Sleep terrors are commonly known by a few terms, including sleep terrors, night terrors, sleep terror disorder, and pavor nocturnus. The person having a sleep terror will awaken from a dream crying or screaming, which may last for minutes. The person is difficult to awaken and confused. There is no recollection of the dream once awake. Sometimes the person can be violent by swinging their fists or punching. This paper will look in depth at sleep terrors and give a concise review of the causes, prevalence, treatment, symptoms, and safety measures in the sleep lab when dealing with sleep terrors.
Definition The definition of sleep terrors is “a sleep disorder involving abrupt awakening from sleep in a terrified state” (Kiriakopoulos, 2005, p. 1). “The cause is unknown but night terrors are commonly associated with periods of emotional tension, stress, or conflict” (Kiriakopoulos, 2005). Overview To understand sleep terrors, you first need to understand normal sleep patterns. “Normal sleep cycles involve distinct stages from light drowsiness to deep sleep” (Kiriakopoulos, 2005, p. 1). These include REM and non-REM sleep. Non-REM sleep involves four stages.
The normal sleeping person will have several cycles of REM and non-REM sleep through the night. Night terrors occur during deep sleep, which occurs during stages 3 and 4 of non-REM sleep, beginning approximately 90 minutes after falling asleep (Connelly, 2003) and they generally have a duration of 10 to 20 minutes. The patient usually screams in panic, but there is no memory of what caused them to be scared. (Kiriakopoulos, 2005) Sleep terrors are like nightmares but with certain distinct differences. Nightmares normally occur during REM sleep vs. sleep terrors occurring during deep sleep.
Nightmares are most common in the early morning vs. sleep terrors occurring during the first one-third of the night. The sleeper can remember the details of a nightmare vs. a sleep terror, which cannot be remembered. Sleep terrors are not normal, but “nightmares are normal on occasion, especially after frightening movies/TV shows or emotional situations” (Kiriakopoulos, 2005, p. 1). “The sleep disorder of night terrors typically occurs in children aged 3-12 years, with a peak onset in children aged 3? years” (Connelly, 2005, p. 1). Boys, girls, and children of all races are equally affected by sleep terrors. An estimated 1-6% of children experience night terrors” (Connelly, 2005,p. 1).
Sleep terrors can be familiar. By adolescence, most children have outgrown sleep terrors. (Connelly, 2005) Sleep terrors can run in families. Although uncommon, adults may have sleep terrors but they are associated “with emotional tension and/or the use of alcohol” (Kiriakopoulos, 2005, p. 1). Although sleep terrors are “not directly caused by a general medical condition or substance use, including medications and drugs of abuse, these symptoms cause clinically important distress or impair work, social or personal functioning” (Narcolepsy Association UK, 2003).
Diagnosis “Usually, a complete history and a physical examination are sufficient to diagnose night terrors” (Connolly, 2003, p. 6). Review of symptoms is necessary for accurate diagnosis of all sleep disorders. In many cases, considering the symptoms, no tests are necessary. (Kiriakopoulos, 2005) It is important to rule out seizure disorders and nightmares when making the differential diagnosis of sleep terror. (Narcolepsy Association UK, 2003) This may include an electroencephalogram (EEG) which measures brain activity and can rule out a seizure disorder, or a sleep study to rule out other sleep disorders.
Other tests such as CT Scans and MRI’s are unnecessary. (Connelly, 2003) The cause is unknown. Sleep terrors are frequently brought on by “stress, fever, sleep deprivation, and medications that affect the central nervous system” (Connelly, 2003, p. 2). Symptoms Symptoms of sleep terrors include sudden awakening from sleep. “During each episode the patient shows evidence of marked fear and autonomic arousal, such as rapid breathing, rapid heartbeat and sweating” (Narcolepsy Association UK, 2003).
When awakened from the sleep terror, the person is difficult to comfort and is unable to explain what happened or recall the dream, though they may have a sense of being frightened. “They will have no memory of the event on awakening the next day” Kiriakopoulos, 2005, p. 1). Thankfully, sleep terrors generally only occur once per night. (Narcolepsy Association UK, 2003) Treatment, Prognosis, And Prevention There is no true treatment for sleep terrors. It is important to “educate the family about the disorder and reassuring them that the episodes are not harmful” (Connelly, 2003, p. ). “Comfort and reassurance are the only treatment required” (Kiriakopoulos, 2005, p. 1). It is important for parents of children with sleep disorders to take the following precautions. “Make the child’s room safe to prevent the child from being injured during an episode, eliminate all sources of sleep disturbance, and maintaining a consistent bedtime routine and wake-up time” (Connelly, 2003, p. 7). When medication is used, it is benzodiazepine or benadryl given just prior to or at bedtime. These medications will reduce sleep terrors.
Although rare, “in severe cases, in which daily activities (for example, school performance or peer or family relations) are affected” (Connelly, 2003, p. 8), the person may require antidepressant therapy. “Minimizing stress or using coping mechanisms may reduce night terrors. The number of episodes usually decreases after age 10” (Sheth, 2005, p. 1). Most children outgrow night terrors. When this does not occur, “stress reduction and/or psychotherapy may be helpful for sleep terror in adults” (Kiriakopoulos, 2005, p. 1). “Night terrors may also be treated with hypnosis and guided imagery echniques” (Narcolepsy Association UK, 2003, p. 1). There are also support groups available. Role of the Polysomnographic Technologist The sleep technologist is responsible for the patient during the polysomnography study. The technologist needs to have reviewed the patient’s questionnaire and be prepared for the outburst and confusion that may occur during a sleep terror event. The technologist needs skills to comfort and protect the patient during a terror. The patient may be combative so the technologist would need to be able to protect the patient and any near him from hitting and punching that could occur.
It would be important to be able to gently restrain them so they are both comforted and safe. Polysomnographic Record Of A 3 Year Old With Sleep Terror Disorder Summary/Conclusion Sleep terror disorder is a sleep disorder that involves waking from deep sleep in a panic. The person is difficult to arouse and confused. If they can recall any of the dream at that time, when they wake then next day, they will not remember that the terror even occurred. The disorder occurs mostly in young children before their teen years begin. Most children out grow the disorder, but some adults are affected.
Diagnosis is simple, requiring few tests. Treatment is mostly supportive requiring education of the family and comfort of the individual with the sleep terror disorder. In rare cases, psychotherapy and/or counseling may be necessary if it affect the persons daily functioning and relationships. Sleep terrors are very interesting to me. I have never even known anyone with terrors, and but the prevalence is enough that most people should know someone with the disorder. Although the diagnosis is usually easy, the sleep technologist has a role in the diagnosis when more than the patient’s symptoms are needed.