| Night terror | |
|---|---|
| Classification and external resources | |
| ICD-10 | F51.4 |
| ICD-9 | 307.46 |
| MeSH | D020184 |
A night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, and typically occuring in the first few hours of sleep during stage 3 or 4 NREM sleep.[1] Night terrors should not be confused with nightmares, which are bad dreams that cause the feeling of horror or fear. An estimated 1-8% of children have at least one night terror in their life but have no memory of the occurrence.
According to the American Academy of Child and Adolescent Psychiatry, nightmares are relatively common during childhood.[2] Children from age two to six are most prone to night terrors. They affect about fifteen percent of all children, although people of any age can be affected. Episodes may happen for a couple of weeks then suddenly disappear. The symptoms also tend to be different, with the child being unable to recall the experience. While nearly arisen, hallucinations occur.
Children who have night terrors are usually described as 'bolting upright' with their eyes wide open, and a look of fear and panic. They will often scream. Further, they will usually sweat, breathe fast and have a rapid heart rate (autonomic signs). Although it seems like children are awake during a night terror, they will appear confused, be inconsolable, and will not always recognize others.
Strong evidence has shown that a predisposition to night terrors and other parasomniac disorders can be passed genetically. Though there are a multitude of triggers, emotional stress during the previous day and a high fever are thought to precipitate most episodes. Ensuring the right amount of sleep is an important factor. Special consideration must be used when the subject suffers from narcolepsy, as there may be a link.
Though the symptoms of night terrors in adolescents and adults are similar, the etiology, prognosis and treatment are qualitatively different. These night terrors can occur each night if the sufferer does not eat a proper diet, get the appropriate amount or quality of sleep (e.g. sleep apnea) or is enduring stressful events in his or her life. Adult night terrors are much less common, and often respond to treatments to rectify causes of poor quality or quantity of sleep. There is no scientific evidence of a link between night terrors and mental illness. There is some evidence of a link between adult night terrors and hypoglycemia. In addition to night terrors, some adult night terror sufferers have many of the characteristics of depressed individuals including inhibition of aggression, self-directed anger, passivity, anxiety, impaired memory, and the ability to ignore pain. When a night terror happens it is typical that person can wake themself up screaming, kicking, and often can not make out what they are saying. Often the person can even run out of the house (more common among adults) which can then lead to violent actions.
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The sleep disorder of night terrors typically occurs in children between the ages of three to twelve years, with a peak onset in children aged three and a half years old.[3] An estimated one to six percent of children experience night terrors. Boys and girls of all backgrounds are affected equally. The disorder usually resolves during adolescence.[3] Sleep disruption is parents’ most frequent concern during the first years of a child’s life. Half of all children develop a disrupted sleep pattern serious enough to warrant physician assistance. In children younger than three and a half years old, peak frequency of night terrors is at least one episode per week. Among older children, peak frequency of night terrors is one or two episodes per month. Children experiencing night terrors may be helped by a pediatric evaluation. During such evaluation, the pediatrician may also be able to exclude other possible disorders that might cause night terrors.[3]
Since night terrors are most commonly triggered by being overtired, sometimes no treatment is necessary except for a bedtime schedule that ensures proper sleep. If the night terrors are more frequent, however, it has been suggested that the sufferer should be awakened from sleep just before the time when the terrors occur most to interrupt the sleep cycle. In many cases, a child who has a night terror only needs comfort and reassurance. Psychotherapy or counseling may be appropriate in some cases. Benzodiazepine medications (such as diazepam) used at bedtime will often reduce night terrors; however, medication is rarely recommended to treat this disorder.[4]
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