Sleep Terrors Differential Diagnoses

Updated: Mar 14, 2019
  • Author: Eve G Spratt, MD, MSc; Chief Editor: Caroly Pataki, MD  more...
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Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis, other medical conditions that interrupt sleep and can distress an individual should be considered, including the following:

  • Acute stress disorder

  • Gastroesophageal reflux

  • Hypnagogic hallucinations

  • Nocturnal frontal lobe epilepsy (NFLE)

  • Noncturnal panic attacks

  • Noncturnal seizures

  • Separation anxiety

  • Sleep breathing disorders

  • Sleep paralysis

It is especially important to distinguish sleep terrors from nightmares. The table below compares features of both.

Table 2. Comparison of sleep terrors and nightmares. (Open Table in a new window)

Feature Sleep Terror Nightmare
Categorization Disorder of arousal REM parasomnia
Timing Usually occurs during the first half of the night and typically out of stage N3 slow-wave sleep Begins out of REM sleep and typically occurs in the last third of the night
Family history Frequently positive May be positive
Behavior semiology Sudden arousal with intense screaming, inconsolable crying, agitation, heightened autonomic discharge Paroxysmal awakenings with anxiety dream recall
Event duration Few seconds to minutes Few seconds to minutes
Age at onset Typically < 10 years old Typically < 10 years old
Triggers Sleep deprivation, febrile illness, anxiety, stress, sleep apnea, motor disorders of sleep Sleep deprivation, febrile illness
Frequency Few times per month/week; very rarely >1 episode in a single night Few times per month/week; very rarely >1 episode in a single night
Post-spell Limited to no recall of the events with confusion Recall is typical at times with vivid detail
PSG changes Abrupt arousal from slow-wave sleep (stage N3) with expression of confusion/ambulation/intense fright in all three arousal types, followed by return to sleep; increased cyclic alternating pattern Dense eye(phasic) movements during REM sleep


Differential Diagnoses