Sleep terrors (also known as sleep terrors, incubus attacks, and pavor nocturnus) are forms of sleep disorders that get confused with nightmares more often than they should. According to the American Academy of Sleep Medicine, sleep terrors affect less than 1-2.2% of adults yet they account for exaggerated forms of sleep disturbances. Sleep terrors peak in adults in their 20s to 30s. They affect males and females equally. They are categories of parasomnias (sleep disorders that involve undesirable movements, behaviors, emotions and dreams) which are manifested in the form of dread or terror occurring during the first hours of stage 3 NREM sleep.
What is NREM sleep?
NREM sleep is abbreviation for non-rapid eye movement sleep. It is characterized by no eye movement, rare dream occurrence and no muscle paralysis. NREM consists of stages 1-3. There are distinct characteristics seen in each stage. The first stage is usually referred to as relaxed wakefulness because it occurs right in the beginning of sleep. People usually experience the hypnic jerk (an involuntary twitch which resembles the jump that a person experiences when startled) during that stage. The second stage is where there is almost no eye movement and sleepers are quite easily awakened. Brain activity is very high during this stage.
In the third stage of NREM sleep, the person is less liable to external environmental stimuli. It is referred to as deep sleep or slow-wave sleep (SWS). This stage often occurs between the times of midnight and two a.m. A sleep terror may last from seconds to a few minutes but in graver cases they last up to 20 minutes per episode.
Sleep terrors Demographics:
Sleep terrors are more common in children. About 15% of younger kids have occasional sleep terrors and the occurrence is more prevalent in the kids between the ages of 2 and 6.
The definition of sleep terrors may be a bit tricky. It is usually a representation of the state that the person is in while suffering from this parasomnia. A broad definition would be “episodes of flailing, intense screaming and panic experienced while still asleep or on suddenly waking up in the night.” It is important to take note that nightmares are also a form of parasomnia.
Sleep terrors, however, shouldn’t be confused with terror by night. “Terror by night” is a 1946 Sherlock Holmes movie starring Basil Rathbone and Nigel Bruce as Sherlock Holmes and his faithful friend Dr. John H. Watson, respectively. “Terror By Night” is also the title of a non-fiction, true crime book about a brutal murder that took place in Texas six years ago, where the author’s daughter’s boyfriend opens fire on him and his wife, killing her and the couple’s two sons while wounding the author, Terry Caffey, 12 times before running away.
Sleep terrors vs. Nightmares:
Back to sleep terrors, despite being so often confused with nightmares, the main difference between them is that the sleeper is able to wake from a nightmare and remembers it (or most of it) later on. Sleep terrors, however, occur while the person remains asleep. Adults might or might not recall a fragment of a nightmare they had during a night terror episode. Adults rarely tell the difference between sleep terrors and nightmares and usually call both occurrences as one long “bad dream”.
Another distinction between sleep terrors and nightmares is that the latter occurs during rapid-eye movement (REM) stage of sleep. Sleep terrors are also experienced as feelings, not dreams, so people do not recall the reason behind their fear when they wake up.
The problem with sleep terrors is that doctors often misdiagnose them for PTSD or a sequence of nightmares.
Causes of Sleep terrors:
Sleep terrors have varying causes. They differ from one adult to another and the reasons behind them could be attributed to a number of factors. Some studies suggest that sleep terrors are in fact, congenital. Many people who suffer from sleep terrors have reported one or more family members having regular episodes of sleep terrors or other parasomnias.
Other contributing factors to sleep terrors may include:
- Sleep deprivation.
- Imbalanced diet.
- Obstructive sleep apnea (OSA).
- Post-traumatic stress disorder (PTSD).
- Bipolar disorder.
- General Anxiety Disorder.
- Stressful lifestyle.
- Nocturnal Asthma.
- Gastroesophageal reflux disease (GERD).
- Alcohol abuse.
Scientists discovered that there might be a link between sleep terrors and narcolepsy. Narcolepsy is a sleep disorder manifested as poor control of sleep-wake cycles leading to excessive sleepiness, and frequent, irresistible daytime sleep attacks that can strike at anytime. Narcolepsy is caused by insufficiency of the neurotransmitter hypocretin, which promotes wakefulness.
Studies (and observers’ testimonials) suggest that narcoleptics have more occurrences of sleep terrors because in narcolepsy, the line between REM stage and NREM stage of sleep are blurred. Narcoleptics find themselves experiencing dreams when awake, uncertain whether they’re awake or asleep and often hallucinating while in-and-out of sleep.
Another condition that is linked to sleep terrors is hypoglycemia or low blood sugar. Diabetic patients who experience hypoglycemia often are susceptible to episodes of sleep terrors because it stimulates the secretion of adrenaline as a defense mechanism to the drop of blood sugar level. Adrenaline secretion increases alertness making it difficult to relax into deep sleep and resulting in a light, superficial sleep which doesn’t involve the healthy transition from one stage to another.
Symptoms of Sleep terrors:
Sleep terrors are often described as a state of fright or terror that a person partially wakes up in. In some cases a person wakes up screaming or crying. Symptoms of sleep terrors include:
- Bolting upright in bed.
- Waking up screaming or crying.
- Increased heart rate (tachycardia).
- Increased breathing rate (tachypnea).
- Kicking and thrashing (might include punching, swinging or fleeing movements).
- Person is unresponsive to stimuli and confused.
- Profuse sweating.
- Wide eyes with dilated pupils.
- Elevated blood pressure.
- Hallucination in severe cases. People describe seeing animals in the room such as snakes or spiders or even humans in the form of a tall and dark, shadowy figure intent on hurting them.
- Person doesn’t recognize what he or she says/does.
- Self-directed anger.
- Impaired memory.
- Risky behaviors like the person attempting to jump from the window or attacking family members with sharp objects.
Adolescence is the stage where sleep terrors seem inexistent. Almost all children grow out of night terror before adolescence while the adults experience it for various psychopathological reasons. Adults with mental disorders such as borderline personality disorder, schizophrenia and depression usually acquire sleep terrors as a side effect of their prescribed medications or a manifestation of their condition. However, a recent study claims that children who are bullied between the ages of 8 and 10 are more likely to experience sleep terrors (and other sleep disorders) in their early teen years.
Sleep terrors Management and Treatment:
Treatment for sleep terrors is usually related to the cause. If sleep terrors are caused by stress, then lifestyle modification is a must. Patients with a stressful lifestyle or anxiety issues should try various forms of treatments including cognitive behavioral therapy, hypnosis, biofeedback and relaxation methods like yoga and palates. Biofeedback is especially an interesting way to manage sleep terrors. In this technique, people learn to control their body functions (e.g. heart rate) by making subtle changes in their bodies, such as relaxing certain muscles, to achieve desired results such as reducing pain.
Biofeedback is considered a relaxation technique where a person uses the internal power of their thoughts to control their bodies. Biofeedback is considered an alternative to medications so as to avoid undesirable side effects which might worsen sleep terrors in some cases. It is a relatively safe method. During biofeedback, a therapist attaches electrical sensors to different parts of the patient’s body. These sensors monitor the body’s physiological functions, such as brain waves, skin temperature, heart rate or muscle tension. The patient is fed back this information via a beeping sound or a flashing light thus teaching him/her to change or control his/her physiological responses by changing their thoughts, emotions or behavior.
Through excessive therapy sessions, adults suffering from sleep terrors could learn how to monitor their physiological reactions at home and use biofeedback at home.
Medications are rarely used to treat sleep terrors as psychological conditions but benzodiazepines were the most effective to handle certain severe cases of sleep terrors where anxiety was involved.
Certain meditative techniques could be used to calm down adults suffering from sleep terrors. Acquiring a regular before-going-to-bed routine might be useful as well. Reading books, listening to classic or meditation music, taking a warm bath or doing Sudoku are helpful to many people who suffer a disorganized lifestyle.
Sleep terrors Prevention Methods:
The sleeping environment plays a huge role in initiating or preventing sleep terrors. The person must take great care to choose the suitable room lighting, create a comfortable and quiet sleeping environment, lock the interior doors, place alarms or bells on doors, pick the perfect bed (steering away from bunk beds) and keep sharp objects out of reach.
For some people, keeping a sleeping diary might be of great help to prevent sleep terrors. A sleeping diary might contain the person’s sleeping habits, whatever normal or bizarre elements there might be. A family member would closely watch the patient and take notes of the exact time the night terror episode takes place after the patient falls asleep. The patient would set his/her alarm 15 minutes before a night terror episode is expected. When the alarm rings, he/she would wake up and wait 5 minutes before going back to sleep. This technique is called “Scheduled Awakenings”.
Herbal remedies and alternative medicine could be used to treat sleep terrors. Many adults suffering from sleep terrors use herbal tea to help them go to sleep. Herbal tea contains ingredients that help a person relax and holistically regulates the brain chemistry so that all tension and alertness disappear. The person becomes calmer and onset of sleep is rapidly induced without the period of staying wide awake in bed, which gives way to negative thinking. Herbal teas have a long history of safe use. They have no impact on dream recall and thus won’t interfere with the normal sleep pattern or blur the differences between sleep stages. Herbal teas may include but are not limited to:
- Chamomile tea: It contains the amino acid glycine which acts as a nerve relaxant and mild sedative.
- Hops tea: It is a mild sedative which rapidly induces the onset of sleep.
- Valerian Root, Passionflower, and Kava Kava tea: It has relaxing and anxiolytic (anxiety-reducing) properties similar to Phenobarbital but without the susceptibility to addiction or the severe side effects.
- Calea zacatechichi tea: Originally called the “dream herb”, this tea induces lucid dreams and stimulates the brain in a very long state of REM sleep.
- Silene capensis (African Dream Root) tea: The effect is not noticed when the person is awake but it works wonders when the person sleeps and induces vivid dreaming like no sleeping pill has ever done.
Emotional support and counseling are both great ways to prevent or stop sleep terrors. A family member or a loved one might simply hug the sleeper and reassure him/her that everything was going to be alright. Physical contact is very important in case of monitoring a person suffering from sleep terrors. It should never be forced or coaxed. The person must not be yelled at or shaken into wakefulness.
Another form of sleep terrors treatment would be the antidepressant drug Paroxetine. It is a serotonin-specific reuptake inhibitor (SSRI) that is used to treat major depression, obsessive-compulsive disorder (OCD) and other psychological disorders. One of its advantages is that patients don’t build up tolerance to Paroxetine so it more the drug of choice than benzodiazepines. However, Paroxetine is said to increase suicidal tendencies in children and adolescents so it shouldn’t be used for treatment of sleep terrors in the young age group.
Sleep terrors Stories and Interpretations:
Most sleep terrors stories published on blogs and online support groups are by parents telling their kids’ stories. Many parents complain that their kids are having 4-5 episodic attacks of sleep terrors. A lot of parents discard this problem as something the kids will “grow out of” someday. Kids become hostile at times as well, screaming at their parents, not wanting to be touched or comforted.
In some night terror tales published on the internet, one parent describes her kid as “acting a scene from The Exorcist every night”.
“It’s like déjà vu, except in 3D” another parent confessed.
Many parents were skeptical whether it was a physical symptom (e.g. colic) because it would be very hard for them to imagine their baby of few months old having an episode of night terror.
On the website “The Last Word On Nothing” a blogger recounts her sleep terrors experience as a syndrome called “The Old Hag”. Old Hag syndrome is an evolutionary hiccup, performed involuntarily as a side effect to a protective mechanism. According to the website, Professor James Cheyne, a sleep researcher at the University of Waterloo in Canada says that 40% of the world population experiences the scary malevolent presence of Old Hag. It is described more or less like an evil night creature: succubus, incubus or a demon. These terrifying feelings are experienced due to a minor malfunction in the central hub of the brainstem and activation of the amygdala, the area in the brain responsible for processing emotion.
Another website explains sleep terrors on the historical backgrounds of religion and supernatural beings. Some state that sleep terrors evidenced the presence of ghosts. In other tales, Old Hag was a witch that came to haunt the sleepers, as they lie vulnerable in their beds.
As we progressed into a modernized era, college professors began explaining other otherworldly tales on the base of sleep terrors. Professor Susan Blackmore, a psychologist at the University of Plymouth, stated that many of the alien abduction stories could be unveiled in the light of sleep terrors symptoms. Sleep researchers and psychologists warn people, though, to not get too involved in supernatural stories as many people admitted to getting sleep terrors only after reading testimonials by those who suffer from them online. Psychologists also praise “lucid dreaming“, a technique in which a person is in control of what he/she dreams and thus could change the path of dreams or end a nightmare at the very beginning.
Sleep terrors comprise a grave psychological problem but with patience, psychotherapy and lifestyle modification, it is easily conquered.