Night Terrors Clinical Presentation

  • Author: Mark Anderson, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jan 18, 2011
 

History

The DSM-IV identifies six criteria for establishing the diagnosis of sleep terrors. Five of these are historical in nature:[6]

  1. Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.
  2. Relative unresponsiveness to efforts of others to comfort the person during the episode. The individual appears awake but confused, disoriented, and unresponsive to stimuli.
  3. No detailed dream is recalled, and amnesia of the episode is noted. Older children and adults occasionally experience a vague recall of the episode, although vivid memory of the event is inconsistent with the diagnosis of sleep terrors.
  4. The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition.

Because sleep terror events are relatively common and many affected individuals have family members with similar experiences, many families may not seek medical attention. When the episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, the diagnosis of sleep terrors advances to the diagnosis of sleep terror disorder.[6]

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Physical

During a sleep terror episode an affected individual demonstrates intense fear and signs of autonomic arousal (eg, tachycardia, rapid breathing, sweating).[6] No specific physical findings or signs are expected during a routine physical examination when the individual is awake. Several conditions that may be associated with sleep terror occurrence may demonstrate distinct physical abnormalities (eg, tonsillar enlargement). These findings are not consistent for all individuals that experience sleep terrors and are frequently noted in individuals with no recognized sleep terror occurrences.

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Causes

No specific cause has been identified for sleep terrors. Many triggers have been suggested including:[8, 9, 10]

  • Inadequate or irregular sleep schedule
  • Unfamiliar or disruptive sleep environment
  • Concurrent fever or illness
  • Certain medications including central nervous system depressants such as sedative-hypnotics and alcohol, and some stimulants
  • A full bladder during sleep
  • Generalized stress
  • Obstructive sleep disorders

No trigger is uniformly or consistently seen in most individuals who experience sleep terrors. These triggers do not cause sleep terrors but may lower the threshold for sleep terror events.

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Contributor Information and Disclosures
Author

Mark Anderson, MD  Lt Col, United States Air Force, 75th Medical Squadron

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson, MD  Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Nguyen BH, Perusse D, Paquet J, et al. Sleep terrors in children: a prospective study of twins. Pediatrics. 2008;122(6):e1164-e1167.

  2. Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Medicine Reviews. 2003;7(5):413-421.

  3. Lecendreux M, Mayer G, Bassetti C, et al. HLA association in sleepwalking. Mol Psychiatry. 2003;8:114-7.

  4. Bisulli F, Vignatelli L, Naldi I, et al. Increased frequency of arousal parasomnias in families with nocturnal frontal lobe epilepsy: A common mechanism?. Epilepsia. 2010;51(9):1852-1860.

  5. DiMario FJ Jr, Emery ES 3rd. The natural history of night terrors. Clin Pediatr (Phila). Oct 1987;26(10):505-11. [Medline].

  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.

  7. Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. SLEEP. 2007;30(8):1039-1047.

  8. Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them?. Pediatrics. Jan 2003;111(1):e17-25. [Medline].

  9. Mindell JA & Owens JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management ofSleep Problems. Philadelphia: Lippincott Williams & Wilkins; 2003.

  10. Pressman, M. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med. Rev. 2007;11:5-30.

  11. Moore M, Allison A, and Rosen CL. A review of pediatric nonrespiratory sleep disorders. Chest. 2006;130(4):1252-1262.

  12. Frank NC, Spirito A, Stark L, and Owens-Stively A. The use of scheduled awakenings to eliminate childhood sleep walking. Journal of Pediatric Psychology. 1997;22:345-353.

  13. Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. Apr 1999;60(4):268-76.

  14. Dahl RE. The pharmacologic treatment of sleep disorders. Psychiatr Clin North Am. Mar 1992;15(1):161-78. [Medline].

  15. Mason TB 2nd, Pack AI. Sleep terrors in childhood. J Pediatr. Sep 2005;147(3):388-92. [Medline].

  16. Siegel JM. Why we sleep. Sci Am. Nov 2003;289(5):92-7. [Medline].

  17. Stores G. Aspects of parasomnias in childhood and adolescence. Arch Dis Child. Jan 2009;94(1):63-9. [Medline].

 
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