Sleep Terror Disorder

Sleep terror disorder (night terrors) is recurrent abrupt awakenings from non-REM sleep with intense fear, screaming and autonomic arousal, with unresponsiveness to comforting and no recall.

• Prevalence 1 to 6% of children (peak 3 to 12 years), under 1% of adults.
• Strong family history; triggers: sleep deprivation, fever, stress, irregular schedule, sleep apnoea, medications.
• Occur in the first third of night, from slow wave sleep.
• Overlaps with sleepwalking.

• Sudden sitting up with a piercing scream, tachycardia, sweating, dilated pupils, agitation, lasting 1 to 10 minutes, then return to sleep.
• Child not truly awake, inconsolable, amnesia afterwards.
• Different from nightmares (REM, recalled, easily comforted).

• Clinical; sleep diary and video.
• Polysomnography if atypical (adult onset, injurious, stereotyped, daily episodes): arousals from N3 sleep; rule out nocturnal seizures, sleep apnoea, REM behaviour disorder, PTSD.
• Medical review for medications, fever, reflux.

• Reassurance that it is benign and self limiting in children.
• Do not wake the child; ensure safety; maintain regular sleep and avoid sleep deprivation, caffeine and stress.
• Scheduled awakenings 15 to 30 minutes before episodes for several weeks.
• Treat sleep apnoea (adenotonsillectomy), reflux, restless legs.
• Medication rarely: clonazepam 0.25 to 0.5 mg in children (short term) or 0.5 to 1 mg in adults, imipramine 10 to 25 mg, melatonin; benzodiazepines only for persistent distressing or dangerous events.
• Adults: CBT, stress reduction, treat psychiatric comorbidity.