Sleep terror

Federica Provini MD (Dr. Provini of the University of Bologna and IRCCS Institute of Neurological Sciences of Bologna received speaker's fees from Bial, Fidia, and Vanda Pharmaceuticals.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released April 7, 1994; last updated January 7, 2017; expires January 7, 2020

This article includes discussion of sleep terror, disorder of arousal, night terrors, NREM-related parasomnia, and pavor nocturnus. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Sleep terrors consist of abrupt arousals out of sleep stage 3 NREM, primarily in the first third of the night, with disordered motor agitation, screaming, fear, and autonomic activation. Sleep terrors affect between 1% to 6% of prepubertal children with a peak incidence between 5 and 7 years of age and a strong familial clustering. Sleep terrors are usually benign and tend spontaneously to decrease in frequency or cease during adolescence. In this update, the author addresses the latest clinical and polygraphic criteria for the differential diagnosis between sleep terrors and other motor phenomena occurring during sleep, focusing on sleep-related hypermotor epilepsy in which the differential diagnosis poses particular problems.

Key points

 

• Sleep terrors are sudden, partial awakenings from deep non-REM sleep, associated with intense motor behavior and strong autonomic responses.

 

• Sleep terrors are mainly a childhood phenomenon, with peak prevalence at 5 to 7 years of age.

 

• During the episodes, children have a terrified expression but do not respond to family members trying to console them.

 

• Sleep terrors are usually benign with a tendency for spontaneous resolution during adolescence.

 

• Safety measures are of primary importance to protect the patient from injury, but treatment with medications is not usually necessary.

Historical note and terminology

Sleep terrors (also called "pavor nocturnus" in children and "incubus" in adults) have commanded attention for centuries. It was not until 1949, when Jones wrote On The Nightmare, that sleep terrors were differentiated from terrifying dreams (Jones 1949).

Gastaut described sleep terrors in a single subject, which originated in slow-wave sleep (Gastaut et al 1962). Fisher confirmed that sleep terrors begin in stage 3 or 4 sleep, generally in the first cycle, and showed that they could be experimentally triggered by external stimuli (Fisher et al 1970). Broughton first suggested that sleep terror is a "disorder of arousal" rather than an epileptic phenomenon (Broughton 1968). In the International Classification of Sleep Disorders, sleep terrors are classified as a disorder of arousal (from NREM sleep) within the class of parasomnias (American Academy of Sleep Medicine 2014).

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