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  • Updated 06.03.2023
  • Released 04.07.1994
  • Expires For CME 06.03.2026

Sleep terror



Sleep terror is one of the manifestations of disorders of arousal and consists 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 to spontaneously decrease in frequency or cease during adolescence. However, since the early 2000s, it has been shown that sleep terrors can persist in adulthood in predisposed individuals or even appear de novo in some cases, often causing excessive daytime sleepiness and altered quality of life. 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. In addition, the author provides the results of the new extensive research on the link between sleep terrors and the concept of local arousal.

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, but they can persist in adulthood in predisposed individuals or even appear de novo in some cases.

• 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 (21).

Gastaut described sleep terrors in a single subject, which originated in slow-wave sleep (15). Broughton first suggested that sleep terror is a "disorder of arousal" rather than an epileptic phenomenon (05). Fisher confirmed that sleep terrors begin in stage 3 or 4 sleep (now N3), generally in the first cycle (14). In the International Classification of Sleep Disorders, sleep terrors are classified as a disorder of arousal (from NREM sleep) within the class of parasomnias (01).

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