Night Terrors in Children and Adults

Night terrors, also called sleep terrors, are a type of sleep disorder. During a sleep terror, you might scream or cry while asleep, or it may seem like you’re acting out a bad dream. These episodes can affect children or adults, but they’re more common during early childhood.

Generally, sleep terrors are not considered to be harmful to your physical or psychological health, but sometimes they can be a sign of underlying anxiety. If you think that you or your child has sleep terrors, you should rest assured that they can be well managed with lifestyle changes and medical care.

In this article, learn about the causes of sleep terrors and how to deal with them in adults and children.

Night Terrors in Children

Sleep terrors are not common, but they are not rare either. They are more common among young children under age 5 than any other age group. One research article published in 2022 estimated the frequency of sleep terrors during early childhood to be between 16.7% and 20.5%. 

There is a genetic predisposition to night terrors, but not everyone with this sleep disorder has a family member who also has had them. 

Causes of sleep terrors during childhood include:

• Fatigue, sleep deprivation
• Anxiety
• Sleep disruption
• Waking up during sleep
• Behavioral problems

Night terrors typically occur during transitions between the phases that cycle throughout sleep. Children are more prone to waking up between sleep phases than adults are. Sleep normally becomes more regulated as the brain matures, and night terrors are rare during adulthood. 

Some Adults Experience Night Terrors Too

While the most common age for night terrors is early childhood, these episodes can continue or begin during adolescence or adulthood.

Having night terrors at any age does not indicate a psychiatric condition, and there is no reason to be embarrassed or concerned if you or your child is having them. However, if you experience night terrors at any age, it is important to get a medical evaluation. These episodes can sometimes be related to underlying health conditions.

Risk factors for adult-onset night terrors include:

• Anxiety
• Sleep deprivation
• Sleep disorders, such as obstructive sleep apnea
• Medication side effects, especially antihistamines and antidepressants

If you have been experiencing sleep terrors, it would be beneficial to learn whether you have an underlying medical condition so that you can get appropriate treatment. Treatment will help the underlying condition and lower the risk of recurrent sleep terrors.

An anxiety disorder can cause anxiety symptoms, but that’s not always the case. Many people can experience periods of anxiety due to stress without having an anxiety disorder. 

Symptoms: Night Terrors, Nightmares, or Nightmare Disorder?

Night terrors occur during sleep, and people who are experiencing these episodes are unaware that the episodes are occurring. When a person has night terrors, they may cry, scream, or punch while they appear to be sleeping.

Symptoms and characteristics of night terrors include:

• Making sounds or movements that indicate distress during sleep
• Rapid breathing
• Rapid heart rate
• Sweating
• Flushing
• Dilated pupils
• Muscle tension
• Not responding to the speech of other people in the room during the episode
• Not being able to remember or describe what happened

After having a night terror, sometimes people can recall having experienced some anxiety during the night or might describe a sense of doom. 

Other Parasomnias 

Night terrors are a type of parasomnia. A parasomnia is an unpleasant sleep experience, such as a nightmare. However, night terrors are not the same as nightmares or other parasomnias.

How other parasomnias compare to night terrors include:

• Nightmares are bad dreams, and people usually remember some of the content of a nightmare. Unlike sleep terrors, people do not act out during a nightmare, and others who are in the room usually don’t notice any changes in movement or behavior. 
• Sleepwalking is a type of coordinated physical movement that occurs during sleep. Sleepwalking does not occur during the dream stage of sleep, and people experiencing them will not recall sleepwalking. They are more common among children than adults.
• Sleep paralysis is a terrifying experience during which you are unable to physically move any part of your own body even though you feel you are awake. Most people remember sleep paralysis episodes, and others who might be present in the room typically do not see any altered behavior.
• Sleep talking is when people talk when they are asleep. This can happen during any stage of sleep, and it isn't usually unpleasant.

Sleep Routines to Stop Night Terrors

If you have been experiencing sleep terrors, there are some ways to prevent them from occurring. You should start by seeing a healthcare provider, who will evaluate your overall health and consider underlying psychological issues (especially anxiety) and health conditions that could be putting you at risk.

Some recommendations for preventing recurrent sleep terrors include lifestyle adjustments. 

Measures you can take to avoid sleep terrors include:

• Avoiding alcohol, caffeine, and other stimulants (such as medications with stimulant action), especially before bedtime
• Avoiding disturbing content, such as frightening books, media, or discussions, especially before bed
• Getting enough sleep if you have not been sleeping well
• Regulating your sleep schedule to sleep and wake up at approximately the same time every day

Additionally, consider going over the following with your healthcare provider:

• A review of your medication list to detect whether you have been taking any medications that could be causing sleep terrors as a side effect
• Whether you may have anxiety that could be overwhelming for you, and how to get help and support with distressful issues
• Whether a sleep evaluation is needed to identify an underlying sleep disorder that needs an assessment and treatment

For a child with ongoing night terrors that occur at a regular time each night, a healthcare provider may recommend scheduled awakenings. In this process, the usual time of the night terror is noted over the course of two weeks.

The parent gently wakes the child 15 to 30 minutes before that time each night and allows them to return to sleep. This is done for two to four weeks.

Mental Health and Night Terrors 

Sometimes people who experience sleep terrors become concerned about whether these events could be an indication of an underlying mental health problem. Older research on this subject has not shown a strong association between sleep terrors and psychiatric conditions.

In general, people who have psychiatric diagnoses, such as post-traumatic stress disorder (PTSD), anxiety disorders, borderline personality disorder, or schizophrenia, may be at a slightly higher risk of experiencing sleep terrors or other parasomnias. However, having sleep terrors is not an indication of an underlying or undiagnosed psychiatric condition.

For Parents: When You See Your Child Having Night Terrors 

If you’ve experienced night terrors in your children, you might be concerned that your child could be having a seizure or a panic attack. It can be difficult for parents to know the difference between night terrors and psychiatric illnesses or neurological conditions.

It could be helpful for you to video or audio record the episodes so that you can share the recordings with your child’s pediatrician when you take them in for an evaluation.

Many children become stressed about a variety of things in life, ranging from exaggerated anxiety about issues that they don’t have control over to serious concerns about issues like parental fighting or bullying at school.

If you feel that you are not able to address your child’s anxiety, it could be helpful to seek professional help from someone who is experienced in counseling children and families with young children.

Summary 

Night terrors, also called sleep terrors, are more common among young children than any other age group, but they can occur at any age. Sometimes sleep disruption, sleep deprivation, or daytime anxiety can contribute to the risk of having night terrors, and they can also occur as a medication side effect.

Night terrors are episodes that involve acting out a sense of terror during sleep, which can be alarming to other people but does not cause distress to the person who is experiencing the episode. Some people may feel a sense of doom or anxiety before or after a night terror. The key feature of night terrors is that people do not remember having them.

If you or your child has been experiencing night terrors, it will be helpful to see a healthcare provider who can try to identify the underlying cause and provide some guidance to help with management.