Night Terror

Aka: Night Terror, Sleep Terror, Pavor Nocturnus, Fearful Night Crier

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II. Epidemiology

  1. Prevalence
    1. Child: 1 to 6.5% (typically age 1-8 years, resolving by age 12 years old)
    2. Adult: 2.2%
  2. Male predominance
  3. More common during stress or Fatigue
  4. Hereditary

III. Findings: Signs and symptoms

  1. Timing
    1. Occurs 90 minutes into sleep (Sleep Stage III-IV)
    2. Episodes last 10-30 minutes
  2. Sudden Agitation or intense fear
    1. May sit up in bed, scream or cry and run about
    2. May see objects in room as dangerous
    3. May act out in dangerous ways
  3. Frightened, but difficult to awaken or comfort
    1. Eyes open, blank stare
    2. Will not remember episode in morning
  4. Associated signs
    1. Tachycardia
    2. Tachypnea

IV. Differential Diagnosis

  1. Seizure Disorder
  2. Nightmares
    1. Event occurs in REM Sleep in any age patient
    2. Patient is arousable and remembers event

V. Associated Conditions: Other Parasomnias

  1. Sleep Walking
  2. Confusional Arousal

VI. Management: General

  1. Reassure parents (episodes resolve without intervention)
  2. Treat as with other Parasomnias
    1. See Sleep Walking
    2. Ensure adequate sleep and consistent sleep schedule
    3. Ensure safe home

VII. Management: Children

  1. Calm your child
    1. Turn on lights so that child less confused
      1. Eliminates shadows
    2. Say soothing comments "You're alright. You're home"
    3. Speak softly and repetitively
    4. Shaking and shouting child only prolongs attack
      1. Does not awaken child sooner
    5. Hold child if it seems to comfort him
  2. Protect your child
    1. Child can fall down stairs, run into wall
    2. Attempt to direct back to bed gently
  3. Prepare baby sitters
    1. Describe Night Terror and what to do if one happens
  4. Help child discuss fears
    1. What frightens him during daytime?
  5. Consider Prompted Sleep Awakening Technique

VIII. Management: Infants

  1. Stay with your child if he is fearful
    1. Stay at crib until infant is calm
      1. Do not lift child out of crib
      2. Sit quietly in a chair in the room
    2. Consider listening to music via headphone
    3. Avoid talking after initial comforting remarks
  2. Leave briefly every 15 minutes
    1. Return after 1-2 minutes
    2. Helps habituate against Separation Anxiety
    3. Leave the door open and the night light on
  3. During the day, show love, attention, affection
    1. Hug, cuddle and comfort generously
    2. Carry about in a backpack or front sling
    3. Play separation games during the day
      1. Peekaboo
      2. Hide-and-Seek
      3. Chase me
  4. Reference
    1. Schmitt (1991), Your Child's Health [PubMed]

IX. References

  1. Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
  2. Pagel (2000) Am Fam Physician 61(7):2037-44 [PubMed]
  3. Thiedke (2001) Am Fam Physician 63(2):277-84 [PubMed]

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Related Studies

Ontology: Night Terrors (C0037320)

Definition (MSHCZE) Pavor nocturnus – lat. noční děs, porucha spánku, (parasomnie) obv. u dětí, kde může být projevem neurózy. Projevuje se náhlým probuzením s křikem a pocitem děsu; mohou být vegetativní příznaky. Dítě větš. po několika minutách usíná, aniž naváže kontakt s okolím, ráno si nic nepamatuje. Srov. noční můra. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A sleep disorder characterized by abrupt awakenings from sleep with a panicky scream, accompanied by signs of autonomic arousal. There is no recall of a nightmare and the person has amnesia for the event in the morning.
Definition (MSH) A disorder characterized by incomplete arousals from sleep associated with behavior suggesting extreme fright. This condition primarily affects children and young adults and the individual generally has no recall of the event. Episodes tend to occur during stage III or IV. SOMNAMBULISM is frequently associated with this condition. (Adams et al., Principles of Neurology, 6th ed, p391)
Concepts Mental or Behavioral Dysfunction (T048)
MSH D020184
ICD10 F51.4
SnomedCT 154928006, 52417003, 192002003, 192458001, 89675003
DSM4 307.46
English Pavor Nocturnus, Sleep Terror Disorder, Night terrors, Night Terrors, Sleep terrors [night terrors], SLEEP TERROR DIS, sleep terror disorder (diagnosis), sleep terror disorder, Sleep terror, Sleep Terror, Sleep Terrors, Terror, Sleep, Terrors, Sleep, Night Terrors [Disease/Finding], night terror, sleep terror, night terrors, pavor nocturnus, night terrors sleep, Night terrors (disorder), Pavor nocturnus, Pavor nocturnus (disorder), Sleep terror disorder, Sleep terrors, Sleep terror disorder (disorder), sleep terrors, sleep disorder; terrors, sleep; terrors, terrors; night, terrors; sleep disorder, Night terrors [Ambiguous], Night terror disorder
Dutch angstdromen, angsten; nacht, angsten; slaapstoornis, slaap; angsten, slaapstoornis; angsten, Pavor nocturnus [nachtelijke panische angstgevoelens], pavor nocturnus, Pavor Nocturnus, Plotseling wakker schrikken
Italian Terrori notturni, Disturbo da terrore nel sonno, Terrore nel sonno, Pavor nocturnus, Terrore notturno
Portuguese Terrores nocturnos, Terror Noturno, Terrores no sono, Pavor Noturno, Terrores do Sono, Terrores Noturnos
Spanish Terrores nocturnos, pavor nocturno, terrores nocturnos, pavor nocturno (trastorno), trastorno de terrores nocturnos (trastorno), trastorno de terrores nocturnos, Terror durante el sueño, Pavor Nocturno, Terrores del Sueño, Terrores Nocturnos
Swedish Nattskräck
Japanese ﾔｷｮｳｼｮｳ, ｽｲﾐﾝｼﾞｷｮｳｶﾞｸ, 睡眠時驚愕, 夜驚症, 睡眠驚愕障害, 夜泣き, 夜泣き症, 夜間恐怖症, 夜驚, 睡眠恐怖異常症
Czech spánkové děsy, noční děsy, pavor nocturnus, Noční děsy, Spánkový děs, noční děs
Finnish Unikauhukohtaus
Russian NOCHNYE KOSHMARY, НОЧНЫЕ КОШМАРЫ
Korean 수면 야경증
Polish Lęki nocne, Koszmary nocne
Hungarian Pavor nocturnus, Éjszakai felriadás
Norwegian Nattskrekk, Søvnterror, Pavor Nocturnus
French Terreurs nocturnes
German Pavor nocturnus, Nachtängste, Nächtliche Angstanfälle
Derived from the NIH UMLS (Unified Medical Language System)

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