Sleep terrors
Sleep terrors involve sudden sitting up in bed, screaming, and sometimes walking around during non-REM sleep. They typically happen early in the night and can last for a few minutes to 40 minutes. These episodes are often associated with increased sympathetic nervous system activity and may be seen in individuals with psychiatric conditions like PTSD or anxiety. Treatment includes behavioral strategies like avoiding sleep deprivation and alcohol, as well as educating family members on how to safely interact during episodes. In severe cases, medications like clonazepam may be used.
2023-12-31 23:52:10 - Editor
Overview of Sleep Terrors
Sleep terrors are episodes of arousal from non-REM sleep that often involve sudden sitting up in bed, screaming, and walking around. These episodes are marked by increased sympathetic nervous system activity, including symptoms like pupillary dilation, sweating, and tachycardia. Affected individuals appear scared and inconsolable but are usually amnestic about the events. Sleep terrors typically occur in the early part of the night and are different from nightmares, which occur during REM sleep. In adults, sleep terrors may indicate comorbid conditions like PTSD, anxiety, or other psychiatric disorders. (1, 2, 3)
Management of Sleep Terrors
Behavioral and Preventive Strategies
The main focus is on eliminating precipitating factors such as sleep deprivation and avoiding alcohol and certain medications like zolpidem. Modifications in the sleep environment are advised to prevent injury, and caregivers should be educated on safe interaction during episodes. Cognitive behavioral therapy (CBT) techniques like guided imagery, relaxation training, hypnosis, and mindfulness-based stress reduction can be beneficial in some cases. (5)
Pharmacotherapy
Pharmacotherapy, typically reserved for more severe cases, may include medications like clonazepam (0.5-1 mg at bedtime). This treatment is effective in eliminating sleep terrors in patients who are resistant to behavioral and preventive measures. (6)
References
1-American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
2- Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry 1999; 60:268.
3- Ohayon MM, Mahowald MW, Leger D. Are confusional arousals pathological? Neurology 2014; 83:834.
4- Attarian H, Zhu L. Treatment options for disorders of arousal: a case series. Int J Neurosci 2013; 123:623.
5- US Food and Drug Administration (FDA). FDA adds boxed warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines. FDA Drug Safety Communication, April 30, 2019.
Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia
6-Drakatos P, Marples L, Muza R, et al. NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients. Sleep Med 2019; 53:181.