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3. Sleep Terrors

Sleep Terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic (Controlled by the part of the nervous system that regulates motor functions of the heart, lungs, etc.) and behavioral manifestations of intense fear. Also known as Pavor Nocturnus, incubus, severe autonomic discharge, night terror. 

What are the symptoms of Sleep Terrors?

  • A sudden episode of intense terror during sleep

  • The episodes usually occur within the first third of the night

  • Partial or total amnesia occurs for the events during the episode.

Associated features include:

  • Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep

  • Tachycardia usually occurs in association with the episodes.

  • Other medical disorders are not the cause of the episode, e.g., epilepsy

  • Other sleep disorders can be present, e.g., nightmares.

How serious are Sleep Terrors?

Some people have episodes of sleep terror that may occur less than once per month, and do not result in harm to the patient or others. While some people experience episodes less than once per week, and do not result in harm to the patient or others. In its severest form, the episodes occur almost nightly, or are associated with physical injury to the patient or others. Consult a sleep specialist if you are concerned.

Sleep Terrors are different from Nightmares see our section on Nightmares:

Nightmares

What are nightmares?

Nightmares are frightening dreams that usually awaken the sleeper from REM sleep. Nightmares have sometimes been referred to as dream anxiety attack, terrifying dream or REM nightmare. Nightmare is the preferred term and has been widely used to describe this condition for many years in the pediatric and adult literature. The reason the other terms have been suggested is to differentiate this phenomenon from sleep terrors (sometimes called stage 4 nightmares) on the assumption that nightmare was an overall lay term that covered the stage 4 as well as the REM sleep event. However, it is preferable to use the term nightmares for the REM phenomena, as they differ radically from sleep terrors.

What are the symptoms?

  • At least one episode of sudden awakening from sleep with intense fear, anxiety and feeling of impending harm

  • Immediate recall of the frightening dream

  • Alertness is full immediately upon waking with little confusion or disorientation

Associated features:

  • Return to sleep after the episode is delayed and not rapid

  • The episodes occur during the later half of the sleep period


Polysomnography (sleep recording) shows:

  • An abrupt awakening after at least 10 minutes of REM sleep

  • Mild tachycardia (rapid heart beat) and tachypnea (rapid breathing) during the episode

  • Absence of epilectic activity in association with the disorder

  • Other sleep disorders such as sleep terrors and sleepwalking can occur

Why it happens:

Night terrors are mysterious sleep disturbances that preschoolers and older children are occasionally subject to, always during the deepest part of non-dreaming sleep, usually within one to two hours of falling asleep. During a night terror — which can last anywhere from ten to 40 minutes — your child may bolt out of bed, thrash around and scream, or run wildly through the house. While his eyes may be wide open, he is not awake and will not be aware of your presence. Unlike with a nightmare, he will fall right back to sleep after the episode and have no memory of the incident the next morning. About 5 percent of all children will have an episode of night terrors.

What you can do about it:

  • Don't try to intervene in the middle of a night terror. Let your child scream it out, and unless he is in danger of hurting himself, don't try to physically restrain him. If you attempt to hold your terrified child it could lead to wilder behavior. Instead, speak calmly and place yourself between him and anything dangerous.

  • Before bed, take the same precautions you would for a sleepwalking child: Pick up any toys or other objects from the floor, fasten gates at the top of stairs, and lock all windows and doors leading outside.