Night terror

, Inconsolable, 1878 (Royal Museum of Fine Arts Antwerp) The universal feature of night terrors is inconsolability—very similar to that of a panic attack. During night terror bouts, sufferers are usually described as "bolting upright" with their eyes wide open and a having look of fear on their face. Individuals with night terrors will often yell, scream, or attempt to speak, but such speech is frequently incomprehensible. Furthermore, they usually sweat, exhibit rapid breathing, and have a rapid heart rate (i.e., autonomic signs). In some cases, individuals are likely to have even more elaborate motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions. There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury. Sleepwalking is also common during night terror bouts, as sleepwalking and night terrors manifest the same parasomnia. The risk of injury to others may be exacerbated by inadvertent provocation by nearby people, whose efforts to calm the individual may result in a physically violent response from the individual as they attempt to escape. During polysomnography, individuals with night terrors are known to have very high voltages of electroencephalography (EEG) delta activity, an increase in muscle tone, and a doubled or faster heart rate. Brain activities during a typical episode show theta and alpha activity when monitored with an EEG. Episodes can include tachycardia. Night terrors are also associated with intense involuntary rapid and shallow breathing, profuse sweating, reddening of the skin, and pupil dilation. There have been some symptoms of depression and anxiety that have increased in individuals that have frequent night terrors. Low blood sugar is associated with both pediatric and adult night terrors. A study of adults with thalamic lesions of the brain and brainstem have been occasionally associated with night terrors. Night terrors are closely linked to sleepwalking and frontal lobe epilepsy. Children Night terrors typically occur in children between the ages of three and twelve years, with a peak onset in children aged three and a half years old. An estimated 1–6% of children experience night terrors. Children of both sexes and all ethnic backgrounds are affected equally. Adults Night terrors in adults have been reported in all age ranges. Although the symptoms of night terrors in adolescents and adults are similar, the cause, prognosis, and treatment of symptoms are qualitatively different. These night terrors can occur each night if the individual does not eat a proper diet, get the appropriate amount or quality of sleep (e.g., sleep apnea), endure stressful events, and if they remain untreated. Adult night terrors are much less common and often respond to treatments to rectify causes of poor quality or quantity of sleep. Night terrors are classified as a mental and behavioral disorder in the ICD. The prevalence of other psychiatric symptoms among most patients has been identified, suggesting potential comorbidity. When a night terror happens, it is typical for a person to wake up yelling and kicking and to be able to recognize what they are saying. The person may even run out of the house (more common among adults), which can then lead to violent actions. It has been found that some adults who have been on a long-term intrathecal clonidine therapy show side effects of night terrors, such as feelings of terror early in the sleep cycle. This is due to the possible alteration of cervical/brain clonidine concentration. ==Causes==

There is some evidence that a predisposition to night terrors and other parasomnias may be congenital. Individuals frequently report that past family members have had either episodes of sleep terrors or sleepwalking. In some studies, a tenfold increase in the prevalence of night terrors in first-degree biological relatives has been observed—however, the exact link to inheritance is not known. Other contributing factors include nocturnal asthma, gastroesophageal reflux, central nervous system medications, Adults who have experienced sexual abuse are more likely to receive a diagnosis of sleep disorders, including night terrors. ==Diagnosis==

The DSM-5 diagnostic criteria for sleep terror disorder requires: Nightmares almost never involve vocalization or agitation, and if there are any, they are less intense in comparison to night terrors. In addition, nightmares appear ordinarily during REM sleep in contrast to night terrors, which occur in NREM sleep. Finally, individuals with nightmares can wake up completely and easily and have clear and detailed memories of their dreams. A distinction between night terrors and epileptic seizure, which can happen during the night or day, is required. An EEG with anomalies can be suggestive of an epileptic seizure rather than a night terror. == Assessment ==

The assessment of sleep terrors is similar to the assessment of other parasomnias and must include: • When the episode occurs during the sleep period • Age of onset • How often these episodes occur (frequency) and how long they last for (duration) • Description of the episode, including behavior, emotions, and thoughts during and after the event • How responsive the patient is to external stimuli during the episode • How conscious or aware the patient is, when awakened from an episode • If the episode is remembered afterwards • The triggers or precipitating factors • Sleep–wake pattern and sleep environment • Daytime sleepiness • Other sleep disorders that might be present • Family history for NREM parasomnias and other sleep disorders • Medical, psychiatric, and neurological history • Medication and substance use history Additionally, a home video might be helpful for a proper diagnosis. A polysomnography in the sleep laboratory is recommended for ruling out other disorders, however, sleep terrors occur less frequently in the sleep laboratory than at home and a polysomnography can therefore be unsuccessful at recording the sleep terror episode. ==Treatment==

In most children, night terrors eventually subside and do not need to be treated. It may be helpful to reassure the child and their family that they will outgrow this disorder. The duration of one episode is mostly brief but it may last longer if parents try to wake up the child. Awakening the child may make their agitation stronger. There is some evidence to suggest that night terrors can result from lack of sleep or poor sleeping habits. In these cases, it can be helpful to improve the amount and quality of sleep the child is getting, including good sleep hygiene. A polysomnography can be recommended if the child continues to have significant night terror episodes, while hypnosis can help sleepers become less sensitive to their sleep terrors. Widening the nasal airway by surgical removal of the adenoid was previously considered and demonstrated to be effective; however, invasive treatments are now generally avoided. ==Research==

A small study of paroxetine found some benefit. Another small trial found benefit with L-5-hydroxytryptophan (L-5-HTP). ==See also==