Medications for Night Terrors
For night terrors specifically, clonazepam is the primary medication option for short-term use when episodes are frequent, severe, or cause functional impairment, though benzodiazepines should be avoided as first-line treatment due to addiction risk and relapse potential. 1, 2
Important Distinction: Night Terrors vs. Nightmares
Night terrors and nightmares are fundamentally different conditions requiring different treatments:
- Night terrors occur during stage 3-4 NREM sleep (first third of night), involve autonomic hyperactivity (screaming, tachycardia, diaphoresis), confusion, and complete amnesia for the event 1
- Nightmares occur during REM sleep, involve vivid dream recall, and are treated with entirely different medications (prazosin, clonidine, trazodone) 3, 4
Treatment Algorithm for Night Terrors
First-Line: Non-Pharmacological Approaches
- Reassurance and parental education are the primary interventions, as most children outgrow night terrors by late adolescence 1
- Sleep hygiene optimization is critical since sleep deprivation predisposes to night terrors 1
- Anticipatory awakening performed 30 minutes before typical episode timing is often effective for frequent night terrors 1
- Environmental safety measures to prevent injury during episodes 1, 5
Second-Line: Pharmacological Treatment
When to consider medication: 1
- Frequent and severe episodes
- Functional impairment (fatigue, daytime sleepiness, distress)
- Risk of injury to patient or others
Medication options:
Clonazepam may be used short-term at bedtime for severe cases 1
SSRIs or tricyclic antidepressants can be selected for high-frequency attacks in adults 2, 5
- These are preferred over benzodiazepines as first-line pharmacotherapy due to lower addiction potential 2
Third-Line: Psychotherapy
- Psychotherapy may be effective in adults where psychopathology plays a primary role 6
- Hypnosis has shown success in case reports, using techniques focused on regulating sleep cycle transitions 7
Critical Caveats
- Do not attempt to interrupt or awaken the patient during a night terror episode 1
- Medical intervention is usually unnecessary in the majority of cases 1
- Treat underlying conditions if identified (sleep apnea, fever, medications) and avoid precipitating factors 1
- Benzodiazepines are not preferred first-line despite historical use, due to dependence and relapse issues 2
Medications NOT for Night Terrors
The following medications are for nightmares (not night terrors) and should not be confused: