Night Terrors Follow-up

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

Further Outpatient Care

Routine follow-up and developmental assessment is indicated for all children, including those affected by sleep terrors.

Continued support and reassurance can be helpful for affected families. Surveillance for deviation from classic sleep terror characteristics or increasing severity of behavior during episodes may prompt reconsideration of the diagnosis or increased protective interventions.

Efforts during an episode should focus on protecting the individual from harming self or others. These efforts can be supported by removing hazardous objects from the sleep area, securing windows, and impeding exit from the sleep area. Affected children are typically resistant to interference in the midst of a sleep terror event, but patient surveillance to avert injury as permitted may be all that is required. When the episode has terminated, parents should assist the child back to bed. Discussion of the event immediately or the following day is usually not helpful as the experience is either not remembered or only vaguely recalled.

Scheduled awakenings is a process proposed to help reduce sleep terror occurrences.[12]

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Prognosis

Most children with sleep terrors experience resolution before adolescence. No increased occurrence of psychiatric diagnoses is found in children. Adults who experience sleep terrors have an increased occurrence of other psychiatric conditions, particularly posttraumatic stress disorder, generalized anxiety, and dependent, schizoid, and borderline personality disorders.[6, 13]

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Patient Education

Families and individuals must understand that sleep terrors are fundamentally benign, self-limited events. Safety measures including sleep environment modification to afford increased patient protection, securing windows and assuring limitation of access to potentially harmful situations.

Because the affected individual is generally unresponsive to outside interventions, aggressive attempts to intervene should be discouraged. Improvement of sleep hygiene and avoidance of potential triggers may reduce the frequency or severity of events.[9]

For excellent patient education resources, visit eMedicine's Sleep Disorders Center. Also, see eMedicine's patient education articles Night Terrors, Disorders That Disrupt Sleep (Parasomnias), and REM Sleep Behavior Disorder.

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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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