What is the treatment for night terror?

Treatment for Night Terrors

For night terrors, the most effective treatment approach includes reassurance, parental education, and good sleep hygiene, with pharmacological interventions such as clonazepam reserved for severe cases. 1

Understanding Night Terrors

• Night terrors are frightening episodes that typically occur within the first three hours of sleep during arousal from stage three or four non-rapid eye movement (NREM) sleep 1
• Common symptoms include abrupt awakening with screaming, intense fear, confusion, autonomic hyperactivity (tachycardia, tachypnea, diaphoresis), and retrograde amnesia for the episode the following morning 1
• Night terrors affect approximately 1-6.5% of children aged 1-12 years, with peak occurrence between 5-7 years of age 1

First-Line Treatment Approaches

Non-Pharmacological Interventions

• Reassurance and parental education are the cornerstone of management in most cases 1
• Maintain good sleep hygiene as sleep deprivation can trigger night terror episodes 1
• Anticipatory awakening performed approximately 30 minutes before the typical occurrence of night terrors is often effective for frequently occurring episodes 1
• Avoid attempting to interrupt a night terror episode as this may worsen the situation 1

Behavioral and Psychological Treatments

For persistent night terrors, especially in adults, the following therapies may be considered:

• Image Rehearsal Therapy (IRT) is recommended for nightmare disorder and can be adapted for night terrors 2
• Progressive Deep Muscle Relaxation (PDMR) involves tensing and releasing muscles to induce physical relaxation and reduce anxiety (Level B evidence) 2
• Systematic Desensitization uses graduated exposure therapy to help patients cope with and manage stressors (Level B evidence) 2
• Hypnosis may be considered, with case reports showing effectiveness in both children and adults 2, 3
• Sleep Dynamic Therapy combines sleep hygiene with cognitive behavioral interventions (Level C evidence) 2

Pharmacological Interventions

Medication should be reserved for severe cases where non-pharmacological approaches have failed:

• Clonazepam may be considered on a short-term basis for frequent and severe night terrors that cause functional impairment 1
• Benzodiazepines can be effective for the sleepwalking/night terror syndrome in adults 4
• Serotonin re-uptake inhibitors may be considered in adult cases, particularly when associated with underlying anxiety or depression 4

Special Considerations

• Identify and address underlying conditions or precipitating factors that may trigger night terrors 1
• Psychotherapy may be beneficial for adult patients with night terrors, particularly when associated with psychopathology 5
• Provide a secure environment to prevent injury during episodes 4
• Reassure families that most children outgrow night terrors by late adolescence 1, 6

Treatment Algorithm

1. Start with reassurance and education about the benign nature of night terrors
2. Implement good sleep hygiene and regular sleep schedule
3. For frequent episodes, try anticipatory awakening
4. For persistent cases, consider behavioral therapies (PDMR, systematic desensitization)
5. For severe cases with functional impairment, consider short-term clonazepam
6. For adults with persistent night terrors, consider psychotherapy and evaluation for underlying psychological factors

Remember that attempts to wake the person during a night terror episode should be avoided, and the primary goal is to ensure safety during episodes while implementing strategies to reduce their frequency and severity.