Sleep Terrors Medication

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

Medication Summary

Medications rarely are indicated for sleep terrors and usually provide no long-term help to patients. They should be prescribed only for severe symptoms that affect waking behavior (eg, school performance and peer or family relations) and only after behavioral interventions have failed. Pharmacologic therapy should be administered only as a temporary measure.

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Tricyclic Antidepressants

Class Summary

Tricyclic antidepressants decrease deep delta sleep and arousal between sleep stages.

Imipramine (Tofranil, Tofranil-PM)

Imipramine hydrochloride inhibits reuptake of norepinephrine or serotonin at the presynaptic neuron. This agent is an antagonist at histamine H1 and alpha1 adrenoceptors, as well as at M2 muscarinic acetylcholine receptors. In limited studies, imipramine has stopped the disorder when administered at bedtime for 8 weeks.

Amitriptyline

Amitriptyline is a tricyclic antidepressant (TCA) with sedative effects. It inhibits reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, which increases concentration in the central nervous system (CNS). Amitriptyline has been effective in the treatment of REM sleep disorder behaviors.

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Benzodiazepines

Class Summary

Some studies suggest that long-term management with low dose clonazepam is effective for adults with severe sleep terrors involving violence or self-injurious behaviors. [28, 6]

Clonazepam (Klonopin)

Long-acting benzodiazepine that increases the presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. It has been used off-label for REM and nonREM sleep behavior disorders.

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Antidepressants, selective serotonin reuptake inhibitors (SSRIs)

Class Summary

SSRIs are antidepressant agents that inhibit the central nervous system (CNS) neuronal uptake of serotonin and may also have a weak effect on norepinephrine and dopamine neuronal reuptake. SSRIs are used effectively to treat panic attacks. The overlap in symptoms between nocturnal panic attacks and night terrors could suggest a role for SSRIs in the treatment of night terrors.

Paroxetine (Pexeva, Paxil, Paxil CR)

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake, but it has a weak effect on norepinephrine and dopamine neuronal reuptake. This agent is a low-affinity antagonist at some subtypes of muscarinic acetylcholine receptors and is a nitric oxide synthase inhibitor. The anticholinergic effects of paroxetine may result in sedation or cardiovascular effects. Patients suffering from night terrors have been shown to respond to paroxetine therapy.

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