What is a Night Terror?

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A night terror, also called a sleep terror, is a type of parasomnia. Parasomnias are sleep disorders where unwanted physical events occur during sleep (1). Other parasomnias include sleepwalking, sleep talking, and sleep paralysis.

What Happens During a Night Terror?

During a night terror, the sleeper remains asleep but may sit up with their eyes open (2). The sleeper may scream, shout, or flail, and they appear afraid. Some sleepers might get out of bed and attempt to leave the room (3) through a window or door. When awakened, the sleeper often feels confused and disoriented. Sleepers, especially children, rarely remember the night terror events. Occasionally, sleepers experiencing a night terror move objects in the home. In some cases, the sleeper may injure themselves or others.

Night terrors tend to occur during non-REM sleep, in the first half of the night. Non-REM sleep includes stages 1, 2, and 3 of sleep (4). Night terrors most commonly occur when the sleeper is aroused shortly after falling asleep (5) or when they’ve been awakened from stage 3 sleep, the deepest stage. Night terrors typically last between 30 seconds and five minutes.

Causes of Night Terrors

While the exact causes of night terrors are unknown, several factors are common among sleepers who experience night terrors. Stress, lack of sleep, certain medications, noise, or a fever can worsen night terrors (6). Sleep disorders such as sleep apnea or restless legs syndrome contribute to poor sleep, which may increase the possibility of night terrors.

Genetics also affect the likelihood of experiencing night terrors. Sleepers are more likely (7) to experience sleep terrors if they have close family members with a history of this parasomnia.

What is the Difference Between a Night Terror and a Nightmare?

The simple difference between a night terror and a nightmare is that a nightmare is a bad dream (8) that typically occurs in the second half of the night. Daytime stresses such as a new routine or a major life change can contribute to nightmares. While nightmares can make the sleeper experience feelings of anxiety, fear, distress, or terror, these feelings are not acted out physically. If you have nightmares, you probably dream of something frightening. The frightening image often wakes you, and you might even remember it upon waking.

Night terrors, on the other hand, do not necessarily coincide with sequenced images the way nightmares and dreams do. To others watching you have a night terror, it may appear as if you are acting out a dream. You might punch, kick, scream, or show other signs of fear. Some people who experience night terrors may get out of bed and attempt to run for safety, all while still asleep. However, when people who experience night terrors wake up, they typically do not remember the events of the night or what caused them.

Night Terrors in Children

Night terrors are common among children. Up to 56% of all children (9) experience a night terror at least once before age 13. Toddlers who are 1.5 years old most commonly have night terrors, with more than 34% experiencing a night terror at least once. Nearly one-third of children who experience night terrors also sleepwalk later in childhood.

Children who experience night terrors do not recall the incidents. They also should not experience adverse psychological effects because of night terrors. Often, night terrors happening to a child are more frightening to their parents because the child appears so distressed.

During a night terror, parents should avoid waking their child. Disrupting the night terror can frighten or cause more confusion for the child. When the child wakes, parents can reassure the child that they are present and ready to provide support.

Parents can protect their child by keeping the sleep environment free of hazards (10). They can clear the bedroom floor of objects, lock windows, and set the mattress on the floor. Parents can also increase sleep time overall to ensure their child gets an adequate amount of sleep, even if a night terror occurs.

If night terrors persist in the child, pediatricians can assist parents in several ways. One recommendation is for parents to keep a sleep diary or record of night terrors for their children, so they know approximately what time the events occur. Then, they can wake the child before the predicted time the night terror will occur. These scheduled awakenings are decreased over time.

Older children whose daytime activities are affected by the night terrors may be prescribed short-term benzodiazepines. These are anti-anxiety drugs that induce sleep and help decrease the likelihood of night terrors.

Often, as children grow, night terrors naturally stop occurring. Studies show that only 4% of all parasomnias, including night terrors and sleepwalking, continue after adolescence.

Night Terrors in Adults

Night terrors occur for about 2.2% of adults. Like children, adults are unlikely to remember the events of the night terror. However, night terrors can be disruptive to your sleep, and to the sleep of your partner if you share the bed.

What to Do if You Experience Night Terrors

If you experience night terrors frequently, consult your doctor. There are various approaches to preventing night terrors. Some treatments include prescription medications, such as antidepressants or sleeping pills. Cognitive behavioral therapy may also help address any underlying anxiety or stress that could be triggering the night terrors.

Make your sleep environment safer by locking up or removing any weapons or dangerous objects from the home. Put bedside lamps out of reach and keep bedside water in a plastic cup or bottle. Childproof locks or an alarm system can also help keep you safe.

Additionally, it’s beneficial to pay close attention to your sleep hygiene. Avoid drug and alcohol use, as these substances can exacerbate night terrors. Keep a regular sleep schedule and create a comfortable sleep environment (11). With assistance from your doctor and improvements to your sleep habits, you can reduce the occurrences of night terrors.

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