Night terror

Night terrors generally occur in the first half of the night and arise with an awakening out of non-REM sleep. The sleeper awakens with a scream, looks frightened with dilated pupils, an elevated heart and respiratory rate, and may be perspiring profusely. They may mumble incoherently. The night terror sufferer is difficult to contact and does not appear to be fully conscious -- and is inconsolable. When finally fully awake or if they return to sleep, the person has little or no memory of the experience. The condition is more common in children and frightens the child's parents. The appropriate response is to return the person to bed and not try to awaken him or her with entreaties as to what's wrong. Generally nothing is wrong and the event has no health related significance. Night terrors are unusual in an older person.

Nightmares tend to occur more commonly in the second half of the night, when more dreaming sleep occurs. Nightmares are frightening dreams from which we awaken -- as distinguished from frightening dreams from which we do not awaken. The content does not distinguish nightmares from other dreams nor are they always accompanied by increases in heart or respiratory rate. The experience is universal as almost all people have had nightmares. The idea or concept of the nightmare is described by people as more intense than the actual experience of the nightmare.

The frequency of nightmares varies. They tend to decrease with age. They tend to increase at times of stress or with certain medications and illnesses. The emotional aspect of the nightmare may be a response to the experience in the awakening process. Not all people who experience nightmares would seek treatment for them. Rescripting of the nightmare -- that is, learning to change the events in the nightmare -- has been shown to be an effective treatment for those who suffer chronically from nightmares

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. REM (rapid eye movement) sleep is a different type of sleep, where the eyes move rapidly and vivid dreaming is most common. During a night, there will be several cycles of non-REM and REM sleep. Night terror (sleep terror) occurs during Stage 3 and Stage 4 sleep (deep sleep). The cause is unknown but night terrors are commonly associated with periods of emotional tension, stress, or conflict. Night terror is similar to nightmares except that nightmares usually occur during REM sleep and include unpleasant or frightening dreams. Nightmares are most common in the early morning.

Night terrors occur usually in the first half of the night heralded by a scream. The child does not usually remember the details of the scare. Nightmares are normal on occasion, especially after frightening movies/TV shows or emotional situations. Night terror occurs most often in preadolescent boys, although it can occur in girls and in adults. It is fairly common in children 3 to 5 years old, and incidence usually reduces greatly after that. It may run in families. Night terror can occur in adults, especially with emotional tension and/or the use of alcohol.

Night terrors are characterized by waking abruptly from sleep (usually earlier in the evening), screaming and appearing quite frightened. The attacks last for anywhere from less than a minute to about 5 minutes. Some patients will sleepwalk after the terror. There is no recall of the problem (unlike nightmares or dreams). The peak occurrence is at about age 6, and the attacks go away on their own in most patients by adolescence.

In many cases, comfort and reassurance are the only treatment required. Psychotherapy or counseling may be appropriate in some cases. Benzodiazepine medications (such as diazepam) used at bedtime will often reduce night terrors; however, medication is not usually recommended to treat this disorder. A safe over-the-counter drug, Benadryl elixir (diphenhydramine), given 1 hour before bedtime may reduce the incidence of night terror.