7 Common Symptoms of Sleep Terrors (Night Terrors) You Should Know

Sleep terrors, also known as night terrors, are episodes of intense fear, screaming, and thrashing that occur during sleep. Unlike nightmares, which happen during REM sleep and are often remembered, sleep terrors occur during the deepest stages of non-REM sleep and typically leave no memory of the event. This parasomnia disorder primarily affects children between ages 3 to 12, though it can also occur in adults. Understanding the symptoms of sleep terrors is crucial for proper identification and management of this condition.

Sleep terrors can be extremely distressing for family members who witness them, even though the person experiencing them usually has no recollection of the episode. These events typically occur during the first third of the night when deep sleep is most prominent. While they may appear frightening, sleep terrors are generally not a sign of serious psychological problems, especially in children.

1. Sudden Screaming or Shouting During Sleep

One of the most distinctive and alarming symptoms of sleep terrors is the sudden onset of loud screaming or shouting. This typically occurs without any warning, usually within the first few hours after falling asleep. The screaming is often piercing and filled with terror, which can be extremely distressing for anyone nearby.

The person experiencing a sleep terror may scream as if they are in genuine danger or experiencing extreme pain. This vocalization is involuntary and comes from a state of partial arousal from deep sleep. Unlike a simple nightmare where someone might whimper or call out softly, sleep terror screaming is typically loud enough to wake other household members.

The intensity of the screaming can vary from episode to episode, but it generally reflects a state of intense fear or panic. This symptom alone is often what prompts parents or partners to seek medical advice, as it can be genuinely frightening to witness.

2. Sitting Up in Bed with Eyes Wide Open

During a sleep terror episode, individuals often abruptly sit up in bed with their eyes wide open. However, despite appearing awake, they are actually in a state of partial consciousness and are not truly aware of their surroundings. This creates an eerie appearance, as the eyes may have a glassy, unfocused look.

When you look at someone experiencing a sleep terror, they may appear to be staring straight ahead or looking around the room, but they are not processing visual information in a normal way. Their eyes might be open, but they are not seeing the real environment around them. Instead, they are experiencing internal imagery related to their terror state.

This symptom can be particularly confusing for caregivers because the person looks awake and their eyes are open, leading many to assume they can be reasoned with or comforted. However, attempts to communicate are usually unsuccessful because the individual is not in a state of full consciousness.

3. Intense Fear and Panic Expression

People experiencing sleep terrors display unmistakable signs of intense fear and panic on their faces and through their body language. Their facial expressions may show extreme terror, with wide eyes, raised eyebrows, and an open mouth. This fear appears genuine and overwhelming, even though there is no actual threat present.

The panic exhibited during a sleep terror is typically much more intense than what would be seen during a regular nightmare. The person may appear to be experiencing life-threatening danger, showing fight-or-flight responses that seem entirely out of proportion to the safe sleeping environment they are actually in.

This intense emotional state is accompanied by physiological signs of fear, including rapid breathing, dilated pupils, and a look of absolute terror. Family members often describe the expression as one they have never seen on their loved one’s face during waking hours, which adds to the distressing nature of witnessing these episodes.

4. Rapid Breathing and Increased Heart Rate

Sleep terrors trigger a strong autonomic nervous system response, resulting in rapid breathing (tachypnea) and increased heart rate (tachycardia). If you were to measure vital signs during an episode, you would find that both respiratory rate and pulse are significantly elevated compared to normal sleep states.

The breathing during a sleep terror is often noticeably fast and may appear labored or gasping. This is the body’s physiological response to perceived danger, preparing for a fight-or-flight reaction. The person may breathe so rapidly that they appear to be hyperventilating, which can be alarming to observers.

The elevated heart rate can sometimes be felt if you place a hand on the person’s chest or wrist, though attempting to do so during an episode may increase their agitation. These cardiovascular changes are temporary and typically return to normal shortly after the episode ends, though the person may remain in an elevated state for several minutes after the terror subsides.

5. Profuse Sweating

Heavy sweating, or diaphoresis, is a common physical symptom of sleep terrors. People experiencing these episodes often wake up drenched in sweat, with perspiration soaking their sleepwear and bedding. This sweating is a direct result of the intense activation of the sympathetic nervous system during the terror episode.

The sweating typically begins during the episode itself and may continue for some time afterward. It is most noticeable on the forehead, face, neck, and chest, but can affect the entire body. In children, parents may find their child’s hair is wet with sweat and their sheets are damp when they check on them.

This symptom is one of the lingering physical signs that an episode has occurred, even if no one witnessed the actual terror. The next morning, dried sweat or damp bedding may be the only evidence that a sleep terror took place during the night.

6. Thrashing and Flailing Movements

Physical agitation in the form of thrashing, flailing, or violent movements is another hallmark symptom of sleep terrors. During an episode, the person may kick their legs, wave their arms wildly, or make other uncontrolled movements that can be forceful enough to cause injury to themselves or anyone trying to help.

These movements appear purposeless and uncoordinated, unlike the more controlled movements seen during sleepwalking. The person might punch, grab at the air, or push away from perceived threats that exist only in their terrified state. In some cases, individuals may actually leave the bed during these episodes, which can be dangerous.

The intensity of the physical movements can vary significantly from one episode to another and between different individuals. Some people may exhibit relatively mild restlessness, while others may thrash so violently that they risk falling out of bed or striking nearby furniture. This is why safety measures are often recommended for those who experience regular sleep terrors.

7. No Memory of the Event Upon Waking

A defining characteristic of sleep terrors, which distinguishes them from nightmares, is the complete or near-complete lack of memory of the episode. When the person fully awakens, either immediately after the episode or the next morning, they typically have no recollection of the screaming, fear, or any of the events that occurred during the terror.

This amnesia occurs because sleep terrors happen during non-REM deep sleep, a stage when the brain is not forming the same types of memories as during REM sleep or wakefulness. The person may wake up confused about why their sheets are tangled or why family members seem concerned, but they cannot recall what happened.

In some cases, individuals may have vague, fragmentary impressions or a sense that something happened, but they cannot describe specific images or narratives like they could with a nightmare. This lack of memory can actually be beneficial, as it means the person does not carry the emotional distress of the episode into their waking hours. However, it can also make the condition difficult to self-diagnose, as the affected person must rely on witness accounts to understand what is happening during their sleep.

What Causes Sleep Terrors?

Sleep terrors can result from various factors that disrupt normal sleep patterns. Understanding these causes can help in managing and potentially reducing the frequency of episodes:

• Sleep deprivation: Lack of adequate sleep is one of the most common triggers for sleep terrors. When the body is overtired, it may experience more intense deep sleep periods, increasing the likelihood of partial arousal disorders like sleep terrors.
• Irregular sleep schedules: Inconsistent bedtimes and wake times can disrupt the natural sleep cycle, making sleep terrors more likely to occur.
• Fever and illness: Elevated body temperature and illness, particularly in children, can trigger sleep terror episodes.
• Stress and anxiety: Psychological stress, major life changes, or anxiety can contribute to sleep disturbances, including sleep terrors, especially in adults.
• Sleep-disordered breathing: Conditions like obstructive sleep apnea can fragment sleep and increase the occurrence of sleep terrors.
• Certain medications: Some medications that affect the central nervous system may increase the likelihood of sleep terrors as a side effect.
• Genetic factors: Sleep terrors tend to run in families, suggesting a hereditary component to the condition.
• Sleeping in unfamiliar environments: Being away from home or sleeping in a new place can disrupt normal sleep patterns and trigger episodes.
• Full bladder: Physical discomfort, such as having a full bladder, can contribute to partial arousals from deep sleep.

Prevention Strategies for Sleep Terrors

While not all sleep terrors can be prevented, several strategies may help reduce their frequency and intensity:

• Maintain a consistent sleep schedule: Going to bed and waking up at the same time every day helps regulate the sleep cycle and may reduce sleep terror episodes.
• Ensure adequate sleep duration: Make sure you or your child gets enough sleep for your age group. Sleep deprivation is a major trigger for sleep terrors.
• Create a relaxing bedtime routine: Establish calming pre-sleep activities such as reading, gentle music, or warm baths to promote better sleep quality.
• Reduce stress and anxiety: Address sources of stress during waking hours through relaxation techniques, counseling, or stress management strategies.
• Limit stimulation before bed: Avoid exciting activities, screen time, and stimulating content in the hour or two before bedtime.
• Make the sleep environment safe: Remove sharp objects, secure windows, and consider safety gates if the person tends to move around during episodes.
• Address underlying sleep disorders: If sleep apnea or other sleep disorders are present, treating these conditions may reduce sleep terrors.
• Keep a sleep diary: Track when episodes occur to identify potential triggers or patterns that can be addressed.
• Use scheduled awakening: In some cases, briefly waking the person 15-30 minutes before their typical sleep terror time may help break the cycle, though this should be discussed with a healthcare provider.
• Ensure bathroom use before bed: Encourage using the bathroom right before sleep to minimize physical discomfort during the night.

Frequently Asked Questions About Sleep Terrors

What is the difference between sleep terrors and nightmares?

Sleep terrors occur during deep non-REM sleep, typically in the first third of the night, and the person has no memory of them. Nightmares happen during REM sleep, usually in the later part of the night, and are often remembered upon waking. Sleep terrors involve more intense physical symptoms like screaming, thrashing, and sweating.

Are sleep terrors dangerous?

Sleep terrors themselves are not dangerous, but the movements during an episode can potentially lead to injury. The person might fall out of bed, run into furniture, or accidentally harm someone trying to help. Making the sleep environment safe is important for those who experience regular episodes.

Can adults have sleep terrors?

Yes, while sleep terrors are more common in children, adults can experience them too. Night terrors in adults are often associated with stress, anxiety, sleep deprivation, or underlying sleep disorders. Adult onset sleep terrors may warrant medical evaluation to rule out other conditions.

How long do sleep terror episodes last?

Most sleep terror episodes last between 30 seconds to 5 minutes, though some may extend longer. The person typically returns to peaceful sleep afterward and has no memory of the event in the morning.

Should I wake someone having a sleep terror?

Generally, it is not recommended to forcefully wake someone during a sleep terror episode, as this can prolong the confusion and agitation. Instead, ensure their safety by gently guiding them away from danger and speaking in calm, soothing tones. Most episodes resolve on their own.

Will my child outgrow sleep terrors?

Most children do outgrow sleep terrors, typically by adolescence. The condition is most common between ages 3 and 12, with frequency often decreasing as the child gets older. However, if episodes are frequent or causing significant disruption, consultation with a healthcare provider is advisable.

When should I see a doctor about sleep terrors?

You should consult a healthcare provider if sleep terrors occur frequently (more than once a week), lead to dangerous behavior or injury, continue past the teenage years, are accompanied by daytime sleepiness or other symptoms, or cause significant disruption to the household. A sleep specialist can help determine if there are underlying issues that need to be addressed.

Are sleep terrors a sign of psychological problems?

In children, sleep terrors are rarely a sign of psychological problems and are considered a normal developmental phenomenon. In adults, while they may be associated with stress or anxiety, they are not necessarily indicative of serious mental health issues. However, persistent episodes warrant evaluation to rule out contributing factors.

References:

• Mayo Clinic – Sleep Terrors
• Sleep Foundation – Night Terrors
• NHS – Night Terrors
• Johns Hopkins Medicine – Parasomnias
• American Academy of Family Physicians – Parasomnias