Sleep Terrors Clinical Presentation

Updated: Mar 14, 2019
  • Author: Eve G Spratt, MD, MSc; Chief Editor: Caroly Pataki, MD  more...
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Sleep terror is characterized by a sudden arousal from non–rapid eye movement (NREM) sleep (usually from slow-wave sleep) and associated autonomic and behavioral manifestations of fear. Commonly, patients let out a piercing scream, followed by fear, crying and inconsolability. In adults, agitation is often seen. Significant autonomic hyperactivity is present, with tachycardia, tachypnea, flushing, diaphoresis, and increased muscle tone.

The patient is routinely unresponsive to external stimuli and, if awakened, is confused, disoriented, and amnestic regarding the event. It should be cautioned that confrontation of an individual during an episode may be dangerous, in that the individual may become violent. Incoherent vocalizations or micturition have been reported to accompany the event.

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 NREM sleep arousal disorder, sleep terror type. [3]


Physical Examination

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 who experience sleep terrors and are frequently noted in individuals with no recognized sleep terror occurrences.