From the Guidelines
Night terrors should be managed by establishing consistent sleep routines, reducing stress, and ensuring adequate sleep, as these measures are crucial in preventing episodes and improving quality of life. The causes of night terrors are multifactorial, including over-arousal of the central nervous system during sleep transitions, sleep deprivation, stress, fever, certain medications, and having a full bladder 1. Treatment primarily involves ensuring safety during episodes by removing hazardous objects from the bedroom and not attempting to wake the person.
Prevention and Management
Key preventive measures include:
- Establishing consistent sleep routines
- Reducing stress
- Ensuring adequate sleep For frequent or severe night terrors, scheduled awakenings (waking the child 15-30 minutes before the typical episode time) can be helpful. However, the use of medications such as benzodiazepines should be approached with caution due to potential side effects and the lack of clear recommendations for their use in night terror treatment, as noted in the context of nightmare disorder treatment 1.
Medication Considerations
While medications like prazosin may be used for the treatment of nightmare disorder 1, their application in night terror management is not clearly established. The American Academy of Sleep Medicine position paper primarily addresses nightmare disorder, highlighting the need for clinician judgment in treating individual cases, considering accessible treatment options and resources 1.
Cognitive Behavioral Therapy
Cognitive behavioral therapy can be beneficial for older children and adults by addressing underlying anxiety, which may contribute to night terrors. This approach aligns with the management of conditions that share similar underlying factors, such as nightmare disorder, where psychological interventions are valued 1. Most children outgrow night terrors by adolescence without intervention, as they represent a developmental sleep disorder rather than a psychological problem.
From the Research
Causes of Night Terrors
- Night terrors are estimated to occur in 1 to 6.5% of children 1 to 12 years of age 2
- The exact etiology is not known, but developmental, environmental, organic, psychological, and genetic factors have been identified as potential causes of sleep terrors 2
- Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep 2
- Factors that can precipitate sleep terrors include sleep deprivation, and increasing sleep fragmentation resulting in dissociated state of sleep 2, 3
Symptoms of Night Terrors
- A typical attack involves the child awakening abruptly from sleep, sitting upright in bed or jumping out of bed, screaming in terror and intense fear, and being panicky and having a frightened expression 2
- Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone 2
- The child is difficult to arouse and console and may express feelings of anxiety or doom 2
- There is retrograde amnesia for the attack the following morning 2
Treatment of Night Terrors
- Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment 2, 4
- Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors 2
- Behavioral management is of prime importance, including addressing precipitating factors, family reassurance, safety measures, and scheduled awakenings 3, 5
- Pharmacologic agents such as clonazepam and antidepressants are used infrequently in case of disruptive episodes 3
- Multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias may be effective 5