Night Terrors
Night terrors are episodes of screaming and intense fear during the deep sleep phase. They are common in children and usually disappear when they reach adolescence.
Symptoms and Causes
Night terrors are a type of sleep disorder that causes intense fear, screaming, and physical agitation during deep sleep (non-REM phase). Once the patient wakes up, they usually do not remember the trigger. Although they are often confused, they are not the same as nightmares, which occur during the REM phase and are remembered in detail.
The duration of the episodes varies, as night terrors may last only a few seconds or continue for several minutes. Although they may occur in adults, they are more common in babies and children and usually disappear upon reaching adolescence.
Night terrors are distressing, but they do not pose a risk to the physical or mental health of the person affected. Since they stop occurring over time, treatment is usually unnecessary unless they prevent sufficient sleep or the agitation is severe enough to endanger the patient’s safety.
Symptoms
Night terrors present the following signs during sleep, usually two or three hours after falling asleep:
- Screaming or crying.
- Sitting up in bed.
- Displaying signs of fear.
- Staring with wide-open eyes and dilated pupils.
- Sweating.
- Flushed face.
- Difficulty breathing.
- Rapid pulse.
- Hitting and kicking.
- Getting out of bed.
- Running around the house.
- Displaying aggression.
- Being inconsolable.
Patients with night terrors are unaware that someone is trying to help them, as they either remain asleep or wake up disoriented. Shortly afterward, they fall back asleep and, in the case of children, wake up the next morning without remembering what happened. Adults, on the other hand, usually retain a slight memory of the dream that triggered the night terror.
Isolated episodes are not concerning, but consultation with a specialist is recommended in the following cases:
- Episodes recur frequently, repeatedly interrupting the patient’s sleep or that of family members.
- The physical response results in injuries.
- Excessive daytime sleepiness occurs due to insufficient rest.
- Episodes persist after puberty.
- Episodes occur during adulthood.
Causes
The exact cause of night terrors is unknown, although it may be related to brain immaturity during childhood.
Risk Factors
The risk of experiencing night terrors increases when one or more of the following factors are present:
- Age: episodes are more common between 3 and 7 years of age.
- Family history, since this type of parasomnia is often hereditary.
- Sleep deprivation.
- Changes in sleep habits.
- Travel, especially involving time zone changes.
- Fever.
- Excessive fatigue.
- Emotional tension: stress, anxiety, conflicts with other people, moving house, sleeping away from home.
- Obstructive sleep apnea: breathing repeatedly stops for a few seconds or even minutes during sleep.
- Restless legs syndrome: a neurological disorder that causes an irresistible urge to move the legs due to a tingling or itching sensation that worsens during rest or sleep.
- Excessive alcohol or caffeine consumption.
- Certain medications: drugs that affect the central nervous system may contribute to night terrors. In general, antidepressants, beta-blockers, or treatments for Parkinson’s disease.
Complications
Night terrors may lead to the following complications:
- Excessive daytime sleepiness.
- Impaired performance at school or work.
- Physical harm.
- Injuries to others.
- Embarrassment or social difficulties.
Prevention
Although night terrors cannot be prevented, certain healthy habits may reduce the risk of experiencing them:
- Good sleep hygiene: going to bed at the same time every day in a calm environment, with a moderate temperature and without screen use in the hours before bedtime.
- Following a relaxing bedtime routine, such as drinking a glass of milk, taking a bath, reading a story, or listening to calming music.
- Avoiding excessive fatigue. In very young children, resuming daytime naps may be necessary.
- Managing stress whenever possible.
- Providing the child with reassurance and calmness during the day and at bedtime.
- When episodes are recurrent and always occur at the same time, gently waking the child a few minutes beforehand may be effective. By interrupting sleep, when the child falls asleep again, the terror episode usually does not occur.
What doctor treats night terrors?
Night terrors are diagnosed and treated within the specialties of Neurology, Pediatrics, as well as the Sleep unit.
Diagnosis
The diagnosis of night terrors is usually based on reports from the patient’s family members, who describe the episodes occurring during sleep. Family history of parasomnias such as sleepwalking or sleep fears is also taken into account due to their hereditary nature.
To identify the origin of night terrors and provide advice to prevent them, the specialist will inquire about the patient’s sleep habits and lifestyle.
When it is necessary to rule out other conditions or when the symptoms described do not exactly match the characteristic signs of night terrors, a sleep study may be requested. This test is performed in a medical center, in a private room, and consists of measuring brain activity, heart rate, breathing, blood oxygen levels, and eye and leg movements during sleep. The patient is usually recorded while sleeping to detect possible abnormal behaviors.
Treatment
Night terrors usually do not require treatment, as they commonly disappear once the brain reaches maturity. In cases where they cause complications or occur in adult patients, treatment focuses on the underlying cause, such as sleep apnea or stress.
On rare occasions, medication is used to manage night terrors. The most effective drugs are those that help induce sleep.
