Night Terrors
Also known as: Sleep terrors, Pavor nocturnus
Night terrors are episodes of intense fear, screaming or thrashing that happen during deep, non-dream sleep, usually in the first few hours after falling asleep. Unlike a nightmare, the person is not fully awake, is very hard to console, and typically has no memory of the event in the morning. They are most common in young children between about 3 and 7 years old and are frightening for parents to witness but not harmful to the child. Most children outgrow them by adolescence. In adults, night terrors are less common and may be linked to stress, sleep deprivation, alcohol or other sleep disorders.
At a Glance
- Common symptoms
- Sudden sitting up in bed, screaming or crying out in apparent terror, Wide-open eyes with a glassy stare, yet the person is not really awake, Rapid breathing, racing heart, sweating and flushed skin
- Main treatments
- Reassurance and no specific treatment in most children, as episodes resolve on their own with time, Keeping the person safe during an episode rather than trying to wake them, then guiding them gently back to bed, Scheduled awakenings: briefly waking the child 15 to 30 minutes before the usual time of the episode for a couple of weeks, which can break the cycle
- Category
- Pediatric · Common in young children; much less common in adults
- See a doctor if
- Episodes are becoming more frequent, happening most nights or more than once a night
Symptoms
Causes
- Partial arousal from deep slow-wave sleep, when the brain is caught between sleeping and waking
- An immature central nervous system in young children, which is why they are so common at that age
- Sleep deprivation or an irregular sleep schedule
- Fever or illness
- Stress, anxiety or a change in routine such as travel
- Medications or substances that affect sleep, including some antihistamines, sedatives and alcohol
Risk Factors
- Age 3 to 7 years
- A family history of night terrors or sleepwalking
- Being overtired or having a disrupted sleep schedule
- Other sleep problems such as sleep apnea or restless legs
- Stress, anxiety or recent emotional upheaval
- Sleeping in an unfamiliar place
Diagnosis
- A description of the episodes from a parent or bed partner, including timing in the night and whether the person remembers them
- Review of sleep schedule, stress, illness and medications
- A sleep diary or home video of an episode
- An overnight sleep study if episodes are very frequent, start in adulthood, cause injury or might be seizures
Treatment
- Reassurance and no specific treatment in most children, as episodes resolve on their own with time
- Keeping the person safe during an episode rather than trying to wake them, then guiding them gently back to bed
- Scheduled awakenings: briefly waking the child 15 to 30 minutes before the usual time of the episode for a couple of weeks, which can break the cycle
- Treating underlying triggers such as sleep apnea, fever, or a medication that disrupts sleep
- Addressing stress with relaxation routines, counselling or cognitive behavioural therapy when anxiety is a factor
- Medication (such as low-dose benzodiazepines or certain antidepressants) is reserved for severe, frequent or dangerous episodes and is prescribed by a sleep specialist
- Supportive: a consistent, calming bedtime routine and enough total sleep for age
Prevention
- Make sure your child gets enough sleep and keeps a regular bedtime
- Create a calm wind-down routine and avoid screens and roughhousing before bed
- Reduce stress and talk through worries during the day
- Avoid caffeine and, in adults, alcohol in the evening
- Make the bedroom safe: clear the floor, lock windows and consider a gate on stairs
- Treat fevers and other illnesses promptly
When to See a Doctor
- Episodes are becoming more frequent, happening most nights or more than once a night
- The person is injured or leaves the house during an episode
- Night terrors start or persist in a teenager or adult
- Episodes are accompanied by stiffening, jerking, drooling or incontinence, which could indicate seizures
- Daytime sleepiness, loud snoring or behaviour problems that suggest another sleep disorder
Frequently Asked Questions
Related Conditions
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