Night terrors, also known as sleep terrors, are an early childhood parasomnia characterized by screams or cries, behavioral manifestations of extreme fear, difficulty waking and inconsolability upon awakening[1].Parasomnias can often occur during any stage of sleep; however, night terrors specifically are associated with non-rapid eye movement (REM) sleep stages in which the person or child is in a transitional state in between sleep and wakefulness.Most episodes last 45-90 minutes and are most common as the individual passes through stages 3 and 4 non-rapid eye movement sleep. Night terrors are most common in between ages 4 until puberty.
The three main stages of sleep are (1) wakefulness, (2) non-rapid eye movement (non-REM) sleep, and (3) rapid eye movement (REM) sleep. These states are subsequently subdivided into distinct stages. Stages 1, 2, 3, and 4 of sleep are classified as non-rapid eye movement (non-REM) sleep, and stage 5 is classified as REM sleep. The states and stages mentioned may exhibit overlapping characteristics, and it is during these transitional states that parasomnias may manifest[2].
Episodes of night terrors typically occur during the early part of the night when the child is in a state between wakefulness and sleep. This specific period is known as the arousal state. Episodes may seem quite intense, with the child screaming and thrashing without being aware of their surroundings. Children may exhibit symptoms of heightened autonomic activity, including rapid heart rate, rapid breathing, dilated pupils, and excessive perspiration. In certain instances, enuresis may also manifest.It is common for children to not respond to verbal cues, attempts to comfort them, or efforts to awaken them. Waking these children during an episode can be quite challenging. These episodes typically last for about 10 to 20 minutes before the child suddenly goes back to sleep. Many children do not remember the episodes.
Etiology
The precise cause is uncertain, however there are significant associations with fever and illness, extreme physical exertion, excessive use of coffee or alcohol, sleep deprivation and fatigue, and emotional strain.
