Sleep Terrors

Overview

Sleep terrors, also known as night terrors, are episodes of intense fear, screaming, and flailing that occur while a person is still asleep. They are classified as a parasomnia, an undesirable behavior or experience during sleep. Sleep terrors are usually paired with sleepwalking and happen during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. They can be triggered by various factors such as sleep deprivation, stress, and certain medications or underlying sleep disorders like sleep-disordered breathing or restless legs syndrome. Sleep terrors are more common in children, and most children outgrow them by their teenage years. If sleep terrors cause problems with sleep or pose a safety risk, they may require treatment.

Understanding the disease

Symptoms

The symptoms of sleep terrors may include:

1. Frightening screams or shouts
2. Sudden sitting up in bed and appearing frightened
3. Staring wide-eyed
4. Sweating, heavy breathing, rapid heart rate, flushed face, and dilated pupils
5. Kicking and thrashing
6. Being difficult to awaken and being confused if awakened
7. Being inconsolable
8. No or little memory of the event the next morning Sleep terrors differ from nightmares in that the person remains asleep during an episode and usually doesn't remember anything in the morning. They generally occur during the first third to first half of the night and can lead to sleepwalking.

Risk Factors

Risk factors for developing sleep terrors include sleep deprivation and extreme tiredness, stress, sleep schedule disruptions, travel, or sleep interruptions, fever, and underlying conditions that interfere with sleep such as sleep-disordered breathing, restless legs syndrome, or mood disorders like depression and anxiety. Having a family history of sleep parasomnias, such as talking during sleep, may also increase the likelihood of experiencing sleep terrors.

Development

Sleep terrors develop as a result of various factors, including sleep deprivation, extreme tiredness, stress, sleep schedule disruptions, travel, or sleep interruptions. They are classified as a parasomnia, which is an undesirable behavior or experience during sleep. Sleep terrors occur during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Other NREM disorders, such as sleepwalking, can occur together with sleep terrors. Some underlying conditions that interfere with sleep, such as sleep-disordered breathing, restless legs syndrome, certain medications, mood disorders like depression and anxiety, may also trigger sleep terrors. If sleep terrors cause problems getting enough sleep or pose a safety risk, they may require treatment.

Assessment and Diagnosis

Triage

You should consult a doctor if sleep terrors:

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

Diagnosis

To diagnose sleep terrors, your doctor will typically review your medical history and symptoms. The evaluation may include a physical exam to identify any contributing factors or underlying conditions, discussing your sleep behaviors and family history of sleep problems, and possibly filling out a questionnaire about your sleep patterns. In some cases, your doctor may also recommend a nocturnal sleep study (polysomnography) to monitor your sleep patterns and behaviors during an overnight stay in a sleep lab.

Management and Treatment

Complications

The potential complications of sleep terrors may include:

1. Excessive daytime sleepiness: Sleep terrors can lead to disturbed sleep and lead to excessive daytime sleepiness, which can cause difficulties at school, work, or in performing everyday tasks.
2. Disturbed sleep: The frequent occurrence of sleep terrors can disrupt the overall quality and duration of sleep, which can further exacerbate daytime sleepiness and adverse effects on overall well-being.
3. Embarrassment and relationship problems: Individuals experiencing sleep terrors may feel embarrassed or self-conscious about their condition, leading to potential problems in their personal relationships or social interactions.
4. Injury to oneself or others: During a sleep terror episode, a person may thrash around, flail their arms, or get up and walk around, potentially causing harm to themselves or others nearby. It is important to seek treatment if sleep terrors are causing significant disturbances in sleep, daytime functioning, or posing a safety risk. Consult with a healthcare professional for appropriate guidance and management.

Treatment

Treatments for sleep terrors primarily focus on addressing underlying causes and promoting good sleep hygiene. There are several strategies you can try to manage sleep terrors:

1. Good sleep hygiene: Ensure the person gets enough sleep and maintains a consistent sleep schedule. Create a relaxing bedtime routine to signal to the brain that it's time for sleep.
2. Comforting environment: Keep the sleep environment quiet, cool, and dark. Use comfortable bedding and pillows to promote a relaxing atmosphere.
3. Relaxation techniques: Encourage relaxation techniques such as deep breathing exercises, progressive muscle relaxation, or guided imagery to help reduce stress and promote relaxation before sleep.
4. Address underlying conditions: If there are underlying conditions contributing to sleep terrors, such as sleep-disordered breathing or restless legs syndrome, treating those conditions can help alleviate sleep terrors.
5. Medications: In some cases, medications may be prescribed to address underlying conditions or help manage symptoms. Consult a healthcare professional to determine the most appropriate medications for the individual.
6. Sleep monitoring: In some cases, a sleep study (polysomnography) may be recommended to assess sleep patterns and identify any underlying sleep disorders. It is essential to consult a healthcare professional if sleep terrors cause problems getting enough sleep, pose a safety risk, or continue beyond the teenage years. They can provide personalized advice and recommend appropriate treatments.

Preparing for medical consultation

To prepare for an appointment for sleep terrors, you can do the following:

1. Keep a sleep diary: For two weeks before the appointment, keep a sleep diary to record your sleep schedule, bedtime rituals, quality of sleep, and factors that may affect your sleep, such as sleep schedule disruptions and any medications taken.
2. Gather information: Make a list of any symptoms you have experienced, including those that may seem unrelated to sleep terrors. Also, gather information about your family history of sleep problems, any major stresses or recent life changes, and a list of all medications, vitamins, herbs, or other supplements you are taking and their dosages.
3. Bring a family member or friend: Consider bringing a family member or friend along to the appointment to provide additional information and support.
4. Prepare questions: Make a list of questions to ask your doctor during the appointment, such as the likely causes of sleep terrors, other possible causes, what tests may be needed, and the best course of action.
5. Be ready to discuss your symptoms: Be prepared to share details about when the sleep terrors began, how often they occur, and if there have been any past sleep problems. By being well-prepared, you can make the most of your appointment and work with your doctor to find the best course of action for managing your sleep terrors.