Night Terrors

Night terrors are a type of parasomnia—a group of sleep disorders that cause you to wake up abruptly in the middle of the night—where you fearfully wake up in the middle of sleep. Although adults can experience them, young children are more likely to have night terrors. Around 14% of kids in the United States have night terrors before outgrowing them during puberty.

Researchers have not yet found what causes night terrors. Some studies suggest that in adults, certain lifestyle factors like excessive alcohol intake, illness, and unmanageable stress can increase your risk of developing night terrors. Night terrors could also be hereditary.

Other parasomnia disorders include sleepwalking, confusional arousal, and nightmares. Having a night terror can feel scary, but there are home remedies to help yourself or a loved one manage night terror episodes (suddenly waking up in fear).

Night terrors cause you to wake up feeling frightened and confused. They usually occur during the first three hours of falling asleep.

Common symptoms of night terrors include:

• Screaming and crying as you wake up
• Feeling frightened and confused
• Thrashing around violently
• Waking up afraid and panicked
• Being unaware of your surroundings
• Having an inability to respond to others attempting to comfort you
• Sweating
• Hyperventilating

Night terror episodes usually last around 10-45 minutes. Usually, you won’t have any memory of these episodes happening. Two parasomnias can also exist at the same time. For instance, you might experience night terrors while also sleepwalking (somnambulism).

Researchers believe that night terrors and other parasomnia sleeping disorders might occur due to a disruption in how your brain transitions through the stages of sleep. The normal sleep-wake cycle goes from waking to non-rapid eye movement sleep (NREM) and ends with rapid-eye-movement (REM) sleep. Night terrors happen during the transition from waking to NREM sleep.

Children have more stage 3 sleep than adults. Stage 3 sleep is the stage of sleep where night terrors and other parasomnia typically occur. Children’s sleep cycles are also less regulated. Night terrors typically affect children between 4-10 years old, with kids between 5-7 years old having them the most. On average, children who experience night terrors have one or two night terrors a month.

In adults, having more night terror episodes comes from increased sleep disruption. Some causes of night terrors include drinking excessive amounts of alcohol, having a fever, and experiencing emotional distress.

Additionally, studies suggest that night terrors may be passed down genetically. Research suggests the genes human leukocyte antigen (HLA) DQB1 04 and HLA DQB1 05:01 can cause parasomnia sleep disorders. The DQB1 gene family are molecules that make proteins for cells in your immune system.

One study found the HLA DQB1 05:01 gene was present in 40% of the study population who had parasomnias. The role of this gene in night terrors and other parasomnia disorders needs more research.

Your healthcare provider will ask you questions about your past sleeping patterns to help rule out other sleep disorders like confusional arousal, nightmares, and nocturnal frontal lobe epilepsy. They might also examine you for neurological injuries through a physical exam.

Another key factor in diagnosis is observing how you or your child sleeps. In many cases, a video recording of a night terror event can be helpful. If you or your child are having night terrors more than twice a week, a series of tests like polysomnography may be performed.

For a polysomnography test, sleep specialists will observe you throughout the night at a sleep center. They will place electrodes on your chin, head, and eyelids to record electric signals in your brain while you sleep. This process is not painful but the electrodes may feel slightly awkward around your head as you try to fall asleep. The electric signals in the electrodes measure how long it takes you to go from wakefulness to sleep, start REM sleep, and the consistency of your breathing patterns.

With the results of your polysomnography, your healthcare provider can better assess your sleeping patterns and recommend the next steps for improving your sleep.

There is no specific treatment for night terrors, but your healthcare provider may provide suggestions to help manage your night terrors or your child’s night terror episodes. You can start by keeping your sleep schedule consistent in a calming environment.

Your healthcare provider may prescribe oral medications like tricyclic antidepressants, selective serotonin reuptake inhibitors, or mirtazapine (Remeron) to remedy symptoms. However, medications for night terrors have varying levels of effectiveness.

In children, you can help prevent night terror episodes by waking your child up right before one occurs. Monitor your child’s sleeping patterns to see if there is a typical time they wake up each night. Some healthcare providers may suggest anticipatory awakening—waking them up half an hour before they usually have a night terror to break the pattern.

The following strategies can help prevent night terrors as an adult:

• Establish consistent sleeping patterns
• Avoid excessive alcohol consumption
• Manage emotional distress

Before you go to bed, keep your bedroom clear of sharp objects on the floor, and lock all doors and windows if possible to prevent injury if you tend to move around a lot during night terror episodes. Having a lower bed can also prevent injury, especially if you experience sleepwalking at the same time, while using blackout curtains may help you get better rest throughout the night.

Consider keeping a sleep journal to track any changes you notice in your or a loved one’s sleep quality after making adjustments.

Many health conditions might make it more likely for you to experience night terror episodes. These conditions include:

• Fever
• Fatigue
• Stress
• Anxiety
• Sleep deprivation
• Attention-deficit/hyperactivity disorder (ADHD)
• Obstructive sleep apnea syndrome
• Restless leg syndrome
• Post-traumatic syndrome

Not getting enough sleep can feel draining. While there are no treatments that are guaranteed to prevent night terrors, there are steps you can take to manage night terror episodes affecting you or a loved one.

Contact your healthcare provider if you notice night terrors worsening. They may refer you to a sleep specialist for more tests.