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night terrors ( sleep terrors , pavor nocturnus )

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Night terrors (also called sleep terrors) are a disturbed state of consciousness related to sleepwalking, in which the child wakes in the night, often with a scream, appears extremely frightened, and is difficult to contact. The child remembers nothing the next morning. Night terrors characteristically occur in the first third of the night and are an arousal disorder (usually with a scream and signs of intense fear and autonomic arousal, and the patient is unresponsive to comforting).

Parents should resist trying to awaken and comfort a child in a night terror as wakening may increase the child's disturbance. The most appropriate response is to help the child settle when the acute episode dies down or if child wakens at the end of it.

Night terrors - summary features:

  • are recurrent episodes of abrupt awakening from deep non-REM sleep
  • usually in first third of night (1,2)
  • they may sit up in bed and sometimes engage in automatic behaviour associated with fear and escape
  • usually no detailed recall, and if the patient wakes from a terror (not common), there is confusion and disorientation and only a vague memory of fear (1,2)
  • night terrors are common in children with 30– 40% having at least one episode and repeated episodes in about 5%
  • peak age for these is at about 2–7 years with a gradual diminution up to early adolescence
    • in some cases they persist into adult life; the prevalence in adults is unknown - almost all adult patients have had night terrors or sleepwalking as a child
    • there is a strong genetic component
    • night terrors and sleepwalking in the same patient is fairly common (2)
  • seek expert advice re: management

The cycle of night terrors occurring at regular times can often be broken over the course of a week by waking the child before each episode is due and keeping him or her awake for a few minutes (Lack, B. Novel and non-toxic treatment of night terrors. Br Med J 1988; 297:592).

  • this approach is one of pre-emption, by waking up the child before the night-terror. Initially, over a week or so, a record is kept of the exact time the night terrors occur, which is often around two hours into sleep and fairly constant. Then, for the next few nights the child is gently woken about 15 minutes beforehand, for about five minutes, and allowed to return to sleep. The likelihood of a night terror occurring on these nights is reduced and, with the pattern having been broken, it is claimed that the night-terrors are less likely to return on the following nights when the child sleeps through the night without interruption. However, all that may happen is for the night-terror to re-schedule itself elsewhere in sleep

Note that night terrors are quite common in young children and are often outgrown (1).

Reference:

  1. Parasomnias: epidemiology and management. CNS Drugs. 2002;16(12):803-10.
  2. Wilson S et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019 Aug;33(8):923-947

Last edited 05/2020 and last reviewed 11/2020

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