall back into REM or deep sleep, or may wake up to extreme confusion. Upon waking from a night terror, some may experience temporary amnesia, unable to remember their name or where they are. This usually passes within a few minutes.

Often misdiagnosed as nightmares, night terrors occur before the dream state of REM sleep, in the stage of deep sleep. This may be why night terrors are so difficult to wake from, and why – unlike nightmares – they typically don’t feature imagery.

Similarly, night terrors should not be confused with sleep paralysis. Unlike in sleep paralysis, where sufferers awake to a sense of terror and a temporary inability to move, those who suffer from night terrors only appear to be awake, and may flail around and cry out.

SIGNS OR SYMPTOMS OF NIGHT TERRORS

Due to their loud and seemingly violent nature, night terrors are easily detectable in most cases. Sleep terrors typically occur in the first third to first half of the night, and rarely occur during naps. During a night terror, the sufferer may:

• Suddenly sit upright in bed,
• Shout or scream in distress,
• Experience fast breathing and an accelerated heartbeat,
• Stare wide-eyed,
• Sweat,
• Thrash or flail around,
• Seem upset, scared or distressed,
• Get out of bed and walk or run around, to then act aggressively if blocked or restrained.

After the episode is over, the sufferer will usually calm down and return to sleep. Sufferers who wake from the night terror – or who are woken from it – may seem confused and disorientated.

WHAT CAUSES NIGHT TERRORS?

Sleep happens in stages. Night terrors happen during deep non-REM sleep. Unlike dreams – and nightmares – which occur during REM sleep, night terrors could be described as a sudden reaction of fear that happens during the transition from one sleep stage to another.

While in most people, sleep moves smoothly from the deepest stage of non-REM sleep to lighter REM sleep, those who experience night terrors may become upset or frightened, and that fear reaction is a night terror.

It is thought night terrors may be linked to genetics, so those with a family history of night terrors may also experience them. Sharing the same root causes as sleepwalking, night terrors may also be linked to head injuries, hyperthyroidism, encephalitis, stress, other sleep disorders such as obstructive sleep apnoea, fevers and the ingestion of certain medications.

As night terrors are caused by the over-arousal of the central nervous system during sleep, they may be exacerbated by the following:

• Sleep deprivation – or overtiredness in children,
• Sickness or fever,
• Stress,
• Certain medications,
• Sleep schedule disruptions, such as travel or sleep interruptions,
• Consuming too much caffeine or alcohol,
• For children, sleeping in a new environment, or away from home.

Underlying conditions that interfere with sleep may also trigger night terrors. These include, restless legs syndrome, and sleep-disordered breathing, such as sleep apnoea.

WHAT CAN YOU DO TO STOP NIGHT TERRORS?

While they may be distressing to watch, night terrors are not dangerous. It’s important not to try to wake the sufferer, but simply to remain with them until it passes. This can help to prevent them from potentially harming themselves, while also providing comfort.

If you are able to pinpoint the cause of night terrors, you may be able to prevent them by changing your routine or your habits. For children who suffer night terrors, you may want to:

• Create a bedtime routine that’s simple and relaxing,
• Make sure your child isn’t stressed,
• Help your child from becoming overtired,
• Prevent your child staying up too late.

For those who have children who have a night terror around the same time each night, it may be helpful to wake the child 15-30 minutes before then, to see if that prevents it.

In most children, night terrors pass before their teen years. If the problem persists, or if experienced by an adult, it may be worthwhile to consult a doctor. This may also be recommended if night terrors are affecting day-to-day life, and the quality of sleep experienced.

An overnight sleep study, called a polysomnogram may be advised, which could help to determine any other sleep-related factors that may be contributing to the night terrors, and how they can be limited.

SOURCES

1. https://kidshealth.org/en/parents/terrors.html
2. https://www.sleepassociation.org/sleep-disorders/night-terrors/
3. https://www.mayoclinic.org/diseases-conditions/sleep-terrors/symptoms-causes/syc-20353524