Sleep terror disorders

Clinic

• Also called Night terror
• It is a sleep disorder causing feelings of panic or dread
• Typically occurring during the first hours of stage 3–4 of NREM sleep and lasting for 1 to 10 minutes.
• It is classified in the category of NREM-related parasomnias

• Sleep terrors tend to happen during periods of arousal from delta sleep, or slow-wave sleep.
• Delta sleep occurs most often during the first half of a sleep cycle, which indicates that people with more delta-sleep activity are more prone to night terrors.
• However they can also occur during daytime naps.
• Sleep terrors can often be mistaken for confusional arousal, which is also a NREM Related Parasomnia

Signs / Symptoms

• The universal feature of sleep terrors is inconsolability, very similar to that of a panic attack.
• During night terror bouts, people are usually described as "bolting upright" with their eyes wide open and a look of fear and panic on their faces.
• They will often yell, scream, or attempt to speak, though such speech is often incomprehensible.
• Furthermore, they will usually sweat, exhibit rapid breathing, and have a rapid heart rate (autonomic signs).
• Increased motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions.
• There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury.
• Although people may seem to be awake during a night terror, they will appear confused, be inconsolable and/or unresponsive to attempts to communicate with them, and may not recognize others familiar to them.
• Occasionally, when a person with a night terror is awakened, they will lash out at the one awakening them, which can be dangerous to that individual. Most people who experience this do not remember the incident the next day, although brief dream images or hallucinations may occur and be recalled.
• Sleepwalking is also common during night-terror bouts, as sleepwalking and night terrors are different manifestations of the same parasomnia.
• During lab tests, subjects are known to have very high voltages of EEG delta activity, an increase in muscle tone, and a doubled or faster heart rate.
• Brain activities during a typical episode show theta and alpha activity when monitored with an EEG.
• Episodes can include tachycardia.
• Night terrors are also associated with intense autonomic discharge of tachypnea, flushing, diaphoresis, and mydriasis—that is, unconscious or involuntary rapid breathing, reddening of the skin, profuse sweating, and dilation of the pupils.

Related disease

• PTSD
• Generalized anxiety disorder (GAD)
• Dependent, schizoid, and borderline personality disorders.
• Thalamic / Brainstem lesions have been occasionally associated with sleep terrors.
• Sleepwalking
• Frontal lobe epilepsy

Causes

• Sleep terrors and other parasomnias may be congenital.
• Other contributing factors include
  • Nocturnal asthma
  • Gastroesophageal reflux
  • CNS medications
  • Constricted nasal passage

Characteristics

• Individual abruptly but not completely wakes from sleep
• Usually occurring during the first third major period of sleep.
• Intense fear with a panicky scream at the beginning
• Symptoms of autonomic arousal, such as increased heart rate, heavy breathing, and increased perspiration.
• The individual cannot be soothed or comforted during the episode.
• The individual is unable to remember images of the dream (only a single visual scene for example).
• It causes significant impairment in the individual's functioning

Sleep terror Black Box

Fear
Sympathetic Hyper activity
Altered consciousness

Differential diagnosis

• Nightmares
• Epileptic seizures