Sleep Terrors Workup

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

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. However, note that a normal sleep study does not rule out a diagnosis of sleep terror. [2]

If the individual clearly wakes up at the end of the episode abruptly and at no point in time sits up, stands, or walks, the individual may have nocturnal frontal lobe epilepsy. Also, if the individual is seen to undergo head turning to one direction and dystonic posturing during the event, it suggests epilepsy. [18]

When nocturnal seizures are a possibility, routine electroencephalography (EEG) or sleep-deprived EEG may be helpful. [24, 13] 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. [14] Findings on EEG that suggest parasomnias rather than NFLE include the presence of vertex waves, sleep spindles, non-rhythmic 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. [25]