An adult patient asked me to write about night terrors. While adults can suffer from night terrors, they are much more common in children. It’s hypothesized that this has something to do with brain development.
Night terrors are a subclass of sleep patterns called parasomnias, derived from the Greek root para, meaning abnormal, and Latin somnus meaning sleep. Rather than focus specifically on adults, I’d also like to talk about kids. People who are afflicted with parasomnias often have family members who have them as well. Virtually all of these conditions go away with time.
Parasomnias are a category of sleep disorders defined by abnormal and unnatural movements, behaviors, emotions, perception, and dreams. They occur while falling asleep, during sleep, between sleep stages, or arousal from sleep. They are further classified according to when they occur in the sleep cycle – during REM (Rapid Eye Movement) sleep or during non-REM sleep.
REM sleep is very light sleep characterized by rapid eye movements and muscle relaxation. This is the stage of sleep when dreaming occurs. Babies spend about 50 percent of their sleep time in REM while adults spend about 20 percent in this stage. Non-REM sleep is comprised of three or four stages, with stage 3 or 4 being the deepest sleep.
There are many parasomnias, but I want to focus on two of the most common, nightmares and sleep walking. Since my patient had an interest in night terrors, I’ll go into a little more detail about them as well.
Nightmares occur during REM sleep. People who suffer from nightmares often are under some type of stress during their waking hours. They typically awaken abruptly and appear frightened. The key component of nightmares is that the person typically has vivid recall of what the nightmare was about. They also have trouble returning to sleep.
Children and adults who suffer night terrors, on the other hand, have no recall of their events. Night terrors are found in about five percent of kids three to 12 years old and in about three percent of adults, usually prior to age 65.
These people typically sit up suddenly in their beds and usually scream or yell. They tend to be inconsolable for about 15 minutes. They often show physical signs of fright such as elevated heart rate and rapid breathing. Adults may jump out of bed and run around the house and sometimes commit violent acts.
In contrast to nightmares, night terrors occur during deep sleep (stage 3 or 4), usually in the first third of the night. The depth of sleep accounts for the absence of memory of the events. These people also typically have no problem falling back to sleep after the terror passes.
The best thing to do for night terrors is to stay with the people during the attacks to ensure they don’t endanger themselves. You can try to wake them up, but they are usually very difficult to arouse and tend to be very confused. Children who have severe episodes may benefit from medications like diazepam (Valium®).
Two other interesting parasomnias are sleepwalking (somnambulism) and sleep talking (somniloquy). These are usually found in children between the ages of six and twelve and are more common in boys. They also manifest in the deeper stages of sleep. These kids usually sit up or get out of bed with their eyes open, but appear “unseeing.”
Most children outgrow these conditions by adolescence, but they can persist into adulthood. Similar to night terrors, the main concern with these kids is the possibility of injury. Their bedrooms should be on the first floor if possible and the doors and windows in the home should be safely secured with devices that can easily be opened by an awake person in case of fire or other emergency.
Again, children usually outgrow these problems. Some people recommend keeping a log of when the sleepwalking occurs and then waking the person 15 minutes before that time each night. This has been shown to be about 80 percent effective in terminating the condition.
There are many conditions that can be associated with parasomnias, particularly in adults. The most common are sleep deprivation, elevated thyroid hormone levels, migraine headaches, head injury, stroke, physical or emotional stress, travel, sleeping in unfamiliar surroundings, certain medications, and alcohol or substance abuse.