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Night Terror
A
night terror, also known as pavor nocturnus, is a parasomnia
sleep disorder characterized by extreme terror and a temporary inability to
regain full consciousness. The subject wakes abruptly from slow-wave sleep, with waking usually accompanied by gasping, moaning, or screaming. It
is often impossible to fully awaken the person, and after the episode the subject normally settles back to sleep without waking. A night terror can
occasionally be recalled by the subject. They typically occur during non-rapid eye movement sleep.
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Night Terrors Versus Nightmares
Night terrors are distinct from nightmares in several key ways. First, the subject is not fully awake when roused, and even when efforts are made
to awaken the sleeper, he/she may continue to experience the night terror for ten to twenty minutes. Unlike nightmares, which occur during REM sleep,
night terrors occur during slow-wave sleep, the deepest levels of non-REM sleep. Even if awakened, the subject often cannot remember the episode
except for a sense of panic, while nightmares usually can be easily recalled. The subject often has no recollection of the incident.
Unlike nightmares, which are frequently dreams of a frightening nature, night terrors are not dreams. Usually there is no situation or event (scary
or otherwise) that is dreamt, but rather the emotion of fear itself is felt. Often, this is coupled with tension and apprehension without any distinct
sounds or visual imagery, although sometimes a vague object of fear is identified by the sufferer. These emotions, generally without a focusing event
or scenario, increase emotions in a cumulative effect. The lack of a dream itself leaves those awakened from a night terror in a state of
disorientation much more severe than that caused by a normal nightmare. This can include a short period of amnesia during which the subjects may
be unable to recall their names, locations, ages, or any other identifying features of themselves. This state generally passes after only one or
two minutes.
In Children
Children from age two to six are most prone to night terrors, and they affect about fifteen percent of all children, (although people of any age may
experience them). Episodes may recur for a couple of weeks then suddenly disappear. The symptoms also tend to be different, like the child being able
to recall the experience, and while nearly awake, hallucinate. Strong evidence has shown that a predisposition to night terrors and other parasomniac
disorders can be passed genetically. Though there are a multitude of triggers; emotional stress during the previous day and a high fever are thought
to precipitate most episodes. Ensuring that the right amount of sleep is gained is an important factor. Special consideration must be used when the
subject suffers from
narcolepsy.
In Adults
Though the symptoms of night terrors in adolescents and adults are similar, the etiology, prognosis and treatment are qualitatively different. Adult
night terrors are much less common, trauma-based rather than genetic, chronic, and usually require treatment in the form of psychotherapy and
antidepressant medication.
In addition to night terrors, some adult night terror sufferers have many of the characteristics of abused and depressed individuals including
inhibition of aggression, self-directed anger, passivity,
anxiety, impaired memory, and the ability to ignore
pain.
(adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Night_terrors)
Disorders of Arousal from Sleep and Violent Behavior: The Role of Physical Contact and Proximity
Authors: Pressman MR.
Sleep Medicine Services, The Lankenau Hospital, Wynnewood, PA 19096, USA. pressmanm@mlhs.org
STUDY OBJECTIVES: To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals
that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors - is triggered by direct physical contact or close
proximity to that individual and does not occur randomly or spontaneously. DESIGN: Historical review of case reports in the medical and legal
literature. MEASUREMENTS AND RESULTS: A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of
violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations
and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were
associated with provocation or close proximity in 40%-90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken
into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered
differed among sleepwalking, confusional arousals, and sleep terrors. CONCLUSIONS: In the cases reviewed, violent behavior directed against other
individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another
individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions
are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated
with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or
absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring
deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It
is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders.
The conclusions of this case series await confirmation by the results of future sleep laboratory based studies.
Journal: Sleep. 2007 Aug 1;30(8):1039-47.
Adapted from PubMed; click here to access full journal article.
L -5-Hydroxytryptophan Treatment of Sleep Terrors in Children
Authors: Bruni O, Ferri R, Miano S, Verrillo E.
Centre for Paediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, University of Rome "La Sapienza", Via dei Sabelli 108,
00185 Rome, Italy. oliviero.bruni@uniroma1.it
To test the hypothesis that the administration of L -5-hydroxytryptophan (L -5-HTP) might exert beneficial effects on sleep terrors, we carried out
an open pharmacological trial in a group of children with sleep terrors compared to a group of children with the same disorder but without L -5-HTP
treatment. Participants in the trial were 45 children (34 males and 11 females; age range 3.2-10.6 years), referred to the Sleep Centre of the
Department of Developmental Neurology and Psychiatry of the University of Rome "La Sapienza", affected by sleep terrors. All subjects underwent: (1)
complete medical and sleep history; (2) complete neurological examination and EEG recording whilst awake and sleeping, (3) a structured sleep diary
for 2 months, (4) after 1 month, all subjects were examined again from the clinical and EEG points of view and (5) after 6 months, a structured
interview in order to evaluate the clinical outcome. After the first visit, L -5-HTP was administered (2 mg/kg per day) at bedtime to 31 randomly
selected patients for a single period of 20 consecutive days. After 1 month of treatment, 29/31 (93.5%) of patients showed a positive response. In
the comparison group without drug therapy, after 1 month, the episodes disappeared only in four children (28.6%) while ten children (71.4%) showed
the persistence of episodes with the same frequency as before. After 6 months, 26/31 (83.9%) of children treated with L -5HTP were sleep terror-free,
while in five children (16.1%) sleep terror episodes persisted. Of the children in the comparison group, ten (71.4%) continued to show sleep terrors
at 6-month follow-up. CONCLUSION:to our knowledge, this is the first study demonstrating the efficacy of a new drug treatment for sleep terrors. These
results confirm our initial hypothesis and represent evidence that treatment with L -5-hydroxytryptophan is able to modulate the arousal level in
children and to induce a long-term improvement of sleep terrors. Copyright 2004 Springer-Verlag
Journal: Eur J Pediatr. 2004 Jul;163(7):402-7. Epub 2004 May 14.
Adapted from PubMed; click here to access full journal article.
Posttraumatic Stress Disorder in the Spouse of a Patient with Sleep Terrors
Authors: Baran AS, Richert AC, Goldberg R, Fry JM.
Department of Psychiatry and Human Behavior, Sleep Disorders Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS
39216, USA. abaran@psychiatry.umsmed.edu
A 27-year-old woman who developed posttraumatic stress disorder (PTSD) as a consequence of her husband's severe sleep terror episode is reported.
A 29-year-old man suddenly aroused from sleep and jumped through the closed second-story window of the room he shared with his wife, sustaining
major lacerations to his arms. He hung onto the roof as his wife screamed at him from the window, and eventually climbed back inside. He was evaluated
with polysomnography and was given the diagnosis of sleep terrors, which was effectively treated with behavioral and pharmacologic interventions.
During a routine follow-up visit with the patient, his wife's PTSD symptoms came to clinical attention and she was referred for treatment. She
demonstrated marked improvement in her condition after an 8 week course of cognitive-behavioral therapy. We conclude that family members of patients
with
sleep disorders manifesting as violent behaviors during sleep can suffer psychological trauma even if they are not physically injured.
Journal: Sleep Med. 2003 Jan;4(1):73-5.
Adapted from PubMed; click here to access full journal article.
Night Terrors in an Adult Precipitated by Sleep Apnea
Authors: Pressman MR, Meyer TJ, Kendrick-Mohamed J, Figueroa WG, Greenspon LW, Peterson DD.
Department of Medicine, Lankenau Hospital and Medical Research Center, Wynnewood, Pennsylvania 19096-3498, USA.
Parasomnias are generally described as disorders of arousal that arise out of stage 3 and 4 nonrapid eye movement (NREM) sleep without identifiable
cause. We present a case of a 35-year-old man who during nasal continuous positive airway pressure (nCPAP) treatment for severe obstructive sleep
apnea experienced an intense night terror triggered by a residual obstructive apnea during rebound deep sleep. The role of rebound deep sleep was
thought to be essential in creating a state of sleep with a high arousal threshold hypothesized to be important for the occurrence of parasomnias.
This case supports the clinical wisdom that identifiable sources of arousal can trigger parasomnias.
Journal: Sleep. 1995 Nov;18(9):773-5.
Adapted from PubMed; click here to access full journal article.
Night Terrors in Adults: Phenomenology and Relationship to Psychopathology
Authors: Llorente MD, Currier MB, Norman SE, Mellman TA.
Department of Psychiatry, University of Miami School of Medicine, Fla.
BACKGROUND: Night terrors have been classically described in children. Night terrors occurring in adults have been linked to psychopathology. Recent
descriptions of sleep panic attacks have raised questions about their relationship to night terrors. METHOD: Evaluations from a medically affiliated
sleep disorders program were reviewed to identify adult patients presenting with events consistent with night terrors. Eleven patients were
identified, 10 of whom had polysomnographic evaluation, and their records were reviewed for information relevant to night terrors and psychiatric
symptoms. Six of these patients were available for further assessment which included inquiry regarding sleep events, a Structured Clinical Interview
(SCID) for psychiatric disorders, and the Millon Clinical Multiaxial Inventory II (MCMI-II) for personality-related measurements. RESULTS: In the
original sample, night terror episodes featured confused behaviors, motor activity, and absent or fragmented recall. Polysomnography documented
arousals from slow wave sleep in 9 of 10 patients. All of the original patients reported psychiatric symptoms. All 6 patients who received the
subsequent structured evaluation met lifetime criteria for Axis I conditions (most commonly affective and substance use disorders) and had elevated
scores on the personality scales of the MCMI-II. Night terrors were not limited to psychiatric episodes. CONCLUSION: Night terrors occur in adults
that are similar to episodes described in children. While distinct from sleep panic attacks, night terrors appear to occur in adults with histories
of psychopathology.
Journal: J Clin Psychiatry. 1992 Nov;53(11):392-4.
Adapted from PubMed; click here to access full journal article.
Sleepwalking, Night Terrors, and Consciousness
Authors: Crisp AH, Matthews BM, Oakey M, Crutchfield M.
Academic Department of Psychiatry, St George's Hospital Medical School, London.
OBJECTIVE--To determine some personality and psychoneurotic characteristics of adults who have the sleepwalking-night terrors syndrome. DESIGN--
Prospective assessment of two groups of consecutive patients with a firm diagnosis of either of two specific
sleep disorders as established
clinically and by polysomnography. SETTING--Outpatient
sleep disorders clinic and sleep laboratory in a tertiary referral centre. PATIENTS--12
Patients referred consecutively to the clinic in whom a diagnosis of sleepwalking (six) or night terrors (six) was confirmed. MAIN OUTCOME
MEASURES--Psychological characteristics as measured at the time of clinical assessment by means of the Eysenck personality questionnaire, the
hostility and direction of hostility questionnaire, and the Crown-Crisp experiential index. RESULTS--Both groups scored exceptionally highly on
the hysteria scale of the Crown-Crisp experiential index and the night terrors group also scored highly on the
anxiety scale. The patients with
sleepwalking also scored highly on a measure of externally directed hostility. CONCLUSIONS--The physiological and psychological features identified
in these patients, possibly reflecting different expressions of a constitutional cerebral characteristic, may be explored in terms of hysterical
dissociation. The findings contribute to the debate concerning the nature of sleepwalking, in particular with and without the forensic aspects.
Journal: BMJ. 1990 Feb 10;300(6721):360-2.
Adapted from PubMed; click here to access full journal article.
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