What Are Night Terrors? Symptoms, Causes, Diagnosis, Treatment, and Prevention

You wake up in the morning in a cold sweat, bedsheets strewn on the floor, and a concerned partner who recounts your screaming, thrashing, and kicking the night before. While most of us look forward to sweet dreams and a relaxing slumber after a long day, those of us who suffer from night terrors are anything but at ease.

While night terrors typically afflict children, this parasomnia sleep disorder can also be found in about 2 percent of adults in the United States, according to the American Academy of Sleep Medicine (AASM).

Night terrors, which are also known as sleep terrors, are classified as an arousal disorder, according to the Sleep Foundation. The person experiencing a night terror will suddenly show signs of panic and terror while sleeping, including screaming, flailing, or kicking.

“You’re breathing rapidly, your heart rate is accelerated, and your speech is mumbled. If a bed partner or parent tries to interrupt the episode, you might lash out. But you’ll have no memory of it,” says Tim Roehrs, PhD, the director of research at the Sleep Disorders and Research Center of the Henry Ford Health System and a professor of psychiatry at Wayne State University in Detroit.

They’re not to be mistaken with nightmares, says Michael Breus, PhD, a diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine.

“Most people confuse the terms. Nightmares are dreams that often involve persecution, and where people wake up feeling scared and will remember them the next day. Night terrors are where a person — usually a child — will sit up, scream, and then go back to sleep. They have little to no memory of it the next day,” Dr. Breus says.

According to the Mayo Clinic, someone having a sleep terror episode might take these actions:

• Cry out, shout, or scream
• Open their eyes, sit up, or get out of bed
• Appear frightened
• Have a rapid pulse and heavy breathing
• Be sweaty or flushed
• Thrash and kick
• Be hard to wake up or comfort
• Become confused or combative if awakened
• Not remember what happened

We cycle through stages of rapid eye movement (REM) and non-REM sleep throughout the night, and night terrors occur during deep non-REM sleep. They appear to come from a problem moving between the different stages, says Vaishal Shah, MD, a pediatrician and sleep specialist at the Cleveland Clinic Center for Pediatric Pulmonary Medicine.

“We get stuck in between this transition between the deepest stages of sleep and a lighter REM sleep,” Dr. Shah says.

According to the AASM, night terrors can be set off by these triggers:

• Fever
• Sleeping with too much light or noise, or in an unfamiliar environment
• Exhaustion or sleep deprivation
• Physical or emotional stress
• Migraine
• Head injury or brain swelling
• Other sleep disorders
• Certain medications and alcohol

Stress and sleep deprivation tend to be the most common culprits for the onset of night terrors in adults, Dr. Roehrs says. By the time adults get to bed, they may fall into a very deep sleep with difficulty transitioning between the sleep stages.

Genetics may play a role in night terrors, too. According to the Sleep Foundation, kids are more likely to have them if they have a parent or sibling who also had them or another parasomnia, such as sleepwalking.

It’s not uncommon for someone with sleep terrors to also have another parasomnia, like sleepwalking or sleep talking.

Most children outgrow night terrors, making them a rarity by the time they get to adolescence and adulthood. However, you should seek medical advice if your night terrors are disrupting yours — or your bed partner’s — sleep, says Breus.

The Sleep Foundation recommends speaking to a sleep specialist under certain circumstances:

• Having night terrors more than once a week
• Endangering or injuring yourself during a night terror
• Also walking or talking in your sleep
• Being overly tired or having trouble functioning during the day

To diagnose sleep terrors, your evaluation will include multiple elements.

A Physical Exam Your doctor will review your medical history and any prescription medications you may be taking, and conduct a physical exam.

Discussion of Your Symptoms Your doctor can usually diagnose sleep terrors after you describe what’s been happening, according to Shah. They may also ask about your family history of sleep problems, have you keep a sleep diary, or have you fill out a questionnaire about your sleep behaviors.

A Sleep Study (Polysomnography) In some cases, your doctor may refer you to a sleep lab for an overnight study. Sleep specialists will place sensors on your body to record and monitor brain waves, oxygen levels in your blood, your heart rate and breathing, as well as eye and leg movements while you sleep and transition through the sleep cycles.

It’s important to rule out other things that could be triggering or worsening your sleep terrors:

• Another sleep disorder
• Alcohol or other substance abuse
• A medical condition, illness, or injury
• Medication
• A mental health disorder like post-traumatic stress disorder

Children may have a single night terror or several before they stop. But for the most part, children will outgrow night terrors on their own as the nervous system matures.

Night terrors in adults are rare and usually infrequent. Only about 2 percent of American adults encounter them, Breus says.

Night terrors aren’t typically treated, especially if they happen infrequently, Shah says.

However, if they’re occurring on a regular basis, or they’re disruptive or dangerous to you or your family members, treatment options are available.

“Night terrors can disrupt family members’ sleep quite a bit, so there are things you can do at home to make sure children and adults have age-appropriate treatment options,” Shah says.

Treatment may include these options:

Thinking About Safety First As a preemptive measure, make sure the bedroom is a safe space for you and anyone sleeping close to you, Roehrs says. In children, this may mean avoiding bunk beds or installing a bedrail to prevent falls. For adults, it could mean blocking doorways or stairways with a gate, and moving sharp or fragile objects away from the bed.

Treating Any Underlying Conditions If your sleep terrors are tied to an underlying medical condition or another sleep disorder, such as obstructive sleep apnea, treatment for these problems can eliminate them. “Although it’s not common, you always want to make sure [that night terrors] are not a feature of brain problems,” Shah says.

Improving Your Sleep Hygiene Shah recommends creating an environment that will help you fall asleep and stay asleep, including removing simple triggers like loud noises or bright lights in the bedroom. Pay attention to whether you’re having caffeine too late in the afternoon or alcohol before bedtime. Aim for getting eight hours of sleep every night too — Roehrs notes that sleep deprivation can trigger an episode of night terrors. “Keep a sleep diary and log what you’re doing in the day before an episode to look for patterns,” he suggests.

Managing Daytime Stress If you’re grappling with stress or anxiety, your doctor may suggest therapy or counseling to address what’s causing it.

Practicing Anticipatory Awakening While you should not try to wake someone up while they’re having an episode, you can note what time of night one usually begins, and try to wake them up about 15 minutes before that. They can stay awake for a few minutes, then go back to sleep. You can also try waking them up about 45 minutes after an episode, asking them a few questions, and then having them return to sleep, Breus says.

Taking Medication Medication is rarely used to treat sleep terrors in children and adults. However, if they’re used, certain sedatives or antidepressants can be effective. “It’s not a common practice and saved for highly frequent episodes — you want to do it under medical supervision,” Shah says.

According to the Mayo Clinic, sleep terrors can cause complications:

• Disturbed sleep for you and your loved ones
• Excessive sleepiness during the day, which can cause problems at school or work
• Embarrassment and stress
• Injury to yourself or others

According to the AASM, night terrors are rare in adults, affecting about 2 percent of people. They’re more common in children, although estimates vary as to how prevalent the disorder is. The AASM reports that up to about 6 percent of children may experience night terrors on a regular basis. While in a survey published in JAMA Pediatrics, more than one-third of parents with 18-month-olds said their children had night terrors.

Most of the time, night terrors disappear on their own as children grow up.

Sleep terrors are a type of parasomnia, which according to the Sleep Foundation, is a catchall term for unusual behaviors that people experience prior to falling asleep, while asleep, or in the period between sleep and wakefulness. Shah says that the most common parasomnias related to night terrors are sleepwalking and sleep talking. In both instances, they typically happen infrequently.

Research also suggests that night terrors are more likely to happen if someone is experiencing other conditions:

• Obstructive sleep apnea
• Restless legs syndrome
• Post-traumatic stress disorder
• Sleep deprivation and extreme fatigue