Understanding Night Terrors: Causes, Symptoms, and Prevention

Night terrors, also called sleep terrors, are a type of parasomnia characterized by purposeful behaviors outside conscious awareness. They are abnormal activities during sleep. Night terrors symptoms include a cry or scream, accompanied by signs of intense fear like rapid heart rate, breathing, sweating, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. To prevent night terrors, maintain a regular sleep schedule, create a comfortable sleep environment, limit stress, avoid triggers like late-night eating and sleep deprivation, and understand the role of mental activity.

What Are Night Terrors?

Night terrors, also known as sleep terrors, are a type of parasomnia—an abnormal activity that can occur during sleep. They are characterized by complex behaviors that may seem purposeful and goal-directed, but are actually outside the conscious awareness of the individual experiencing them.

Night terrors are different from nightmares. They typically occur during the first few hours of sleep, during the deep non-REM sleep stage. A person experiencing a night terror may scream, shout, thrash around, and exhibit signs of panic and fear. However, they usually don’t remember the event upon waking.

Research suggests that night terrors may be associated with certain personality and psychoneurotic characteristics. For instance, individuals with night terrors often score high on hysteria and anxiety scales. However, it’s important to note that the occurrence of night terrors doesn’t necessarily indicate a psychological problem.

A study using high-density EEG (hdEEG) found that individuals with sleep arousal disorders, including night terrors, exhibited a localized decrease in slow wave activity (SWA) power over centro-parietal regions of the brain during non-REM sleep. This suggests that there may be specific neurological characteristics associated with these disorders.

Night terrors affect individuals across various age groups, with the prevalence varying significantly. In children under the age of 5, night terrors can be quite common, with studies indicating that up to 40% may experience these episodes. As children grow older, the prevalence of night terrors tends to decrease. For instance, in children aged between 1 to 12 years, the occurrence of sleep terrors is estimated to be between 1 to 6.5%, with a peak between the ages of 5 and 7.

In adolescents, night terrors are less common, although specific prevalence rates are not readily available. For adults, while exact figures are not explicitly stated in the available literature, it is generally understood that night terrors are less common than in children. However, it’s important to note that the prevalence of sleep disturbances, including nightmares, can increase with age.

These episodes can significantly impact sleep and overall well-being, regardless of the age of the individual experiencing them.

illustration of night terror

What Are The Symptoms of Night Terrors?

Night terrors symptoms may include a cry or piercing scream, accompanied by signs of intense fear like rapid heart rate, rapid breathing, sweating, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone.

It may be difficult to wake up and console someone experiencing a night terror, and they may express feelings of anxiety or doom1. 

Night terrors, occurring during short-wave sleep, are often forgotten the next day due to reduced activity in the neocortex, the brain’s center for higher mental functions.

Why Does Night Terror Happen?

The exact cause of night terrors is not fully understood, but research suggests they may be linked to localized changes in neuronal excitability in certain regions of the brain. A study using high-density EEG found that individuals with sleep arousal disorders, including night terrors, showed a localized decrease in slow wave activity (SWA) power over centro-parietal regions relative to the rest of the brain. This decrease in SWA power was prominent at the level of the cingulate, motor, and sensorimotor associative cortices.

It’s important to note that while some individuals with night terrors have a history of major psychological trauma, this is not the case for all patients. In fact, a study found that a history of major psychological trauma existed in only a minority of adult patients presenting with sleepwalking/night terror syndrome.

Are Night Terrors Harmful?

While night terrors can be distressing to witness, they are generally not harmful. it’s worth noting that chronic sleep disturbances, such as frequent night terrors, could potentially have indirect effects on health and well-being. For example, they could lead to daytime sleepiness, which might affect performance at school or work, or increase the risk of accidents.

If night terrors are causing significant distress or disruption, it may be worth seeking advice from a healthcare professional.

Do Night Terrors Affect Your Sleep?

Yes, night terrors can indeed impact your sleep significantly. These are a type of sleep disorder, specifically categorized under parasomnias, which occur during the non-rapid eye movement (NREM) sleep stage

Although brief, usually not lasting longer than a few minutes, the effects of night terrors on sleep quality and duration can be substantial. They may result in interrupted sleep cycles, leading to not getting enough sleep. Consistently disrupted sleep can then have knock-on effects on daytime function, causing problems like poor performance at school or work, mood disorders, and overall lower quality of life.

The condition can sometimes be mistaken for other sleep disorders such as sleep apnea, specifically obstructive sleep apnea. This is where a sleep medicine specialist’s role becomes critical. They can help differentiate between these conditions, often using a sleep study to accurately diagnose the problem.

How to Prevent Night Terrors?

There are several strategies that may help in preventing night terrors.

  1. Maintain a Regular Sleep Schedule: Ensuring that you have a consistent sleep schedule can help regulate your body’s internal clock and enhance the quality of your sleep. This can potentially reduce the frequency of night terrors.
  2. Create a Comfortable Sleep Environment: Make sure your sleeping environment is quiet, dark, and cool. You might also want to consider investing in a comfortable mattress and pillows.
  3. Limit Stress: High stress levels can contribute to night terrors. Therefore, incorporating stress management techniques such as deep breathing, yoga, or meditation into your daily routine can be beneficial.
  4. Avoid Certain Triggers: Certain factors such as late-night eating, certain medications, and sleep deprivation can trigger night terrors. Avoiding these triggers can help prevent night terrors.
  5. Consider Co-Sleeping: A study conducted by Sean D. Boyden, M. Pott, and P. Starks suggests that co-sleeping with children (≥1-year-old) may prevent night terrors. They argue that from an evolutionary perspective, co-sleeping provides health and safety benefits for developing children1.
  6. Understand the Role of Mental Activity: A study by A. Castelnovo, G. Loddo, F. Provini, S. Miano, and M. Manconi found that adults often recall at least one mental experience associated with their night terrors, such as vivid hallucinatory experiences or dissociative experiences2. Understanding these experiences can provide insights into the nature of night terrors and potential prevention strategies.

Remember, it’s important to consult with a healthcare provider if you or your child are experiencing frequent night terrors. They can provide guidance and help determine if there’s an underlying condition that needs to be addressed.

Night terrors vs Nightmares

Night terrors and nightmares are both sleep disturbances, but they differ in several key aspects.

Night terrors, more common in children, are sudden fearful reactions that occur during transitions from one sleep phase to another. They are characterized by a cry or piercing scream, accompanied by manifestations of intense fear, such as sweating, rapid heart rate, and confusion. Unlike nightmares, night terrors are not technically dreams and individuals usually have no recall of the event upon waking. They are often more dramatic than nightmares and can be difficult to fully wake up from.

On the other hand, nightmares are vividly distressing dreams that can result in awakening and negative feelings, such as fear, terror, or anxiety. They are more likely to be remembered upon waking and can occur at any age, with research suggesting an increase in frequency with age.