Have you ever experienced screaming as you wake up from a bad dream? It’s often depicted in movies, but what does it really mean? Sleep terrors can be a horrifying experience, so let me tell you everything about it.
Sleep terrors are episodes of screaming and feeling extreme fear while still asleep and can be paired with sleepwalking. It is typical for a person with sleep terrors to to wake up screaming and / or kicking.
Sleep terrors are not the same as your average bad dream or “nightmares”. It is also known as “night terror”, and it is often worse when affecting children.
It usually begins in childhood but the severity is known to decrease with age. Severe sleep terrors among adult can be rare, but it can be associated with other influencing factors.
Approximately 40% of children are affected by sleep terrors. However, no matter how frightening this condition is, it is not deemed to be a life threatening disease and can be ignored until it goes away on its own.
Having bad dreams is actually common during childhood but sleep terrors should be less common in children than normal bad dreams.
In general, the prevalence of sleep terrors is still unknown, making the statistics prone to changes any time.
The frequency of sleep terrors may vary along with its severity. Every individual may possess different levels of sleep terror.
Episodes of sleep terrors can happen in intervals of days or weeks, but it may also occur over consecutive nights or multiple times in one night.
Due to this, sleep terrors can sometimes be confused with other nocturnal attacks or nightmare that a person might have.
Sleep terrors are more extreme and dramatic than a common dream as the feelings of terror or dread can last for one up to ten minutes, continuously “haunting” the person suffering from it.
It is also common for night terrors to happen during periods of arousals from delta sleep or the “slow-wave sleep”.
There are different factors that can potentially cause sleep terrors.
This sleeping condition is classified under the category of NREM-related parasomnias in the International Classification of Sleep Disorders.
Parasomnias are qualified as undesirable physical events or experience that occur during falling asleep, during actual sleep or during arousals from sleep.
Sleep terrors have been recognized or known about since old times, but it was not possible to differentiate it from nightmares until rapid eye movement was learned about.
Symptoms
The main sign of sleep terror is when the person affected acts terrified and may seem fully awake, but they’re not. When asked the moment they finally wake up, they will have no memory of what happened to them.
- Signs of Sleep Terror
- Becoming inconsolable
- Sleep walking
- Strange movements during sleep
- “Bolting upright” with eyes wide open
- Showing despaired facial expressions
- Screaming during sleep or as they wake
- Sweating even if the temperate is cool
- Groaning, moaning or crying during sleep
- Unconscious heavy or rapid breathing
- Involuntary reddening of the skin
- Irregular heart rate or rapid heart rate
- Dilated eye pupils
- Punching, swinging or evading motions
Signs of sleep terrors can be very similar to a panic attack or a mental breakdown.
When an episode of sleep terror occurs, patients are often seen with their eyes wide open or dilated pupils while expressing a horrified look on their faces.
It is then followed by screaming and performing actions that imply they are running, trying to escape or protect themselves. Clearly, it shows that they’re in “danger” or “threatened” in their nightmare.
Due to the fear they experience from the sleep terrors, their heart rate increases and starts to beat rapidly along with their breathing which will cause them to sweat uncontrollably.
Once again, these people may seem fully awake during an episode of sleep terrors, but they’re not. You may try to reach out to them or talk to them, but they won’t know you’re there at all.
If you witness an episode of sleep terror, you might mistakenly think that the affected person can see you but they might be experiencing hallucinations and won’t recognize you at all.
When you ask them what or why they were behaving so strange, they often do not remember what they did. However, they may remember specific images or parts of the dream or hallucination.
Waking during a sleep terror episode
When an affected person completely wakes up during a sleep terror episode, there’s a tendency of exhibiting violent behavior due to extreme confusion.
It’s common for sleep terror victims to lash out at the person that wakes them, or vent their confusion, emotions or such to the first object they can see and will be followed by a breakdown or screaming.
There are times when an awakened person may stare silently for seconds as their confused reaction and attempt to understand the situation, but there’s still a chance that they may attack whoever is near them.
This is why some people may not know what to do if a person they know is having a sleep terror episode.
It is best to stay close to them to keep them away from danger and only wake them if it’s necessary. Otherwise, it is the person who wakes the affected patient that may be in danger.
The best option is to call for help or assistance to hold down a person affected by sleep terrors.
Diagnosis
Diagnosing sleep terror actually has a criteria that patients must meet before they can qualify for a test. The qualifications are listed below. Once a patient is qualified, a sleep test may be scheduled.
(Related: “How to Do a Sleep Study?”)
- Recurrent episodes of interrupted sleep
- Waking, but not total wakefulness
- Experiencing intense fear
- Screaming out of panic
- Have an increased heart rate
- Profuse sweating
- Heavy breathing
- Affected person is inconsolable
- Being unable to recall their actions during an episode
- Unable to remember most parts of their dream
- The episodes is affecting the person’s quality of life
- The problem is not caused by another medical condition
- Existing medical conditions are not related to the episodes
Assessment for Sleep Terrors
The way sleep terror is assessed is similar to how other sleep disorders or parasomnias are assessed.
- When the episode occurs during sleep
- When the problem began or first observed
- How frequent the episodes occur
- How long episodes last
- How the episodes are described
- What emotions were shown
- What thoughts were present during and after the episode
- How responsive the affected person during an episode
- How conscious a person is after waking from an episode
- If the affected person remembers what happened
- What seems to trigger the problem
- What is the person’s sleeping pattern and environment
- Does the affected person experience daytime sleepiness
- Does the affected person have other sleeping disorders
- Does the affected person have a family history of sleep terrors
- If the affected person have any medical or neurological history
- If the affected person is under the influence of medication
- If the affected person has a history of addiction
Types of Sleep Terrors
There are two different classifications of sleep terrors depending on their frequency.
- Sleep Terror Disorder
- Sleep terror disorder, is if the episodes of screaming, hallucinating and odd behavior are recurrent and severe to the point that it can be health threatening.
- Sleep Terror Episodes
- Sleep terror episodes is different from its disorder version as it only occurs once in a while, not as frequent as the disorder version does. Both are equally terrifying, regardless.
Sleep terrors can occur in children but can also happen with adults.
- Children
- Sleep terrors are common in children aging between 3 to 12 years old. The onset usually starts during three and a half years of age.
Children of both genders and any ethnic backgrounds are affected equally.
Most children will outgrow their sleep terror condition.
Sometimes, children younger than 3 years old may experience sleep terrors at least once a week. For older children, the episodes may occur once or twice a month.
Children normally have no memory of their experience. Pediatric evaluation can be helpful in resolving sleep terrors in children.
- Sleep terrors are common in children aging between 3 to 12 years old. The onset usually starts during three and a half years of age.
- Adults
- Symptoms of adult sleep terrors may not be different, but may have different possible causes.
Sleep terrors in adults can occur each night but can be treated easier than childhood sleep terrors since there are more coping options.
Sleep terrors in adult are classified as a mental and behavioral disorder in the International International Statistical Classification of Diseases.
Running out of the house as an effect of sleep terror is also more common among adults which can then lead to violent actions.
- Symptoms of adult sleep terrors may not be different, but may have different possible causes.
Apparently, older children and adults tend to provide clear details of what they experienced during the night terror episode, or what they saw in their dream or hallucination unlike younger children.
Different diagnosis
Sleep terrors, or “night terrors” are different from nightmares and it is very important to distinguish the difference between the two.
As a simple explanation, in nightmares, there are nearly zero cases of vocalization or agitation. Even if there are any, they are not as strong as how sleep terrors can be.
Additionally, nightmares commonly occur during REM sleep which is the opposite of sleep terrors that occurs in NREM sleep.
People who only get nightmares can easily be fully awakened and have clear or detailed memories of their dream, unlike people with sleep terrors.
Another condition that might be confused with sleep terrors is epileptic seizures.
It is a fact that epileptic seizures could happen during the day as well, but both epileptic seizures and sleep terrors have similar physical reactions at night.
Causes
According to studies, the main cause of sleep terrors along with other sleep disorders may be congenital, or in other words, it begins right at youth.
It has been observed that family history of sleep terrors seem to pass down every generation. Regardless if it’s about sleep walking or sleep terrors, a family member must have experienced it before.
- Possible causes of Sleep Terrors:
- Young age
- Lack of sleep
- Taking medications
- Unhealthy diet
- Stress
- Severe fever
- Congenital sleep disorders
- Psychopathology
- Post-Traumatic stress disorder (PTSD)
- Generalized anxiety disorder (GAD)
- Dependent personality disorder
- Schizoid personality disorder
- Borderline personality disorder
- Depression
- Low blood sugar
- Seizure disorders
- Genetics / Hereditary
- Nocturnal asthma
- Gastroesophageal reflux
- Central nervous system medications
Another possibility that has been found is that some adults who have been on a long-term intrathecal clonidine therapy show side effects of sleep terrors, such as feelings of terror early in the sleep cycle.
This is due to the possible alteration of cervical / brain clonidine concentration.
In adults, sleep terrors can be symptomatic of neurological disease and can be further investigated through an MRI procedure.
Just like other sleep disorders that mostly involve dreams, nightmares or abnormal phenomenons, the exact answers still remain a mystery.
It is not yet fully understood, what the true nature of dreams or sleep terrors is all about which is why it only leads to various possibilities that have little to no evidence that may link them to sleep terrors.
Treatments
Usually, children with sleep terrors eventually outgrow the condition and for adults, the sleep terrors may also subside after a while. However, there are times when the problem may persist in adults.
Since the condition is known to subside by itself, there aren’t much necessary medical treatment involved with it, but most of the time, lifestyle changes or mental support are sufficient treatment.
For severe cases of sleep terrors, medications such as benzodiazepines or tricyclic antidepressants can be used. But once again, only if the case is extreme.
- Tips on How to Deal with Sleep Terrors
- Avoid waking the patient during an episode unless necessary
- Comfort a child that the condition will go away as they grow
- Remove or keep away dangerous items, objects
- Follow a healthy sleep routine
- Some people consider hypnosis
- Manage stress
- Treat other conditions that may worsen sleep terrors
- Psychotherapy
- Counseling
Risks
Aside from poor quality of sleep, the only risks that sleep terror can possess is the risk of getting into accidents or committing violent acts unconsciously.
It may also affect a person’s lifestyle or the people around them, but overall, it does not harm the physical health but can trigger anxiety or depression for those why may be worrying about it.
Related Questions
What does it mean when you wake up screaming?
Waking up screaming after a nightmare is a sign of a sleep disorder called “sleep terror” or “night terror”. A regular nightmare does not involve screaming, kicking or other physical or vocal reactions.
A night terror involves screaming most of the time, but the content of the dream they experienced are usually blurry.
Waking up screaming can also be a sign of other sleep disorders, but it is the biggest sign of sleep terror or night terrors.
Is Night terrors a mental illness?
As of today, is it unclear whether night terrors or sleep terrors can be considered a mental illness or not.
However, researchers have also known for quite a while that some people who suffer from a mental condition called “schizophrenia” also tend to experience night terrors which may allow it to be considered a part of a mental illness.
Do night terrors affect brain?
Yes, night terrors can potentially affect the brain if sleep is continuously disturbed.
During night terrors, a person’s sleep isn’t actually disturbed as they aren’t fully awake at all. But their family or anyone close to them might wake them up during a night terror episode, disrupting their sleep.
However, sleep disorders often mean that there is already an irregular brain activity that has been going on behind the scenes. Therefore, both must be prevented to avoid worsening each other.
During night terror episodes, a person’s brain is asleep but a part of the brain that is in charge of controlling one’s movement, voice, and expression fails to sleep, causing abnormal sleep behaviors.
