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Night Terrors (Pavor nocturnus) – Causes & Treatment

Night terrors (Pavor nocturnus) are a sleep disorder in which affected individuals suddenly scream and appear confused without waking up. Most common in children aged 3 to 12.

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Things worth knowing about "Night terror"

Night terrors (Pavor nocturnus) are a sleep disorder in which affected individuals suddenly scream and appear confused without waking up. Most common in children aged 3 to 12.

What Are Night Terrors?

Night terrors, medically known as Pavor nocturnus, are a form of parasomnia – a group of sleep disorders characterized by unwanted behaviors or experiences during sleep. Affected individuals suddenly rouse from deep sleep, screaming loudly, appearing panicked or confused, yet are not truly awake. They respond minimally to attempts at communication and typically have no memory of the episode the following morning.

Causes

Night terrors occur primarily during the first hours of sleep, within the deep sleep phase (non-REM sleep). Possible triggers and causes include:

  • Sleep deprivation or irregular sleep schedules
  • Fever or illness, particularly in children
  • Stress and emotional strain
  • Genetic predisposition (known familial clustering)
  • Certain medications, such as sedatives or antidepressants
  • Sleep apnea or other sleep-related breathing disorders
  • Excessive alcohol or caffeine consumption in adults

Prevalence and Affected Groups

Night terrors primarily affect children between the ages of 3 and 12. Estimates suggest that approximately 1 to 6 percent of children experience night terror episodes. In most children, the disorder resolves spontaneously with age. Adults can also be affected, though this is less common and may indicate an underlying psychological or neurological condition.

Symptoms

Typical signs of a night terror episode include:

  • Sudden loud screaming or crying
  • Sitting or standing upright during sleep
  • Significantly elevated heart rate and rapid breathing
  • Sweating
  • Wide-open eyes with a fixed, glassy stare
  • Confusion and lack of responsiveness to others
  • No or very little memory of the event the next morning

Distinction from Nightmares

Night terrors are clearly distinguishable from ordinary nightmares. Nightmares occur during REM sleep, are usually vividly recalled, and frequently result in full awakening. In contrast, during a night terror the individual remains in deep sleep and retains no memory of the episode in the morning.

Diagnosis

Diagnosis is typically established through a detailed medical history, during which the physician discusses sleep habits, frequency of episodes, and family history. In unclear cases or when an underlying condition is suspected, a polysomnography (sleep study) may be performed to monitor sleep stages and physical responses during sleep.

Treatment

In most cases, particularly in children, no specific treatment is required. However, the following measures can be helpful:

General Measures

  • Maintaining regular sleep schedules and ensuring sufficient sleep
  • Establishing calming bedtime routines
  • Avoiding stress and excessive fatigue
  • Parents should not forcibly wake the child during an episode, but calmly remain nearby

Medical Treatment

  • In cases of severe or frequently recurring episodes, behavioral therapy or relaxation therapy may be recommended
  • In rare cases, short-term medication such as benzodiazepines may be used
  • Treatment of underlying conditions (e.g., sleep apnea) that contribute to night terrors

When to See a Doctor?

Parents should seek medical advice if episodes are very frequent or intense, if the child puts themselves at risk during an episode, or if night terrors occur for the first time in an adult. Medical consultation is also advisable when accompanied by symptoms such as daytime sleepiness or breathing pauses during sleep.

References

  1. American Academy of Sleep Medicine (AASM) - International Classification of Sleep Disorders, 3rd edition (ICSD-3), 2014.
  2. Mindell J.A., Owens J.A. - A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, Lippincott Williams & Wilkins, 2015.
  3. Stallman H.M., Kohler M. - Prevalence of sleepwalking: a systematic review and meta-analysis. PLOS ONE, 2016. PubMed.
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