Pavor nocturnus

Alternative names 
Night terror; Sleep terror disorder

Definition
Night terrors are a Sleep Disorder involving abrupt awakening from sleep in a terrified state.

Causes, incidence, and risk factors

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. REM (rapid eye movement) sleep is a different type of sleep, where the eyes move rapidly and vivid dreaming is most common. During a night, there will be several cycles of non-REM and REM sleep.

Night terror (sleep terror) occurs during Stage 3 and Stage 4 sleep (deep sleep). The cause is unknown but night terrors are commonly associated with periods of emotional tension, stress, or conflict.

Night terror is similar to nightmares except that nightmares usually occur during REM sleep and include unpleasant or frightening dreams. Nightmares are most common in the early morning.

Night terrors occur usually in the first half of the night heralded by a scream. The child does not usually remember the details of the scare. Nightmares are normal on occasion, especially after frightening movies/TV shows or emotional situations.

Night terror occurs most often in preadolescent boys, although it can occur in girls and in adults. It is fairly common in children 3 to 5 years old, and incidence usually reduces greatly after that. It may run in families. Night terror can occur in adults, especially with emotional tension and/or the use of alcohol.

Symptoms

     
  • sudden awakening from sleep  
  • persistent fear or terror that occurs at night  
  • screaming  
  • sweating  
  • confusion  
  • rapid heart rate  
  • unable to explain what happened  
  • no recall of “bad dreams” or nightmares       o may have a vague sense of frightening images  
  • unable to fully arouse  
  • difficult to comfort  
  • no memory of the event on awakening the next day

Note: Episodes are most common in the first third of the night. They may last 10 to 20 minutes, then normal sleep returns.

Signs and tests
In many cases, no further examination or testing is necessary. If night terror is severe or prolonged, psychologic evaluation may be appropriate.

Treatment
In many cases, comfort and reassurance are the only treatment required. Psychotherapy or counseling may be appropriate in some cases. Benzodiazepine medications (such as diazepam) used at bedtime will often reduce night terrors; however, medication is not usually recommended to treat this disorder. A safe over-the-counter drug, Benadryl elixir (diphenhydramine), given 1 hour before bedtime may reduce the incidence of night terror.

Expectations (prognosis)
Most children outgrow night terrors. There is usually no recall of the event. stress reduction and/or psychotherapy may be helpful for night terror in adults.

Complications

Calling your health care provider
Call for an appointment with your health care provider if night terror is persistent or frequent, and/or occurs often enough to regularly disrupt sleep.

Also call if other symptoms accompany night terror; or if the night terror causes, or almost causes, injuries.

Prevention
Minimizing stress or using coping mechanisms may reduce night terrors. The number of episodes usually decreases after age 10.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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