Sleeping Disorders

Night Terror

Night Terror (also called Pavor Nocturnus and Sleep Terror), is a parasomnia sleep disorder characterized by extreme terror and a temporary inability to regain full consciousness.  During a Night Terror episode, a person wakes abruptly from the fourth stage of sleep (a very deep stage of sleep), with waking usually accompanied by gasping, moaning, or even screaming.  It is difficult and often impossible to fully wake the person, and after the episode they normally settle back to sleep without waking.  Occasionally, the Night Terror episode can be recalled by the person in the morning, but normally it is not remembered.

Symptoms

While each Night Terror is usually different, all episodes by the same person will generally have similar features.  One seemingly universal quality of night terrors is a strong sense of danger.
Night Terrors are distinct from nightmares in several key ways:
· The person is not fully awake when roused by a Night Terror episode, even when efforts are made to wake the sleeper, and they may continue to experience the night terror for a prolonged period of 10 or 20 minutes.
· Unlike nightmares, Night Terrors occur during the deepest levels of non-REM sleep.
· Even if wakened the subject can often not remember the Night Terror episode except, perhaps, for a sense of panic, while nightmares are easily recalled.
· Nightmares are frequently dreams about a frightening event, such as a monster under the bed, falling to one's death, drowning, etc.  However, Night Terrors are not dreams like this, instead there is no situation or event, scary or otherwise, that is dreamt but rather strong emotions of fear is felt, often with tension and apprehension.  These emotions without a focusing event or scenario that make up the dream itself compound and add to each other increasing the emotional build-up with a cumulative effect.  As a result, the lack of a dream itself leaves those woken from a night terror in a state of disorientation much more severe than a normal nightmare.  This can include a short period of amnesia during which the subject may be unable to recall their name, location, age, or any other personal or identifying features.  This confused state generally passes after one or two minutes.
Night Terror episodes may occur frequently for a couple of weeks and then suddenly disappear.  Each episode usually occurs during the first couple of hours of sleep.

Causes

The main causes, risk factors, and triggers for Night Terror include:
· Age: Children from age four to six are the most prone to experiencing Night Terrors, and they affect about three percent of all youngsters.  However, people of any age may experience them.
· Genetics: strong evidence indicates that a predisposition to Night Terrors and other parasomniac disorders can be passed genetically.  That is, the disorders run in families.
· Emotional Stress
· Fever – especially High Fever
· Lack of Sleep / recent disturbed sleep
Emotional stress during the previous day and a high fever are thought to precipitate most Night Terror episodes.

Diagnosis

Diagnosis for Night Terror is achieved by monitoring a patient's symptoms and sleep diary kept by their family / partner.  The symptoms for Night Terrors are so clear and unique, that no special tests are required.

Complications / Issues

Apart from a disturbed sleep for the Night Terror sufferer and their family / partner, there are no real complications resulting from Night Terrors.

Treatment

Night Terrors are so transitory and temporary that medical help or the taking of medicines or prescribed drugs is often unnecessary.  However, in extreme cases, treatment options can range from treatment of Sleep Apnea to the prescription of benzodiazepines and psychotherapy.
For the vast majority of Night Terror sufferers, the best treatments are:
· Gentleness and calmness by family members to the sufferer,
· Disposal of anything nearby that might hurt the subject, and,
· Avoiding loud voices or movements that might frighten the subject further.
It is also important to remember that the person experiencing the terror is unaware that they are dreaming.  As a result, if they are told that "it was just a dream", then they may become even more agitated because they can be quite convinced that what they are experiencing is real.
The quickest remedy for the vast majority of Night Terror episodes is simply to calm the person and convince them to "go back to sleep" (although they are, in fact, already asleep).

Prevention

If the Night Terrors are triggered by:
· Emotional Stress
· Lack of Sleep / recent disturbed sleep
Then each of these triggers can managed by reducing emotional stress, especially prior to bedtime, and ensuring that a full night's sleep is achieved every night.
If the Night Terrors are triggered by:
· Fever – especially High Fever
then this condition can treated by fever reducing medications.
For other causes or triggers for Night Terror, such as age and genetics, then various treatments are available to prevent or reduce the onset of the symptoms of Night Terrors, especially in severe cases.  See section 4.8.5 Treatment above.

Periodic Limb Movement Disorder (PLMD)