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

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.