Night terror (child and adult): what is it and how to treat it?

What is night terror?

Night terror is a type of parasomnia (sleep disorder) much like sleepwalking. The person has several episodes in which he squirms in bed, screams and cries uncontrollably, and he does not remember anything the next day.

During an episode, the person moans, gets a look of dread on his face, shifts in bed, sits, screams, opens his eyes, runs around the house and cries inconsolably.

These episodes last for about 5 minutes and end naturally, on their own. There is nothing that third parties can do to alleviate the situation.

This disorder is much more common in children. Adults, during an episode, tend to be more aggressive and, unlike children, often remember small snippets of what happened during the night.

Like other parasomnias, as in nocturnal paralysis, the person affected by night terror may have visions. There are reports of people who saw animals and other beings during the episodes, but it is important to remember that these views are not real but caused by the problem.

Nocturnal terror tends to terrify parents and those around them more than the person having the episode itself, as they do not remember what happened. This parasomnia does not cause many complications and is practically harmless.

Its causes are still a mystery, but it is known that the problem has plagued humans since ancient Greece.

Like sleepwalking, in children, episodes of night terror tend to disappear as they grow older. However, it is often necessary to take some precautions so that the person who is having an episode does not get hurt.

It can be found in the International Classification of Diseases (ICD-10) through code F51.4.

Causes

The causes of night terror are still unknown, but researchers speculate that extreme anxiety , stress and intense conflicts, whether conscious or unconscious, facilitate the onset of attacks.

In the case of night terror in children, the group with the highest incidence of this phenomenon, the most accepted hypothesis is that the episodes are related to the development of the Central Nervous System (CNS).

Experts argue that it is as if the brain is not yet mature enough to make the transition between sleep and waking up correctly. Therefore, the child would be in a kind of “limbo” between the stages of sleep and wakefulness.

This thesis has not yet been scientifically proven, but based on it, researchers also assume that problems in the CNS may cause this disorder.

What is known so far is that, in adults, episodes of night terror are more common in anxious or depressed people. This theory takes into account the counterproductive role of cortisol (“stress hormone”, produced in cases of anxiety) in moments of sleep.

Risk factors

Determining what are the risk factors for episodes of night terror to manifest itself is a complicated task. This is due to the fact that we still do not have an answer to what causes night terror.

Still, it is possible to outline some factors that can increase the susceptibility to the occurrence of attacks. Among them are:

Anxiety and depression

In recent years, it has been found that people who have some anxiety disorder, depression or anxiety combined with depression are more likely to have episodes of night terror.

In the case of anxiety, this may happen due to the large amount of cortisol (“stress hormone”) released by the anxious patient during the day, causing his nighttime activities to be hindered by the excess of this substance in the body at bedtime.

Depression, on the other hand, causes its patients to experience a decrease in the production of certain neurotransmitters important for well-being, such as serotonin .

What happens, according to experts, in cases of chronic depression and anxiety, is that the patient already has a negative cognitive tendency, that is, he tends to see things more on the bad side than on the good side.

It is not yet known why depression, in many cases, arises in conjunction with anxiety disorders, but there are some hypotheses.

As depressed and anxious people experience many mood swings, they can enter what experts call the vicious circle of mood.

In these cases, the patient thinks negatively, his neurons become accustomed to making connections that provide pessimistic thoughts and, as a result, more negative thoughts tend to occur.

When the regulation of neurotransmitter levels, such as dopamine, norepinephrine and serotonin, and hormones, such as cortisol, is unbalanced, the patient is more likely to develop some type of parasomnia (sleep disturbances), such as night terror.

Experts still speculate, based on evidence, that frequent episodes of night terror may be an indicator that the patient will develop an anxiety disorder in the future.

Therefore, although it is not known for sure which came first, anxiety and depression or night terror, it is possible to state with a certain degree of certainty that there is a great correlation between the two.

Age

There is a higher prevalence of episodes of night terror in children. Between 10% and 15% of children between 3 and 8 years of age are said to have at least 1 episode of night terror per year.

In adolescents, these rates fall to 5% to 10% and in adults it is 1% to 5%, with no significant difference between men and women.

Stress

There is a still poorly understood relationship between stress and episodes of night terror. Often, the phenomenon occurs after a conflicting and troubled day. Events in which there is a predominance of feelings of insecurity and helplessness can also be a trigger for episodes.

Restless legs syndrome

The restless legs syndrome is a feeling of discomfort, not painful, which is accompanied by an irresistible urge to move the lower limbs. The patient who suffers from this problem usually reports feeling “agony” in the legs, “itching” in the bones, pinpricks or the sensation of insects walking through the legs.

These symptoms tend to appear or worsen only when the individual is at rest, trying to rest, disappearing as soon as he moves. They worsen excessively at night, especially when the person lies down.

It is possible to see involuntary movements of the fingers or toes when the individual is sitting or lying down and this restlessness can often be misinterpreted as nervousness.

Because of this series of symptoms, the person with the syndrome has difficulty sleeping and staying asleep. About 80% of people who suffer from this condition have periodic involuntary movements during the night. When they are sleeping, these “pulls” happen multiple times, with intervals of 20 to 30 seconds between them.

This makes people feel tired and sleepy during the day, increasing irritability, stress, depressive symptoms and difficulty with concentration and memory.

It is these symptoms and complications that can cause a person with restless legs syndrome to develop nighttime terror.

However, it is very important that this disorder is not confused with certain rhythmic and repetitive movements that appear when we are distracted or anxious.

There are people who swing their legs when they read, write or watch television, but that has nothing to do with restless legs syndrome. They are nothing more than simple pieces that disappear as soon as the person realizes them.

Migraine

In recent years, scientists have observed a rather curious correlation between migraine and sleep disorders. They noticed that the circadian rhythm (the biological cycle, corresponding to about 24 hours) of a person who suffers from this problem differs greatly from those who do not.

To give you an idea, recent studies have shown that 8.3% of children and adolescents who suffer from migraine also have changes in sleep patterns, while this happens in only 2.35% of children without this problem.

This has serious consequences for a person’s life, because, in addition to suffering from headaches, the person may feel more tired, depressed, anxious and have difficulty dealing with stressful situations, in addition to decreasing their productivity on a daily basis. morning.

It is these changes in the circadian cycle that can lead a person to develop sleep disorders, such as night terror.

Sleep deprivation

As in other cases, staying without sleep for a long time can alter the circadian cycle, leading to sleep disturbances and changes.

Obstructive sleep apnea

Obstructive sleep apnea is a respiratory arrest that occurs when there is a collapse (obstruction) of the walls of the pharynx. This disorder occurs mainly when the person is asleep and snoring .

When apnea happens, the person stops breathing and stops snoring due to the blockage of the air passage through the pharynx. In adults, breathing stops for about 10 seconds, on average, and these episodes occur about 5 or more times every hour.

In addition to bringing consequences such as decreasing blood oxygenation (which can lead to vascular problems in the future), apnea can cause changes in the sleep cycle, which can lead to disorders such as night terror.

Fever

There are very rare cases where children suffer 2 or 3 episodes of night terror each night. This is due to a very peculiar combination of symptoms and usually happens after a night of sleep deprivation.

During the day, the child may experience high fever , drowsiness and irritation, causing episodes to happen at night. This type of case is more rare, but more serious and medical help should be sought if something like this happens.

Family history

It has been found that children whose parents have sleep disorders such as talking while sleeping or sleepwalking are more likely to have episodes of nighttime terror.

Read more: What are the causes and symptoms of sleep paralysis?

Symptoms

Symptoms of night terror are typical and easily identifiable. Most of the time, when observing a patient who is going through an episode of night terror, one can have the impression that some serious anomaly is happening.

Because of this, there are several reports of mothers who despair when they see their child having an episode of night terror, although the disorder does not harm the child’s learning and normal development.

Even so, watching a person going through an episode can be alarming, since, during the episode, the individual begins to squirm intensely in bed, moan and show other symptoms such as:

  • Facial expression of dread and intense fear;
  • Sit on the bed;
  • Keep an open and fixed gaze;
  • Cry inconsolably;
  • Awaken abruptly with a shout;
  • Kicking and struggling in bed;
  • Behave aggressively towards yourself, objects and other people around you;
  • Presenting wheezing;
  • Lack of responsiveness to the efforts of others who try to control the individual’s impulses during the attack.

In addition, other more subjective and subtle symptoms can also be noticed. Although they are not as disturbing as the others, they are signs that the person is probably experiencing episodes of night terror. Are they:

  • Intense sweating;
  • Recurrent episodes of sudden awakening in the first hours of sleep;
  • Palpitations;
  • Tremors;
  • Suffocation sensation;
  • Difficulty remembering dreams;
  • Total amnesia related to the episode.

Most of the time, people who go through episodes of night terror do not remember what happened during the night. As much as they show aggressive behavior, this is not the person’s fault, but the disorder, which makes them terrified and tries to defend themselves from imaginary risk situations.

Ritmos Circadianos

The circadian rhythm is nothing more than the 24-hour cycle in which the activities of the biological cycle of living beings are completed. Also known as the circadian cycle , its name is the Latin problem ” circa diem” , which means “about 1 day”.

Its main function is to regulate the “biological clock” of living beings, controlling functions such as sleep and appetite. In our brain, there is a kind of “internal pacemaker”. It is located in a place called the suprachiasmatic nucleus, which is in the hypothalamus, a region that connects the nervous system to the endocrine system.

During the 24 hours of operation of the body, each organ of the body reaches its peak of functioning, which guarantees a kind of self-cleaning of the body. In this way, the circadian cycle acts, ensuring that the organism is always well regulated.

Poor regulation of the body means that the whole body does not function properly, and this includes both functions such as digestion and sleep.

Is night terror the same as nightmare?

O Pesadelo – Johann Heinrich Füssli

No,  night terrors and nightmares are not the same . Both have similarities, it is true, but they are two different things.

The first and main difference between the two is the moment they occur. While nightmares occur during a moment of sleep called REM, nighttime terror occurs when the person has not yet reached that stage of sleep.

But what would REM be? It’s very simple. REM is an acronym that comes from English and means Rapid Eyes Moviment , or, in free translation, Rapid Eye Movement. It is during this phase that the most vivid dreams happen.

When we are in the REM sleep stage, the eyes move quickly and the brain activity is similar to that which occurs during the hours when you are awake. However, all the rest of the body’s muscle activity is blocked in this period. This stage usually happens at the end of dawn, when we have been sleeping for many hours straight.

This process happens several times during sleep and, therefore, we can say that we have several dreams, although in most cases we can only remember one of them, especially the last one at night.

Sleep science experts argue that this process is very important for our brain to be able to discard and select memories, especially those we experience during the day or in the past weeks and months.

Therefore, a dream can be a faithful reflection or, in most cases, symbolic, of what occupies our mind, consciously or unconsciously, such as our ambitions, desires and achievements or, in the case of nightmares, our fears, afflictions and tragedies.

Night terror, on the other hand, happens in the first moments of the night, between 15 minutes or 2 hours after starting to sleep, when the person has not yet reached the REM stage.

In addition, unlike nightmares, in which people more or less remember what happened during the dream, in most cases of night terror, the person has no idea what happened during the night.

In nightmares, a person tends to wake up on his own, in fear and is also easily awakened by others. Not in the night terror. In it, behavioral manifestations of extreme fear begin, characterized by a semblance of terror accompanied by cries, screams and moans unable to be interrupted by third parties.

When nocturnal terror occurs, it is common, even, that the person struggles, feels or even flees from the bed or the bedroom. In extreme cases, she may exhibit destructive and aggressive behavior directed at objects, herself or others.

The episodes of night terror last about 1 to 10 minutes and culminate in an intense and abrupt awakening accompanied by a scream of panic and rapid breathing.

Another difference is found in the physical signs. In episodes of night terror, they are much more evident and extreme than those of a common nightmare. Symptoms such as increased respiratory rates, sweating and pupil dilation are common.

How is the diagnosis made?

The diagnosis can be either simple or require a higher investigative degree. When there is suspicion, the doctor will usually do a physical examination, where he will analyze physical aspects.

In addition, the doctor will ask a series of questions to find out what happened at the events, in addition to the patient’s history, cases of sleepwalking or other sleep disorders in the family. It may happen that he asks people close to you, such as the partner you share your bed with, for more details.

For more difficult cases to diagnose, the doctor may still order another test. Understand:

Polissonography

Polysomnography, also known as “sleep examination”, is performed to detect possible changes in the sleep of adults or children.

Contrary to what many people think, it is an easy test to do. In it, sensors are placed on the skin with the use of antiallergic bandages just before the patient falls asleep.

During the night, then, these devices record brain waves, the level of oxygen in the blood, the heart and respiratory rate, as well as the movement of the eyes and legs during the period in which the patient is sleeping.

In some cases, it is quite uncomfortable because of all the sensors placed on the body, in addition to being usually performed in an environment different from what the patient is used to sleeping. However, it is very effective, since all the information collected allows data to be organized and sleep analysis in real time.

Through this exam, the doctor will be able to diagnose any parasomnia, including night terror, with more certainty, which will serve as a guide for him to make the treatment as effectively as possible.

Is there a cure?

In most cases, which occur in children, night terror tends to disappear on its own as children grow. In adults, on the other hand, this problem can last for some time.

The problem is that it is not known for sure what causes night terror, so the treatment options are also somewhat vague and it is not possible to say with certainty that this condition can be cured.

While some patients will have isolated episodes, others will be forced to live with the disease for the rest of their lives. Therefore, most doctors and therapists who will treat this problem suggest alternative treatments such as yoga and meditation.

What is the treatment?

As stated earlier, in most cases, treatment is not necessary. However, there are many people who are chronically affected by the disease.

In addition, as we saw in the topic “Anxiety and depression”, nighttime terror can be an indication that the patient will suffer from anxiety disorders. Therefore, seeking help is very necessary.

The cases in which treatment is necessary are those in which there is the potential for the patient to hurt himself or others, in the event that the disorder causes disruption to family relationships or in cases where it results in embarrassing situations, which make the patient uncomfortable with the situation.

Treatment options include:

Focus on possible causes

In the topic “Risk factors”, we saw that night terror can be caused by several conditions, such as stress, anxiety, depression and some syndromes. Therefore, in these cases, we seek to treat these symptoms in order to find an improvement.

Therefore, we can say that the most medicated and clinical treatments will seek to treat the following pathologies:

  • Anxiety;
  • Depression;
  • Restless legs syndrome;
  • Migraine;
  • Obstructive sleep apnea.

In cases of anxiety and depression, benzodiazepine medications and some antidepressants can be used.

Treatments for stress

If the possible cause for episodes of night terror is stress, techniques to alleviate this symptom may be recommended. In these cases, cognitive-behavioral therapy techniques are especially indicated . Other treatments may include:

  • Hypnosis sessions;
  • Meditation;
  • Acupuncture.

Early awakening

This treatment involves waking the patient who suffers from night terror about 15 minutes before the time when he usually presents the episode. Soon after, the person goes back to sleep.

Medicines

There are no specific medications to treat night terror , however, in cases where night terror affects patients’ day, some low-dose anxiety medications, such as clonazepa m , and tricyclic antidepressants, such as doxepine, can be prescribed forpatients.adults and, very rarely, for children.

These medications are not intended to combat night terror itself, but rather the other factors that, in addition to the symptoms and complications themselves, may be responsible for the incidence of the episodes.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

An interesting tip for both children and adults who suffer from episodes of night terror is to keep an eye on the regular sleeping and waking times. It is very important to avoid sleep deprivation in order to guarantee a regulated circadian cycle.

Sleep disorders, in general, tend to decrease in frequency according to the improvement in the regularity of bedtime and waking hours. In addition, the consumption of fatty foods, meats, coffee, dairy products and other foods that are difficult to eat should be avoided at night.

While impressive, night terror is not as much of a problem as it may seem. Therefore, we will share this topic with tips on how to live together both for parents of children who suffer from the problem and for people who have to live with the episodes. Check out:

For parents

It is quite uncomfortable to have to see your child living with the night terror, especially in cases where he shifts all over and even screams. The desire to protect the child tends to speak louder at these times and you, as a parent, just want it to stop.

However, it is very important not to despair at these times. One should not try to wake the child up  during an episode. This act increases the possibility of events becoming more frequent and intense.

The ideal is not to intervene and let the moment pass on its own. Episodes tend to last only a few minutes. So, as agonizing as they are, there is not much you can do to stop it.

Care should be taken, however, with children who also get up and walk when asleep. In such cases, care must be taken that there are no obstacles or sharp objects in the room.

Another important tip is to block access to stairs and windows. What should be done, for sure, in these cases, is to take measures to avoid possible accidents.

For adults who have night terror

Living with night terror is not easy. When episodes become recurrent and happen more than once a night, the person suffering from the problem may experience symptoms of sleep deprivation, which increases their levels of stress and irritability during the day.

What can be done in these cases is to seek some type of treatment. As stated in the topic “What is the treatment”, there are many ways to decrease the incidence of episodes and improve the quality of life.

Some people who suffer from the problem remember the episodes and even report that they saw animals or other beings. It is extremely important not to panic about these visions, if they happen. Try to keep in mind that they are nothing more than images made by your head and do not represent something that really happened.

Nowadays, many people report experiences with supernatural beings, spirits or extraterrestrials. This is normal. It happens due to the culture of each era, which scares most people.

Night terror is not new. There have been reports of these cases since ancient Greece and, in those times, the beings that “visited” people during the episodes were seen with different eyes, according to the culture of the time.

In the Middle Ages, for example, people reported being chased by demons and other types of hauntings. Nowadays it is no different. The episodes remain the same. What differentiates them is the type of “apparition”.

For people who live with someone who suffers from night terror, the tips are the same as for parents. Do not panic, do not try to wake up the person who is going through the episode and take steps to prevent accidents.

Keeping your cool and your head in place, always thinking of rational explanations, and taking the right precautionary measures are the best way to deal with the problem.

Prognosis

The prognosis for night terror is relatively good. Most of the time, in adults, these are isolated cases that, if recurrent, tend to disappear on their own within a few weeks.

For children, episodes can extend over the years, however they tend to disappear as soon as she enters adolescence.

Complications

Complications related to night terror generally involve problems related to sleep deprivation.

When episodes are recurrent and happen more than once in the night, the individual who suffers from the problem is unable to enter the REM stage of sleep, which results in a bad night’s sleep.

In these cases, the person wakes up tired, without the feeling of recovery that comes after a good night’s sleep, and presents a series of complications related to sleep deprivation and dysregulation of the circadian cycle.

Sleep deprivation can lead to complications such as:

  • Increased stress and anxiety;
  • Reduction of cognitive functions, such as difficulty concentrating and performing simple tasks;
  • Greater irritability;
  • Emotional instability.

An unregulated circadian cycle, on the other hand, causes problems for the organism as a whole. The organs are unable to reach their peak of functioning, so that “self-cleaning” process mentioned above in the topic “Circadian Rhythms” does not happen.

In the long run, this can trigger heart problems, high blood pressure, metabolic changes, obesity , increased propensity for diabetes and decreased immunity.

How to prevent

There is not exactly a prevention against night terror, however, it is possible to pay attention to the risk factors and try to do everything possible to reduce them. Check out some tips that can help:

Decrease stress levels

Nighttime terror has long been closely linked to high levels of stress in the child’s life. So a good way to try to stop episodes is to look for ways to slow them down.

Contrary to what many people think, stress does not occur only when children are exposed to necessarily bad situations. In reality, any very exciting event can trigger child stress, often causing the child to be naughty or tantrum, when in fact he just does not know how to deal with the situations.

Here’s what you can do:

  • Try to identify the cause of the stress and, if possible, try to alleviate the situation;
  • Don’t be overprotective. The child who is very protected does not develop immunity to stress;
  • Stress should be proportional to the child’s age and maturity. When this is not possible (as in the case of the death of a close family member), it is necessary to talk to the child and teach him how to deal with these situations in the best possible way.

Establish a sleep routine

It is very important for child development to have regular sleep schedules. One way to do this is to create routines that adjust your child’s sleep. For example, preventing her from sleeping too much during the day and favoring relaxing activities close to bedtime.

No going to sleep late

When the child goes to sleep very late, there are more chances of having episodes of night terror. Therefore, there is no conversation or treatment: bedtime is sacred and must be respected.

Common questions

Should I try to wake up the person who is going through the night terror episode?

No!  Whether you are a child or an adult, you should not try to wake them up, as this increases the chances of attacks happening again in the future with greater intensity. The average duration of an episode is 5 minutes.

Do not forcefully try to calm her down. If the child seeks your embrace, hug him back, but if he is very agitated, however difficult it may be, let him deal with the problem.

If you try to calm her down abruptly and even force physical contact, you may be able to have the episode go on for longer.

What you can do at these times is to let the crisis go on its own. In cases where the person gets out of bed and walks around, try to keep the place around him safe, in order to avoid accidents. I.e:

  • Lock the windows;
  • Prevent the person from accessing stairs;
  • Try to avoid obstacles in the person’s path;
  • Remove sharp and sharp objects from the path.

By following these instructions, you can prevent major accidents from happening. The person who is going through a night terror does not even know what is happening and is unaware of his actions. So stay calm and do your best to make the episode come to an end naturally.

Do night terrors hurt children?

As impressive as they are, night terrors are no harm to the child or adult who experiences them. In most cases, children and adults do not even remember the episode.

If the individual gets up and walks around the house, accidents can happen. The person may fall to the ground and have an accident in other ways. That is why it is so important, in these cases, to leave the environment around the person safe. Taking the necessary measures, this type of problem should not happen.

Now, something that is said little, especially in relation to young children with night terror, is the impact that the problem has on parents. While children are normal the next day, parents can often feel exhausted, tired and have problems during the day because they have been unable to sleep properly.

Many parents, even, begin to show changes in the sleep cycle because of the episodes, after all, the condition impresses and leaves parents constantly concerned about the child’s health and well-being.

Are parents to blame for episodes of night terror?

Definitely not!  Night terror is just something that happens. It is not yet known exactly why, but, as we saw in the topic “Risk factors”, there are some indications of the reason why night terrors happen and none of them is related to something that the parents did or did not do.


Despite being quite impressive, night terror is a practically harmless condition. What you should always do  is take care that the person who is suffering from an episode does not have an accident.

Is that you? Have you ever had night terror? Has your son ever had it? How did you handle the situation? Tell us in the comments!

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