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Pavor Nocturnus – Sleep Terrors: Causes and Treatment

Pavor nocturnus, or sleep terror, is a sleep disorder in which a person suddenly wakes in apparent panic, screaming and showing signs of intense fear, without fully regaining consciousness.

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Things worth knowing about "Pavor nocturnus"

Pavor nocturnus, or sleep terror, is a sleep disorder in which a person suddenly wakes in apparent panic, screaming and showing signs of intense fear, without fully regaining consciousness.

What is Pavor nocturnus?

Pavor nocturnus, commonly known as sleep terror or night terror, is a type of parasomnia -- a sleep disorder characterised by abnormal behaviours or experiences during sleep. It occurs most frequently in children but can also affect adults. During an episode, the affected person appears to wake up in a state of intense fear, often screaming and showing signs of panic, yet they are not fully conscious and typically have no memory of the episode the following morning.

Causes

Sleep terrors occur during deep non-REM sleep (stage N3) and are triggered by incomplete arousal from this stage. While the exact cause is not fully understood, several contributing factors have been identified:

Genetic predisposition: A family history of parasomnias is a well-recognised risk factor.
Sleep deprivation: Insufficient or irregular sleep can trigger episodes.
Stress and emotional strain: Particularly relevant in children, but also in adults.
Fever: Elevated body temperature may precipitate parasomnia episodes.
Certain medications: Sedatives, antidepressants, and other drugs may increase the risk.
Sleep apnoea and other sleep disorders: Disruptions to normal sleep architecture can predispose individuals to sleep terrors.

Symptoms

An episode of pavor nocturnus typically lasts between a few seconds and up to 15 minutes. Common features include:

Sudden, loud screaming or crying during sleep
Sitting upright in bed with eyes wide open
Intense fear, panic, and confusion
Rapid heartbeat, fast breathing, and sweating (autonomic arousal)
Unresponsiveness to attempts at comfort or communication
No recollection of the episode the next morning (amnesia)

Diagnosis

Diagnosis is typically clinical, based on a thorough description of the episodes and the individual's medical history. The following steps may be involved:

Detailed medical history: Questioning the patient and, if relevant, family members about the nature and frequency of episodes.
Sleep diary: Recording sleep times and any nocturnal events.
Polysomnography: A sleep study may be performed to rule out other sleep disorders, such as sleep apnoea or nocturnal epilepsy.
EEG: Used when epileptic seizures need to be excluded as a differential diagnosis.

Treatment

General Measures

In children, sleep terrors often resolve on their own as the child matures and usually do not require specific treatment. Parental reassurance and education about the benign nature of the condition are the most important first steps.

Sleep Hygiene and Behavioural Strategies

Maintaining consistent sleep and wake times
Reducing stress and anxiety in daily life
Avoiding sleep deprivation
Establishing a calm and relaxing bedtime routine

Medication

In severe or recurrent cases, especially in adults, the following treatment options may be considered:

Benzodiazepines (e.g. clonazepam): May reduce the frequency of episodes, but are suitable for short-term use only.
Tricyclic antidepressants (e.g. imipramine): Occasionally used in adult patients.
Psychotherapy: Cognitive behavioural therapy can be helpful when stress is a significant trigger.

Distinguishing Sleep Terrors from Nightmares

Sleep terrors are often confused with ordinary nightmares, but the two differ significantly. Nightmares occur during REM sleep, are usually recalled upon waking, and do not typically involve intense physical arousal. Sleep terrors, by contrast, arise from deep non-REM sleep, leave no memory trace, and are associated with marked autonomic activation such as a racing heart and sweating.

References

American Academy of Sleep Medicine (AASM) - International Classification of Sleep Disorders, 3rd edition (ICSD-3), 2014.
Mindell, J. A. & Owens, J. A. - A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, 3rd edition, Lippincott Williams & Wilkins, 2015.
National Institute of Neurological Disorders and Stroke (NINDS) - Sleep Disorders Information Page. Available at: https://www.ninds.nih.gov

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