Some people may suddenly wake during the night screaming, crying, or sitting up in bed with an intense look of fear, while appearing unaware of what is happening around them. They may then return to sleep without remembering the episode the next morning. This condition is known as Night Terrors, a type of sleep disorder that can be alarming for the person experiencing it and for family members, particularly when episodes occur frequently or are accompanied by sudden movements.Although Night Terrors can appear frightening, they are usually not a sign of a serious medical problem. They are more common in children and often decrease or disappear as the child gets older. However, understanding their causes, symptoms, and possible triggers can help families manage the condition appropriately and reduce the frequency of episodes.In this Dalili Medical article, we will explore Night Terrors, including their main causes and symptoms, how they are diagnosed, available treatment and management options, and when it is important to consult a doctor.

What Are Night Terrors?

Night terrors are a type of sleep disorder that occurs due to partial arousal from non-rapid eye movement (NREM) sleep, usually during deep sleep. The person may partially awaken and appear extremely frightened, scream, sit up in bed, or make sudden movements, even though they are not fully awake or aware of their surroundings.

Are Night Terrors the Same as Nightmares?

No, there is a clear difference between the two. During a nightmare, a person usually wakes up and can remember the disturbing dream. In contrast, during a night terror, the person may appear terrified or scream while still partially asleep and is often not fully aware of what is happening around them. They usually do not remember the episode the following morning.

Are Night Terrors Dangerous?

In most cases, night terrors are not considered dangerous in themselves, particularly in children. However, they can become a safety concern when an episode involves violent movements, attempts to leave the bed or the house, or other behaviors that could result in falls or injuries.

Does a Person Remember a Night Terror in the Morning?

Usually, the person does not remember what happened during the episode and may wake up in the morning with no memory of it. In some cases, however, they may remember a few details or have a vague recollection of the event.

Do Night Terrors Occur During Dreams?

Night terrors usually occur during deep stages of non-rapid eye movement (NREM) sleep, which distinguishes them from nightmares, which commonly occur during rapid eye movement (REM) sleep. A person experiencing a night terror may appear to be having a frightening dream, but they are not fully awake and do not interact with their surroundings normally.

Can a Person Scream During a Night Terror?

Yes. Screaming, crying, or suddenly making loud noises are common symptoms of night terrors. These may also be accompanied by physical signs such as heavy sweating, a rapid heartbeat, and faster breathing.

Can a Person Talk During a Night Terror?

Yes. A person may speak, scream, or utter unclear words and phrases during an episode. However, they are usually not fully conscious and may be unable to have a normal conversation or respond appropriately to people around them.

Can a Person Walk During a Night Terror?

Yes. Night terrors may occur alongside sleepwalking or other types of movement and sleep-related behaviors. Therefore, it is important to make the surrounding environment safe and remove objects that could cause injury during an episode.

Should You Wake Someone During a Night Terror?

Generally, it is not recommended to forcefully wake someone during a night terror, as this may increase confusion or make the person more resistant. Instead, remain calm, monitor the person, and make sure they stay in a safe environment until the episode ends.

Are Night Terrors Common in Children?

Yes. Night terrors are more common in children than in adults and may occur particularly during childhood. In many cases, the episodes gradually become less frequent and eventually disappear as the child gets older.

Are Night Terrors in Adults Considered Normal?

Night terrors can occur in adults, although they are less common than in children. If they suddenly begin during adulthood or become frequent or severe, it is advisable to consult a doctor to evaluate the condition and rule out other sleep disorders or related health factors.

Can Night Terrors Affect School or Work?

Yes. If night terrors occur frequently and disrupt sleep or prevent a person from getting adequate rest, daytime effects may occur, including excessive sleepiness, difficulty concentrating, mood changes, and reduced academic or work performance.

Do Night Terrors Cause Permanent Brain Damage?

Typical night terrors are not known to cause permanent brain damage. However, unusual or severe episodes should be medically evaluated to make sure that another condition causing similar symptoms is not present.

Can Night Terrors Go Away Completely?

Yes. In many cases, particularly in children, night terrors gradually become less frequent and may disappear completely with age. If episodes persist into adulthood or become more frequent or severe, it is important to look for possible triggers or coexisting sleep disorders that may require treatment.

Types of Night Terrors

Night terrors are not usually divided into multiple official medical types. Instead, they can be described according to the person's age, the nature of the episode, how frequently it occurs, and when it happens during the night. Common forms include:

1. Night Terrors in Children

This is the most common form. It typically occurs during childhood, particularly during deep sleep in the first part of the night. A child may scream, cry, or sit up in bed and appear extremely frightened, even though they are not fully awake or aware of their surroundings.

2. Night Terrors in Adults

Night terrors are less common in adults than in children. In some cases, they may be associated with sleep deprivation, stress and psychological pressure, other sleep disorders, or factors that affect sleep quality.

3. Night Terrors With Motor Behaviors

An episode may involve various physical behaviors, such as sitting up in bed, screaming, kicking, sleepwalking, or attempting to leave the bed. In these cases, ensuring the person's safety and making the surrounding environment secure are particularly important to prevent injuries.

4. Recurrent Night Terrors

Episodes may occur repeatedly over a period of time and can interfere with sleep quality and regularity. This may result in daytime fatigue or sleepiness, particularly when the episodes are severe or frequent.

Medical Classification of Night Terrors

From a medical perspective, night terrors are classified among NREM parasomnias, a group of sleep disorders that occur during non-rapid eye movement (NREM) sleep. This differs from nightmares, which are typically associated with rapid eye movement (REM) sleep.

Causes of Night Terrors

Night terrors are different from a fear of the dark. They are a sleep disorder that usually occurs during deep stages of non-rapid eye movement (NREM) sleep. They are more common in children but can also occur in adults.

There is no single cause of night terrors. Instead, they may be associated with several factors that affect sleep quality or the transition between sleep stages. Common contributing factors include:

1. Sleep Deprivation

Insufficient sleep and not getting enough hours of rest are among the factors that may increase the likelihood of night terrors. Episodes may become more frequent with repeated late nights or irregular sleep and wake times.

2. Severe Fatigue

Significant physical or mental exhaustion can disrupt normal sleep patterns and may increase the likelihood of night terrors in some people.

3. Stress and Psychological Pressure

Daily stress, family problems, academic or work-related pressures, and major life changes can affect sleep quality and may be associated with an increase in night terrors in some individuals.

4. Irregular Sleep Schedules

Irregular sleep and wake times, shift work, traveling, and changes in time zones can disrupt the body's biological clock and sleep patterns. This may increase the likelihood of partial-arousal sleep disorders.

5. Fever and Illness

Some children may experience night terrors more frequently when they are ill or have a fever. This may be related to the effects of illness and elevated body temperature on sleep patterns and sleep stages.

6. Other Sleep Disorders

Night terrors may sometimes be associated with other sleep disorders, such as obstructive sleep apnea or other conditions that cause repeated or partial awakenings during the night.

7. Certain Medications and Substances

Some medications or substances can affect sleep architecture and sleep stages and may contribute to sleep disturbances in certain people. If night terrors begin after starting a new medication, it is advisable to consult a doctor rather than stopping the medication on your own.

8. Genetic Factors

There may be a familial predisposition to night terrors and certain other sleep disorders. Having a family history of these conditions may increase the likelihood of experiencing them, particularly during childhood.

9. Major Changes and Distressing Events

Night terrors may appear or become more frequent in some people following significant events or changes, such as moving to a new home, starting school, experiencing family problems, or going through a frightening experience. However, this does not mean that every case of night terrors is directly caused by a specific psychological event.

10. Immaturity of the Nervous System in Children

Children’s nervous systems are still developing and maturing. As a result, partial arousals from sleep occur more frequently in children than in adults. This is one reason why night terrors are more common during childhood and often become less frequent as the child gets older.

Symptoms of Night Terrors

Night terrors are a type of sleep arousal disorder that usually occurs during the first half of the night, particularly during deep non-rapid eye movement (NREM) sleep. The person may appear to be awake and extremely frightened, even though they are not fully awake or aware of their surroundings.

Symptoms vary from one person to another, but the most common signs of night terrors include:

1. Screaming or Sudden Vocalizations

A night terror may begin suddenly with intense screaming, crying, or cries for help. The sounds may be louder or more intense than usual because of the strong emotional reaction during the episode.

2. Suddenly Sitting Up or Getting Out of Bed

The person may suddenly sit up in bed, get up, or begin moving around, even though they are not fully aware of what is happening around them.

3. Signs of Intense Fear

The person may display obvious signs of fear, such as wide-open eyes, severe tension, staring in a particular direction, or attempts to escape or defend themselves.

4. Rapid Heartbeat and Breathing

The episode may be accompanied by a noticeable increase in heart rate and breathing rate, making the person appear as though they are experiencing intense fear or panic.

5. Sweating

Noticeable sweating may occur during a night terror, particularly during more intense episodes.

6. Difficulty Responding to Others

A family member may try to comfort or speak to the person, but the person may not respond normally. They may appear not to hear others or may not recognize the people around them.

7. Confusion and Reduced Awareness

The person is in a partial state between sleep and wakefulness. Therefore, they may appear confused or may not be fully aware of where they are or what is happening around them.

8. Sudden Movements or Attempts to Escape

The person may make sudden or forceful movements, such as kicking, pushing, or attempting to leave the bed. They may also push away someone who tries to wake them. As a result, injuries can sometimes occur, particularly when the surrounding environment is unsafe.

9. Difficulty Waking the Person During the Episode

One characteristic feature of night terrors is that the person may be difficult to wake during the episode. Attempting to wake them forcefully may increase their confusion or resistance.

10. Not Remembering the Episode in the Morning

The person usually does not remember what happened during a night terror after waking up in the morning. In some cases, they may remember only a few vague or unclear details.

This feature can help distinguish night terrors from nightmares. During a nightmare, the person usually wakes up and is more likely to remember the content of the disturbing dream.

11. Episodes Usually Occur Early in the Night

Night terrors typically occur during the first few hours after falling asleep, particularly during periods of deep sleep, rather than during the hours immediately before waking in the morning.

12. Recurrence of Episodes

A night terror may occur as an isolated episode or may recur at different intervals. Episodes may become more likely under certain circumstances, such as sleep deprivation, severe fatigue, illness, stress, and irregular sleep schedules.

When Should Symptoms Require Medical Evaluation?

Although night terrors are usually not dangerous, it is advisable to consult a doctor if the episodes are frequent, severe, cause injuries, involve dangerous behaviors, interfere with sleep or daily life, or occur for the first time in an adult.

Diagnosis of Night Terrors

The diagnosis of night terrors is usually clinical. This means that the doctor primarily relies on the description of the episodes and the person’s sleep pattern rather than on a specific blood test or imaging study.

What Does the Doctor Look For?

The doctor will usually ask about:

• Episodes occurring during deep NREM sleep, usually during the first part of the night.

• Sudden arousal accompanied by screaming, intense fear, or sitting up in bed.

• Physical signs such as sweating and rapid heart rate and breathing.

• Difficulty waking or communicating with the person during the episode.

• Little or no clear memory of the episode the following morning.

• The frequency of episodes and their impact on sleep or daily life.

• Sleepwalking or other sleep-related behaviors.

• Factors that may increase the frequency of episodes, such as sleep deprivation, stress, certain medications, or other sleep disorders.

Are Tests Necessary?

In typical cases, special tests are usually not required.

A sleep study (polysomnography) may be recommended when the diagnosis is unclear, when another sleep disorder is suspected, such as obstructive sleep apnea, or when the episodes involve unusual movements or recurrent injuries.

The doctor may also use a video recording of the episodes or a sleep diary to help with the evaluation.

What Conditions Need to Be Distinguished From Night Terrors?

It is important to distinguish night terrors from other conditions, including:

• Nightmares: The person usually wakes up and remembers the dream.

• Sleepwalking: The person may get out of bed and perform various activities while remaining partially asleep.

• Nocturnal seizures: Certain types of seizures can occur during sleep and may resemble night terrors.

• Sleep apnea: Repeated breathing interruptions during sleep can cause unusual arousals.

• Other sleep-related behavioral disorders: Some sleep disorders can cause movements or behaviors that resemble night terrors.

Complications of Night Terrors

In most cases, night terrors do not cause permanent physical harm, particularly in children, and many cases gradually become less frequent with age. However, frequent or severe episodes may cause certain effects or complications, especially when they interfere with sleep quality or involve movements and behaviors that could lead to injury.

1. Disrupted Sleep Quality

Frequent night terrors may affect the regularity and quality of sleep, even when the person does not remember the episode the following morning. This may appear as:

• Interrupted or irregular sleep.

• Feeling tired or exhausted upon waking.

• Daytime sleepiness.

• Difficulty concentrating and paying attention.

2. Risk of Injury During an Episode

Injuries are among the most important potential complications, particularly when an episode involves sudden movements or attempts to leave the bed. Injuries may include:

• Falling out of bed.

• Bumping into furniture or surrounding objects.

• Bruises or cuts.

• Injuring oneself or someone who attempts to help during the episode.

For this reason, it is important to make the sleeping environment as safe as possible, particularly when episodes are intense or accompanied by sleepwalking.

3. Effects on Daytime Performance

Repeated sleep disruption or insufficient sleep may lead to daytime effects such as:

• Reduced concentration and attention.

• Difficulty remembering information or reduced memory efficiency.

• Lower academic performance in children.

• Reduced work performance in adults.

• Increased daytime sleepiness, which may increase the risk of sleep-related accidents.

4. Psychological Effects

Night terrors differ from nightmares because the person usually does not remember the details of the episode after waking. Therefore, they may not experience the same type of fear that commonly follows a frightening nightmare.

However, repeated episodes or learning about them from family members may cause some people to experience:

• Anxiety about sleeping.

• Fear that another episode will occur.

• Stress or embarrassment.

• Disruption of their usual sleep routine.

5. Effects on Family Members

The effects of night terrors are not limited to the person experiencing them. Episodes may also affect family members or people who share the same bedroom because of:

• Screaming or sudden movements during the night.

• Repeated awakenings caused by the episodes.

• Concern about the person being injured.

• Disrupted sleep for parents, particularly when episodes occur in children.

6. Indirect Effects in Children

When episodes are frequent and lead to disrupted sleep or insufficient sleep, parents may notice changes in the child, such as:

• Increased irritability or mood changes.

• Difficulty waking up in the morning.

• Daytime sleepiness.

• Reduced attention and concentration.

• Lower academic performance in some cases.

It is important to note that these symptoms do not necessarily mean that night terrors themselves have caused a neurological problem. In many cases, insufficient sleep or poor sleep quality may be responsible for these daytime effects.

Treatment of Night Terrors With Medication

Medication is generally not the first-line treatment for night terrors, particularly in children, because episodes often become less frequent and may resolve naturally with age. Initial management usually focuses on establishing healthy sleep habits, getting enough rest, and addressing factors that may trigger or worsen the episodes.

1. When Might a Doctor Consider Medication?

A doctor may consider medication in specific cases, particularly when the episodes are:

• Severe or unusually frequent.

• Associated with injuries or potentially dangerous behaviors.

• Clearly affecting sleep quality or daily life.

• Continuing despite improvements in sleep habits and management of triggering factors.

• Associated with another sleep disorder that requires medication.

Medication should be selected and prescribed by a qualified healthcare professional because the decision depends on the person’s age, severity of symptoms, possible causes, and any coexisting conditions.

2. Benzodiazepines

Some medications in this group have been used in selected and severe cases of sleep arousal disorders, including clonazepam.

These medications may help reduce certain types of partial arousals from sleep. However, their use is limited because of potential side effects and risks, including:

• Daytime sleepiness.

• Dizziness and impaired balance.

• Problems with memory or concentration.

• Physical or psychological dependence with long-term use.

• Withdrawal symptoms if the medication is stopped suddenly.

• An increased risk of respiratory depression in some people, particularly when combined with alcohol or certain other medications.

Therefore, clonazepam and other benzodiazepines should not be used without a prescription and appropriate medical supervision.

3. Antidepressants

Some antidepressants may be used in very specific situations, particularly when night terrors occur alongside another condition that requires treatment.

However, antidepressants are not considered a routine treatment for night terrors themselves. A doctor determines whether they are appropriate based on the person’s overall health and accompanying symptoms.

4. Other Medications

Various medications and pharmacological interventions have been studied or used in individual cases of sleep arousal disorders. However, evidence for their effectiveness in treating night terrors is limited, and there is no single medication considered a standard treatment for all cases.

Melatonin is not considered a standard treatment for night terrors themselves, although it may be used for certain other sleep disorders. The decision to use melatonin depends on the nature and possible cause of the sleep problem. Particular caution is advised when considering its use in children, and parents should consult a healthcare professional before giving it to a child.

Non-Medication Treatment Is the Main Approach in Most Cases

In many cases, improving sleep habits and addressing triggering factors are more important than medication. Helpful measures include:

• Getting enough sleep for the person’s age.

• Maintaining regular sleep and wake times.

• Avoiding sleep deprivation and repeated late nights.

• Reducing stress and excessive fatigue.

• Treating any coexisting sleep disorders, such as sleep apnea.

If episodes continue or become severe, a doctor can determine whether medication is appropriate and which treatment is safest and most suitable.

Tips for Managing Night Terrors

Night terrors usually do not require medication, particularly in children, because episodes often become less frequent with age. However, knowing how to respond during an episode and taking preventive measures may help reduce their frequency and minimize the risk of injury.

First: How to Respond During a Night Terror

When an episode occurs, the following steps may be helpful:

Stay calm: The person may appear extremely frightened, but they are usually not fully awake or aware of what is happening around them.

Avoid trying to wake the person forcefully: Attempting to wake them may increase confusion, resistance, or sudden movements.

Speak in a calm and reassuring voice: Simple, gentle words may help if they appear to respond, but avoid asking many questions or trying to have a conversation.

Avoid holding the person forcefully: If the person resists, it is generally better to give them enough space to remain safe unless they are in immediate danger.

Remove potential hazards: Remove sharp objects and breakable items, particularly if the person moves around or sleepwalks during the episode.

Gently guide the person if they try to leave the bed: If they get up or begin walking, gently guide them toward a safe area rather than trying to restrain them forcefully.

Allow the person to return to sleep after the episode: Once the episode has ended, allow the person to return to sleep naturally while ensuring that they are safe and settled.

Second: Ways to Help Prevent Night Terrors

1. Maintain a Regular Sleep Schedule

Sleep deprivation and insufficient sleep can increase the likelihood of night terrors. Therefore, it is helpful to:

• Maintain consistent bedtimes and wake-up times.

• Get an appropriate amount of sleep for the person’s age.

• Avoid repeated late nights.

• Establish a calm and consistent bedtime routine, especially for children.

2. Avoid Triggers Before Bedtime

Some factors may interfere with sleep quality and can be reduced before bedtime, including:

• Excessive screen use and stimulating electronic games.

• Intense physical activity late at night.

• Caffeinated drinks, particularly in the evening.

• Stress, heated discussions, or emotionally stimulating situations before bedtime.

3. Make the Sleeping Environment Safe

If the person moves around or sleepwalks during an episode, safety precautions are important. These may include:

• Making sure windows and doors are securely closed.

• Removing sharp objects and breakable items from the sleeping area.

• Keeping the floor clear of objects that could cause tripping or falling.

• Taking appropriate precautions around stairs.

• Avoiding placing a child’s bed near windows or elevated areas.

4. Keep a Sleep and Episode Diary

A sleep diary can help identify factors that occur before episodes and reveal patterns. You can record:

• Bedtime.

• Time of the episode.

• Approximate duration of the episode.

• Symptoms and behaviors observed during the episode.

• Morning wake-up time.

• Total number of hours of sleep.

• Whether the person experienced sleep deprivation, fatigue, stress, or illness that day.

Keeping these records may reveal that episodes occur at approximately the same time each night, which can provide useful information for the doctor when evaluating the condition.

5. Scheduled or Anticipatory Awakening

If night terrors occur at approximately the same time every night, a doctor may suggest scheduled awakening. This involves briefly waking the person before the usual time of the episode and then allowing them to return to sleep.

This approach may be particularly useful for children who experience episodes at a predictable time. However, it is preferable to discuss this method with a doctor first to determine whether it is appropriate for the individual situation.

6. Avoid Turning Night Terrors Into a Source of Fear

It is important to respond calmly, particularly when the episodes occur in children. Parents should avoid scolding, frightening, or blaming a child for what happened during an episode.

Night terrors are not intentional behavior, and the person generally cannot control their actions during the episode. Since most people do not remember what happened the following morning, providing reassurance and a sense of safety can help prevent additional anxiety surrounding sleep.