Treatment of Night Terrors
Night terrors are distinct from nightmares and require different management—reassurance and sleep hygiene are first-line, with clonazepam reserved only for severe, functionally impairing cases.
Critical Distinction: Night Terrors vs. Nightmares
Night terrors (sleep terrors) are not the same as nightmares and the evidence you're asking about primarily addresses nightmare disorder, which is a different condition 1. Night terrors occur during deep non-REM sleep (stage 3-4), typically in the first third of the night, with the person appearing terrified but remaining asleep, showing autonomic hyperactivity (screaming, tachycardia, sweating), and having complete amnesia for the event 2, 3. In contrast, nightmares occur during REM sleep with full recall 1.
Management Approach for Night Terrors
First-Line: Non-Pharmacological Management
- Reassurance and parental education are the cornerstone of treatment, as most children outgrow night terrors by late adolescence without intervention 2, 3
- Sleep hygiene optimization is essential since sleep deprivation is a major precipitating factor for night terrors 2, 3
- Anticipatory awakening performed approximately 30 minutes before the typical time of night terror episodes is often effective for frequently occurring events 2
- Avoid attempting to interrupt an active episode, as this can prolong the event or cause injury 2
- Environmental safety measures should be implemented to prevent injury during episodes 4
Pharmacological Treatment (Reserved for Severe Cases Only)
- Clonazepam at bedtime may be considered on a short-term basis only if night terrors are frequent, severe, or associated with functional impairment such as daytime fatigue, sleepiness, or significant distress 2
- Benzodiazepines and serotonin reuptake inhibitors have been used in adults with severe sleepwalking/night terror syndrome 4
- Medical intervention is usually not necessary in the majority of cases 2
Natural Supplements
There is no evidence supporting natural supplements for night terrors specifically. Melatonin is FDA-approved only for occasional sleeplessness and insomnia 5, not for parasomnias like night terrors. The pathophysiology of night terrors (disorders of arousal from deep NREM sleep) differs fundamentally from insomnia, making melatonin theoretically inappropriate 2, 3.
Common Pitfalls to Avoid
- Do not confuse night terrors with nightmares—the treatments differ significantly, and medications like prazosin that work for PTSD-associated nightmares have no role in night terrors 1, 6, 2
- Do not rush to pharmacological treatment—the vast majority of cases resolve with reassurance and sleep hygiene alone 2, 3
- Address underlying precipitating factors including sleep deprivation, fever, stress, and comorbid sleep disorders like obstructive sleep apnea 2, 3
- Screen for comorbid conditions that may trigger or worsen night terrors, including medical disorders and psychological conditions 3
When to Consider Medication
Pharmacological intervention should only be considered when 2:
- Episodes are occurring multiple times per week
- There is significant risk of injury to the patient or others
- Daytime functioning is impaired (excessive fatigue, sleepiness)
- The family is experiencing severe distress
- Sleep hygiene measures and anticipatory awakening have failed