Sleep Terrors Workup
- Author: Eve G Spratt, MD, MSc; Chief Editor: Caroly Pataki, MD more...
No consistent irregularities in laboratory evaluation have been identified, and no additional workup is required in a classic sleep terror presentation. No specific imaging is indicated with normal development and no focal neurologic abnormalities. If trauma during an episode has been sustained, appropriate imaging should be sought to evaluate the injury.
A sleep diary may help families identify particular triggers for sleep terror events. Comorbidities should be investigated independently of their association with sleep terrors.
Further evaluation and intervention may be required for individuals with significant daytime somnolence, for those who exhibit violent behavior during the episodes that threatens harm to self or others, or in situations where the sleep terrors generate severe distress to family members. Polysomnography is useful if a respiratory disturbance is suspected.
Physicians should also ask about specific symptoms that might suggest nocturnal seizures, including repetitive stereotypic behaviors or abnormal posturing during the episodes. When nocturnal seizures are a possibility, routine electroencephalography (EEG) or sleep-deprived EEG may be helpful.[19, 20] EEG findings are often similar with sleep terrors and nocturnal seizures, especially nocturnal frontal lobe epilepsy (NFLE), making diagnosis difficult. Additionally, a normal awake EEG or interictal sleep EEG may not rule out a seizure disorder. Findings on EEG that suggest parasomnias rather than NFLE include the presence of vertex waves, sleep spindles, nonrhythmic theta activity, or evidence of EEG state dissociation with a posterior dominant alpha rhythm. Additionally, NFLE most often presents in stages 1 and 2 of sleep as opposed to parasomnias, which most often present in stages 3 and 4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
Fialho LM, Pinho RS, Lin J, et al. Sleep terrors antecedent is common in adolescents with migraine. Arq Neuropsiquiatr. 2013 Feb. 71(2):83-6. [Medline].
Bruni O, Ferri R, Miano S, Verrillo E. L -5-Hydroxytryptophan treatment of sleep terrors in children. Eur J Pediatr. 2004 Jul. 163(7):402-7. [Medline].
Nguyen BH, Perusse D, Paquet J, et al. Sleep terrors in children: a prospective study of twins. Pediatrics. 2008. 122(6):e1164-e1167.
Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Medicine Reviews. 2003. 7(5):413-421.
Lecendreux M, Mayer G, Bassetti C, et al. HLA association in sleepwalking. Mol Psychiatry. 2003. 8:114-7.
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.
Petit D, Pennestri MH, Paquet J, Desautels A, Zadra A, Vitaro F, et al. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr. 2015 Jul. 169 (7):653-8. [Medline].
Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them?. Pediatrics. 2003 Jan. 111(1):e17-25. [Medline].
Mindell JA & Owens JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management ofSleep Problems. Philadelphia: Lippincott Williams & Wilkins; 2003.
Pressman, M. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med. Rev. 2007. 11:5-30.
DiMario FJ Jr, Emery ES 3rd. The natural history of night terrors. Clin Pediatr (Phila). 1987 Oct. 26(10):505-11. [Medline].
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.
Thünker J, Pietrowsky R. Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Behav Res Ther. 2012 Sep. 50(9):558-64. [Medline].
Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. SLEEP. 2007. 30(8):1039-1047.
[Guideline] Paruthi S, Brooks LJ, D'Ambrosio C, Hall W, Kotagal S, Lloyd RM, et al. Recommended Amount of Sleep for Pediatric Populations: A Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016 May 25. [Medline]. [Full Text].
Carter KA, Hathaway NE, Lettieri CF. Common sleep disorders in children. Am Fam Physician. 2014 Mar 1. 89 (5):368-77. [Medline].
Moore M, Allison A, and Rosen CL. A review of pediatric nonrespiratory sleep disorders. Chest. 2006. 130(4):1252-1262.
Cornaggia CM, Beghi M, Giovannini S, Boni A, Gobbi G. Partial seizures with affective semiology versus pavor nocturnus. Epileptic Disord. 2010 Mar. 12 (1):65-8. [Medline].
Weber P, Jüngling F, Datta AN. Differential diagnoses of nocturnal fear and movement paroxysm: a case report. Eur J Pediatr. 2012 Sep. 171 (9):1309-15. [Medline].
Williams SG, Correa D, Lesage S, Lettieri C. Electroencephalographic hypersynchrony in a child with night terrors. Sleep Breath. 2013 May. 17 (2):465-7. [Medline].
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.
Lask B. Novel and non-toxic treatment for night terrors. BMJ. 1988 Sep 3. 297 (6648):592. [Medline].
Ferri R, Zucconi M, Marelli S, Plazzi G, Schenck CH, Ferini-Strambi L. Effects of long-term use of clonazepam on nonrapid eye movement sleep patterns in rapid eye movement sleep behavior disorder. Sleep Med. 2013 May. 14 (5):399-406. [Medline].
Schenck CH, Mahowald MW. Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med. 1996 Mar. 100 (3):333-7. [Medline].