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Sleep Disorder: Night Terrors
Updated: Feb 25, 2008
Introduction
Background
Sleep disruption is a frequent concern among parents of children aged 2 years or younger. Half of all infants develop a disrupted sleep pattern serious enough to seek physician evaluation.
Night terror disorder is characterized by recurrent episodes of intense crying and fear and by difficulty in waking the child. Children with night terrors often experience signs of autonomic arousal (eg, tachycardia, tachypnea, sweating) during episodes. Children do not recall a dream after a night terror and typically do not remember the episode the next morning. Night terrors are frightening episodes for parents to watch and may cause the child significant distress, fatigue, and impaired daily function. Onset is usually in children aged 4-12 years; the disorder generally spontaneously resolves by adolescence.
Pathophysiology
Sleep is divided into 2 categories: rapid eye movement (REM) and nonrapid eye movement (non-REM). Non-REM sleep is further divided into 4 stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 non-REM sleep to stage 4 non-REM sleep. Approximately 30-90 minutes after falling asleep, the child enters this light sleep stage and suddenly arises with symptoms of autonomic discharge.
Frequency
United States
An estimated 1-6% of children experience night terror episodes. Recurrent night terror episodes accompanied by significant distress and impairment are less frequent.
Mortality/Morbidity
Most children outgrow night terrors as they mature neurophysiologically.
Race
Children of all races and cultures are affected.
Sex
Males and females are equally affected.
Age
Night terrors are most common among children aged 3-12 years. The median age of onset is 3.5 years. Peak frequency in children younger than 3.5 years is at least one episode per week; among older children, peak frequency is 1-2 episodes per month.1
Clinical
History
The most important step toward diagnosing this disorder is to obtain a detailed history.
- Approximately 90 minutes after falling asleep, the child sits up in bed and screams. Prominent autonomic activity (eg, tachycardia, tachypnea, diaphoresis, flushing) occurs. The child appears awake but confused, disoriented, and unresponsive to stimuli.
- Most episodes last 1-2 minutes, but the child may remain inconsolable for 5-30 minutes before relaxing and returning to quiet sleep.
- If the child awakens during the night terror, only fragmented pieces of the episode may be recalled.
- In the morning, the child typically has no memory of the experience.
Physical
A complete physical examination is important to exclude other disorders. In general, however, physical examination adds little to information obtained from a complete history.
Causes
- Episodes of night terrors may be preceded by the following:
- Stressful life events
- Fever
- Sleep deprivation
- Medications that affect the CNS
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References
DiMario FJ Jr, Emery ES 3d. The natural history of night terrors. Clin Pediatr (Phila). Oct 1987;26(10):505-11. [Medline].
Dahl RE. The pharmacologic treatment of sleep disorders. Psychiatr Clin North Am. Mar 1992;15(1):161-78. [Medline].
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].
Pesikoff RB, Davis PC. Treatment of pavor nocturnus and somnambulism in children. Am J Psychiatry. Dec 1971;128(6):778-81. [Medline].
Siegel JM. Why we sleep. Sci Am. Nov 2003;289(5):92-7. [Medline].
Wise MS. Parasomnias in children. Pediatr Ann. Jul 1997;26(7):427-33. [Medline].
Further Reading
Keywords
night terrors, night-terrors, sleep terrors, night frights, parasomnia, pavor nocturnus, autonomic arousal, sleep disruption, rapid eye movement, REM, nonrapid eye movement, non-REM, tachycardia, diaphoresis, disrupted sleep pattern, night terror disorder, sleep deprivation
