Night Terrors: Sometimes They Come Back

Here’s how I remember it: I dreamed that a rat got under the covers of my bed and I jumped up to get away from it. As I jumped away I heard my wife scream and then the sound of the scream became louder and louder until it shattered time and space. My initial fear rose to terror and finally to absolute oblivion—nothing existed except her piercing wail and the terror. I comforted my wife, sitting next to me in bed, and told her, “It’s okay, it’s just me, relax.”

This is how my wife remembers it: She was awakened by me vaulting out of bed and landing by the foot of the bed. I then became catatonic, shaking like a leaf, twitching, and making a repetitive guttural noise as my jaw opened and closed. She called my name and tried to rouse me but I was completely unresponsive… for an entire minute. Finally, I straightened out and said,“It’s okay, it’s just me, relax.”

In retrospect, my attempts to comfort her must have been pretty annoying.

Welcome to the night terror—or pavor nocturnus. This is no ordinary nightmare; in fact night terrors occur in an entirely different stage of sleep. Common in children under the age of seven, the night terror also comes back to haunt some adults when the conditions are right.  In my mind, it all happened in a few moments, but in reality I was spaced out in terror loop for an entire minute.

I figured this would be a good chance to review the causes, symptoms and deeper considerations of the night terror, as it is often confused with nightmares and really requires a different way of handling.

Night terrors are an arousal disorder. Unlike nightmares, which are frightening dreams, night terrors occur in the deep sleep, also called Stage IV or slow wave sleep. The biological mechanism is an over-activation of the sympathetic autonomic nervous system. In other words, flight or flight kicks in while you’re in deep sleep, leading to a fugue state of awakening. The terrorized can move around but is still essentially asleep. Body awake, mind asleep.

Symptoms of Night Terrors

Everyone has a unique set of symptoms, but here are some of the most common.

  • Awakening with a scream or yelp, followed by gutteral noises such as grunts and low moans.
  • Violent, and sometimes repetitive, thrashing about in bed
  • Unresponsive to comforting
  • Sometimes aggressive when touched
  • Sweating
  • Pounding heart – as high as 170 beats per minute
  • Eyes can be open or closed
  • No memory, or partial foggy recall, of the event once roused
  • Unlike nightmares, many do not remember any dream image – they only remember the overwhelming feeling of terror.
  • Recalled dream imagery – if any — often includes aggressive animals, like dogs, insects, and in my case: a rat!

What to do if your child or partner has a night terror

  1. Using a soothing voice, try to reassure the terrorized sleeper that everything is OK.
  2. Don’t touch the person if they are violently thrashing about – you can get hurt, and the terror may continue. Children can be safely restrained if necessary.
  3. Only touch and comfort physically if the sleeper has calmed down
  4. If you are a parent, try singing a familiar lullaby

When to Call the Doctor

According to Cincinatti Children’s Hospital, it’s a good idea to call the pediatrician if:

  • the child has drooling, jerking, or stiffening
  • terrors last longer than 30 minutes
  • your child does something dangerous during an episode
  • terrors are happening during the second half of the night
  • your child has daytime fears

Causes of Night Terrors

Night terrors are a biological event, but they are precipitated by environmental and psychological factors. In my opinion, night terrors are a reliable indicator to pay attention to what’s going on in your life, and in the household.

Anxiety

Tension, conflict or generalized life stress triggers night terrors in susceptible sleepers. For children, this can include going back to school, or bullying. Family stressors may be parental relationship stress, divorce, moving, or sibling rivalries. For children, night terrors are basically a barometer for how safe the home feels to them on an unconscious level.

For adults, other life stresses can include changes at work, relationship break ups, deaths or illness in the family. Spiritual emergencies or crises of faith also can trigger repetitive night terrors.

Sleep Deprivation

Often, the stressor is simply that you are not getting enough sleep, or not getting enough quality sleep. Also, sudden changes in bedtimes, or consistently erratic sleep schedules,  can cause this condition. By establishing a regular bedtime, you may be able to kick the terrors.

Fever

Night terrors and other unusual sleep disturbances are common when you are sick in bed with fever.

Unfamiliar Quarters

Some people only get night terrors when traveling. Nothing like waking up scared out of your mind and not knowing where you are. This points to yet another way that anxiety can trigger this biological event. If you travel a lot, bring a familiar smell in your luggage, like a dream pillow or your favorite incense or perfume.

Stimulants

Drinking too much coffee, or having a caffeinated beverage after 3pm, can increase the risk.

Substance Abuse

Adults with a history of substance abuse are more likely to suffer from repetitive night terrors.  Alcohol is especially noted by psychiatrists. Counseling and starting a mindfulness practice like meditation or yoga can address the root causes of substance abuse.

Mental Instability

This is not the most likely scenario, but chronic night terrors are more prevalent in those who have a history of emotional disorders and psychopathology.

Underlying Health Conditions

Night terrors can be a symptom of migraines, thyroid conditions, seizure disorders and recent head injuries. Premenstrual period is also correlated to monthly night terrors.

Medications

Some antibiotics can bring on night terrors. Antihistamines and sedatives also may trigger it, ironically enough.

The Big Picture – How to Learn From A Night Terror

For most people, night terrors are an indicator to get some rest, physically and emotionally. It’s a wake up call that our stress management techniques are falling short and we need to feel safer and less anxious in our daily lives. I’ll illustrate how you can respond to a night terror as a wake up call with my own recent experience.

When I reviewed what was up for me the day before I had the night terror, and my general life circumstances, sure enough, I discovered the perfect behavioral cocktail to bring on a night terror:

Physically and emotional stress: The day before, I helped move a friend to a new house, which involved a lot of heavy lifting of furniture. I also had to drive somewhere new in the dark, which always elevates my stress.

Stimulants: I also had a large cup of coffee at 7pm because we didn’t start the move until 8pm. I should know better.

Erratic sleep schedule: We didn’t get to bed until after 1:30am.

General Life situation: On top of these temporary stressors, my wife and I just moved less than 2 months ago to a new city, and the dust is still settling.

My personal plan

time to go hiking! Fall in Pennsylvania is amazing

I interpret my night terror as a warning sign that I need to take better care of myself during this transitory time when I am more sensitive to stimulants and sleep irregularities than normal. For starters, I’ve decided to lessen my caffeine input: somehow I’ve gotten in the habit of drinking coffee every morning again. It really sneaks up on me.

Secondly, I need to be more proactive about stress management. For instance, I haven’t been taking enough hikes and walks since we moved. I also have been working too much on the computer and not playing enough.

Lastly, I need to be more careful about my sleep hygiene in this transitory time. Sometimes having an erratic sleep schedule can bring on creative dreams for me, but it seems that right now I am needing more of a routine as the dust settles. So, for a while anyways, it will be early to bed and early to rise. Well, sort of early anyways.

Now the only thing left to figure out is… who’s the dirty rat?

Resources for Parents

Night Terrors Resource Center

About.com: Night Terrors

Mayo Clinic: Night Terrors: Causes, Symptoms and Risk Factors

PennMedicine Health Encyclopedia: Nightmares and Night Terrors

Cinncinati Childrens Hospital: Night Terrors

Additional References

Crisp, A.H.  The sleepwalking/night terrors syndrome in adults. Postgraduate Medical Journal 1996; 72(852): 599–604.

Hirshkowitz, M. and Smith, P. Sleep Disorders for Dummies. 2004; Wiley Publishing.

Llorente MD, Currier MB, Norman SE, Mellman TA. Night terrors in adults: phenomenology and relationship to psychopathology. Journal of Clinical Psychiatry 1992 Nov;53(11):392-4.

Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: Their frequency and relationship to other sleep and mental disorders. Journal of Clinical Psychiatry 1999; 60: 268–76.

Comments

  1. says

    Excellent article Ryan! I can relate to this 100% and the combination of triggers you mentioned explains the spate night terrors I had a few years ago. I knew my trigger was anxiety back then (moving to a new country) but now I also see the obvious secondary triggers – in a timezone 12 hours ahead which wrecked my body clock, sleeping in an unfamiliar place, coming to terms with the emigration, etc, etc. Make so much more sense! I am glad to say that by removing the anxiety trigger they went away and I haven’t experienced any like this for a long time now. Night terrors are the worst but in a kind of masochistic way at least we get to learn a bit more about how our brain works :)

  2. carole lindberg says

    I really identified with this article. As I told you a few months ago, I rid myself of night terrors after decades of suffering from them. I still fear that they will return, actually never read anything about them, or your book or subsequent articles, because of fear of activating them again! However, your title caught my eye – as yes, they do return, although now very infrequently. I am still getting used to the calm of not having them anymore. Anyway, to get back to your article, I like the formula,– mind asleep, body awake. Yes, thats it.

    Carole

  3. Jodie says

    Thanks for the great article. I have been suffering from night terror for over 10 years and avoided discussing it until my husband of 4 years finally started bringing my episodes to my attention. After my third episode in less than a month, I was getting worried and stumbled onto your article. Thanks for the great info- a sleep journal with stress side-notes might help my situation.

  4. says

    I just found this excellent article! I especially like your description of your rat episode: I can definately relate to it. Your summary of factors that may contribute to night terrors is also very good.

  5. Lana says

    Thanks for this factual and personal account of night terrors. I’ve suffered from night terrors for as long as I can remember, and I can completely relate to your article. While I am still suffering from night terrors quite regularly, I realise that there are a few stressors in my life that I need to deal with first. Thanks again!

  6. Amanda says

    I just wanted to say, my night terrors started again when I was 17. Luckily, from what my husband has told me, I haven’t had a real night terror in a long time, at least longer then he can remember. When I was 23 I was diagnosed with Hypothyroid. I had trouble sleeping, but would sleep for 17 hour stints at times. I had a dime sized bald spot on the back of my head and a rash that devoloped, this all happened in a 6 month frame. I also gained 30lbs in that short time. It has been almost 4 years since I was diagnosed and the only other times I remember my husband saying I had them or feeling terror was during both my pregnancies. I really wonder if when the Terrors started if it wasn’t an alarm to tell me my thyroid was going wrong before I was diagnosed 6 years later…

    My night terror was so similar to this article because I woke up and saw a dark figure in my room about 4 feet from my bedside and lightning outside. I guess I screamed although I thought I yelled. My dad came running out of his bedroom (as he told me) and I came out of mine running. He went to hold/ hug me and make sure someone wasn’t actually in there. I thought he put his arm out to hurt me and didn’t really recognize him. I just thought he was blocking me. I hit his arm so hard and fell to the floor when I realized it was my dad. I relaxed immediately and apparently was babbling but I thought I was telling him about the shadow man in my room. Finally I said please go check, please. My dad checked and came back and held me. It was scary and I think the jolt from running into him made me remember. My parents said I had screamed before, but I didn’t and haven’t remembered it. My husband also attests to the fact that I have woken him on many a nights, luckily he can fall asleep so easy lol he just worried about me being ok. <3 Anyways to anyone who has this, it can be hard, especially if it effects your dream recall or brings on dissociated nightmares. Well maybe a little associated, heh. It really does make you wonder what, or why? It would be interesting to know what is really happening when we experience night terrors, or remember why. I just wanted to share my experience as it really resonated in my life for a long time. I had night-terrors very regularly for 6 years and again with pregnancy. My husband says now it is very rare. I still apparently jump up startled, but then he yells as I start to and then says nicely he is there and I start very disgruntled to babble and then lay down babbling and fall asleep. I no longer wake with any dread most of the time. It may be partially the thyroid medicine why they aren't as bad. I don't have a clue, I do worry though because my two year old does exactly what I did. I also had this as a child as well as far back as when I was 1 or 2. I stopped having them as bad between the ages of 9 to 17 and then blam. I still had them according to my parents, but not as often. When I got them bad as a 17 year old is when they were concerned although we had no idea it could be associated with a thyroid problem. It wasn't until I had all the other symptoms I was even tested for it. And it was totally out of wack. I still have problems with my sleep. I am an insomniac sometimes and can lay in bed for 5 hours letting thoughts wonder and not hold onto them and still be awake, other times I can sleep easily and have a few days of my body waking and sleeping on its own. I have desperately tried to nail down the culprit but to no avail. I will continue and post my findings as well. Wishing you all the best in dealing with this.