While a night terror might sound like a particularly bad nightmare, night terrors — also known as sleep terrors — are a type of sleep disorder called a parasomnia. Parasomnias involve unusual behaviors during, before, or after sleep, and other disorders in this category include sleepwalking and sleep paralysis. In the case of night terrors, the unusual behavior involves screaming and other expressions of fear that cause you to wake up.
Night terrors cause the sleeper to wake suddenly and scream, thrash, sit upright, or display other expressions of fear and agitation. Although they appear to be awake, they may not respond to others or be aware of their surroundings, and they are unlikely to remember the night terror in the morning. A night terror episode can last from a few minutes to more than an hour, after which the person generally goes back to sleep.
Like other disorders of arousal, night terrors are believed to occur when the brain becomes trapped halfway between sleep and wake. The part of the brain that controls motor activity is awake, but the sleeper has no control over what they do or think. Sometimes, a night terror may become sleepwalking if the sleeper leaves the bed.
Night Terrors vs. Nightmares
Nightmares are bad dreams that can lead to fear or distress due to what happens during the dream, whereas night terrors are associated with little to no dream imagery.
People who have had a nightmare quickly regain alertness and sometimes remember what they dreamed about, but people who experience a night terror do not remember a narrative cause and are unlikely to remember their night terror the next day.
Nightmares and night terrors also happen during different stages of sleep. Whereas night terrors usually happen during deep NREM sleep non-rapid eye movement sleep, nightmares more often occur during the rapid eye movement stage that is more commonly associated with dreaming.
Most people do not physically move during nightmares unless they have REM sleep behavior disorder. By contrast, night terrors are characterized by physical behaviors like screaming and thrashing. People who wake up from night terrors tend to be extremely confused and often cannot speak clearly or understand other people.
Two similarities between night terrors and nightmares are that they are both more common in children, and when they occur in adults they may be associated with similar factors, such as stress.
Causes of Night Terrors
There do not appear to be any clear-cut brain abnormalities associated with night terrors, apart from possible changes in levels of the neurotransmitter serotonin. However, having a relative with night terrors makes someone more likely to experience them.
For those who are predisposed, stress, sleep deprivation, and external stimuli such as sound or touch may trigger a night terror episode. Night terrors may also be associated with:
- Having a full bladder
- A noisy sleep environment
- Exhaustion and physical activity
- Other sleep disorders that trigger semi-awakenings
- Medications, caffeine, and alcohol
Night terrors are not believed to increase the risk of having a mental health disorder, although it is not uncommon for someone with sleep terrors to also have another parasomnia.
Most night terror episodes happen near the beginning of the night when the sleeper is transitioning out of deep non-rapid eye movement (NREM) sleep. Along with the obvious manifestations of fear, the sleeper may also display a quickened heartbeat, rapid breathing, dilated pupils, or sweating. More rarely, they may wet the bed.
Up to 6.5% of children may experience night terrors on a regular basis, though as many as 25% may have had at least one night terror before the age of 5. The disorder is far rarer after puberty, with an estimated 2.2% of adults experiencing night terrors.
Night Terrors in Children
While night terrors can be confusing and upsetting for both children and their families, they are not usually considered harmful. Most children grow out of night terrors around puberty. Some studies have found that childhood night terrors are most common in boys, while other research indicates that both girls and boys experience them equally.
Night Terrors in Adults
Adults are much less likely than children to experience night terrors, especially if they did not experience them in childhood. Although the experience is largely the same, adults may be more likely jump up and get out of bed during a night terror. They may also become violent in response to attempts to restrain them. In adults, night terrors may be associated with neurological problems or alcohol consumption.
Treatment for Night Terrors
Night terrors in children usually only require comforting and reassurance during the night. Since most children do not remember their night terrors in the morning, parents and caregivers may be more disturbed by the experience than their children are. In that case, learning more about night terrors can help set their minds at ease.
You should not try to wake someone from a night terror, regardless of their age, since being woken or disrupted can upset them further. Waking up someone with night terrors, like waking up a sleepwalker, is also very difficult. Instead, ensure that their bedroom is safe and that they cannot injure themselves if they leap out of bed.
If night terrors are bothering someone, the first step is to remove any factors that might be causing the issue. Both caffeine and sleep deprivation are associated with the disorder, so a treatment plan might involve eliminating caffeine from your diet and practicing good sleep hygiene. Families may also want to take steps to ensure sound sleep, such as reducing ambient noise, keeping pets out of the bedroom, and limiting fluid intake in the evening so the person is not awoken by a full bladder. Addressing sources of stress with therapy and coping techniques may also help the person sleep better.
Medication is available to treat night terrors in adults if required, but it is not generally recommended for children. Families may be able to reduce regular night terrors by performing scheduled awakenings, in which someone wakes the sleeper up about half an hour before the night terror episode tends to start.
When to Talk to Your Doctor About Night Terrors
Although night terrors do not generally result in lasting harm, they can still be highly upsetting and may interfere with proper rest. Some people may injure themselves or others during a night terror episode, and night terrors may contribute to fatigue, daytime sleepiness, anxiety, depression, and migraines during adolescence. If your or your child’s night terrors interfere with daily life, it may be time to speak to your doctor.
Doctors can usually diagnose night terrors based on descriptions from family members. Your doctor may order additional tests to ensure the episodes are night terrors rather than seizures or other health conditions. They may also recommend treatment options for other disorders that could be provoking the night terrors.
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