After spending the last 20+ years of my life experiencing night terrors, I decided to find out more about this sleep disorder. I hope the following will help shed some light on the subject. The first thing I found was that this problem goes by a few different names. Sleep Terrors, Sleep Terror Disorder, Night Terrors, Pavor Nocturnus and then the mouthful DSM-IV AXIS I: 307.46 are just a few. This fact made it very difficult to do an internet search for more information. Another problem I ran into was that HSP (Hallucinatory sleep disorder) has some similarities to Night Terrors. I have included information about sleep paralysis to help you figure out which you may have.
The purpose of this site is to help people understand that there are medical solutions and reasons for Night Terrors. You will not be preached to here or told that Satan caused your Night Terrors. Night Terrors are a medical ailment and not demon posession. (Contrary to what others may tell you.)
Sleep labs across the United States and Canada have shown through sleep studies, that Night Terrors happen due to increased brain activity.
| |
The common thought among researchers is that a chemical trigger in the brain causes your brain to "misfire" and cause a Night Terror. These misfires can be caused by many factors such as stress and various other medical ailments. Please check out the Additional NT Information page to find out more.
Night Terrors
People who have night terrors are often misdiagnosed. The most common one is a simple nightmare. Any of you who have had a night terror can say they aren't even close! Another common misdiagnosis (especially among veterans) is PTSD or Post Traumatic Stress Disorder. For this reason I have included a description of the difference between nightmares and night terrors.
Night Terrors Symptoms: Sudden awakening from sleep, persistent fear or terror that occurs at night, screaming, sweating, confusion, rapid heart rate, inability to explain what happened, usually no recall of "bad dreams" or nightmares, may have a vague sense of frightening images. Many people see spiders, snakes, animals or people in the room, are unable to fully awake, difficult to comfort, with no memory of the event on awakening the next day.
Night Terror or Nightmare?: Nightmares occur during the dream phase of sleep known as REM sleep. Most people enter the REM stage of sleep sometime after 90 minutes of sleep. The circumstances of the nightmare will frighten the sleeper, who usually will wake up with a vivid memory of a long movie-like dream. Night terrors, on the other hand, occur during a phase of deep non-REM sleep usually within an hour after the subject goes to bed. This is also known as stage 4. (A link to a sleep stages chart can be found on the navigation bar to the left) During a night terror, which may last anywhere from five to twenty minutes, the person is still asleep, although the sleepers eyes may be open. When the subject does wake up, they usually have no recollection of the episode other than a sense of fear. This, however, is not always the case. Quite a few people interviewed can remember portions of the night terror, and some remember the whole thing.
New Treatment options: Ongoing research is being done on scheduled awakening therapy, which has been shown to cure night terrors in 9 out of 10 in children. Scheduled awakening therapy involves waking the child from sleep 15–30 minutes before the episodes typically occur to interrupt the sleep cycle and prevent the onset of a night terror. A research group at Stanford University is conducting a study for an investigational treatment that uses a non-medication, at-home sleep management system to perform scheduled awakenings. To find out more about this ongoing research, visit: Stanford University NT Research Site
Although night terrors can occur anytime in a persons life span, the most common is reported in children between the ages of three and five. (However more recent studies have turned up showing that many adults as well as children as young as six months experience night terrors on a weekly basis.) Night terrors usually occur fifteen minutes to one hour after going to sleep. I personally experience mine at just about the 45 minute mark. The longer the person is in NREM (the stages before REM) before the night terror strikes, the more petrified they will be when it occurs. Keep in mind though not everyone falls to sleep in the same amount of time as others. This makes a sleep study about the only way of determining what stage of sleep you are in when these events occur.
| Night terrors have been shown to appear in stage 4 of sleep. This is just one thing that separates them from nightmares which can occur anytime in sleep. It is possible to make a night terror occur in some people, simply by touching or awakening them during stage 4 of sleep. Why night terrors occur is still a mystery. The mind is supposed to be practically void during the deeper stages of sleep. Most sufferers will awake gasping, moaning, crying but more often screaming. | |
Breathing rapidly they will sit up in bed with a wide eyed terror filled stare. This panic will often last anywhere from five to twenty minutes. I find the most amazing aspect of night terrors is that it generates a heart rate of 160 to 170 beats per minute. This is much faster than the normal heart rate that can be attained under most stressful circumstances.
Some things that can help bring out a night terror are stress, medications that affect the brain, (It is hard to list exactly which ones) being over-tired or eating a heavy meal before going to bed. Combining all of the above I can usually guarantee an occurrence for myself. Many different medical ailments contribute to the frequency of Night Terrors. (Once again to many and to hard to list, Please do not e-mail me to have one added.) The listed items DO NOT cause night terrors, they just seem to put your body into the state where a night terror can manifest itself. People without night terrors will not have a night terror just by trying the above.
There seems to be a common thread in how night terrors manifest themselves. Many people who remember the night terror have talked about seeing animals or people. Most people describe the person that they see as dark and shadowy and feel that the person is going to hurt them. Quite a few people see snakes and spiders. At first I thought people were seeing only things they are afraid of during waking hours. After more research I found that only a small percentage of people were afraid of what they see (in night terrors) during waking hours.
Some people remember the Night Terror. Some don't. There is no explanation to why some have no recall of the events during a Night Terror. If you are told by a doctor that the fact you remember your night terror it must not be a night terror, find another doctor.
Many people have written me to disagree, but I have found the best method of controlling someone during a night terror is to hug and reassure them and tell them that everything is all right. Agree with what they are saying and doing. Sometimes it is not possible to hug them. Don't try to force physical contact. DO NOT yell at them or tell them they are only dreaming as this seems to only upset them even more. Move objects that can injure the person out of the way. This method seems to work better in children rather than in adults. (Adults are a little more physical) The most important thing to remember is that someone having a night terror does not know what they are doing. Make sure that there is not anything nearby that they can hurt themselves or others with. It is perfectly safe to wake someone who is having a Night Terror. Please be gentle!
It is also interesting to note that two other disorders, sleepwalking and bed wetting, are experienced during stage 4 of sleep. (Don't e-mail me and ask me about those disorders though.) Even more interesting is the fact that all three of these sleep disorders often run in families. My father only realized he had night terrors after I started researching the subject. Some families will dismiss night terrors as nightmares and grow more and more upset blaming the problem on television or other before bed stimulus. Episodic night terrors DO NOT signify psychological problems. Don't ever tell the subject that nothing has happened. It is OK to tell that person, the next morning, they had a night terror. It is however not advisable to notify children the next morning if they do not remember.
| Remember night terrors happen in stage 4 (highlighted) |
 |
| Stage | Bodily Activity | Depth Of Sleep | Thought Process | Miscellaneous |
0
Awake | Slows down, decreased muscle tension | Borderline wakefulness | Relaxation, mind wanders, awareness dulls | Heart rate, pulse, temperature and blood pressure slightly diminished. |
1 | Eyes roll slowly on falling asleep, eyes quiescent in later stage 1 periods. Body movements slowed. | Light sleep, easily awakened, might deny being asleep if awakened. | Drifting thoughts and floating sensation. | Temperature, heart rate, pulse decline further. Regular breathing. May have hypnogogic hallucinations on falling asleep. |
2 | Eyes quiet. Few body movements. Snoring is common. | Light to moderate sleep. Relatively easy to awaken. Eyes will not see if open. | Some thought fragments, memory processes diminished, may
describe vague dream if awakened | Decreased heart rate, pulse, blood pressure, temperature and metabolic rate, regular breathing with increased airway resistance. |
3 | Occasional movement, eyes quiescent. | Deep Sleep, takes louder sounds to be awakened. | Rarely able to remember thoughts. A few vaguely formed dreams. Possible memory consolidation. | Metabolic rate, pulse, heart rate, blood pressure and temperature decrease further. Increased secretion of growth hormones. |
4 | Occasional movement, eyes quiet. | Deepest sleep, very difficult to awaken. | Virtually oblivious, very poor recall of thoughts if awoken possibly involved in memory consolidation. | Continued decline in heart rate, temperature and metabolic rates. Increased secretion of growth hormone. (possibly to restore bodily tissues) |
REM | Large muscles paralyzed. Fingers toes and facial muscles twitch. Erections, snoring uncommon. | Variable. If sound is incorporated into dream, then harder to awake. | 80 percent dreaming, good vivid dream recall, especially later in the evening. Possibly involved in unconscious conflict resolution. | Heart rate 5 percent greater than above stages. Pulse, temperature and metabolic rates increase. Irregular breathing one-half extra breath per minute. |
This chart is copyright ©1996-2006 David W.Richards. All rights reserved.
Please contact me for permission to reuse.
| Medications |
|
Below are just a few of the medications currently prescribed for Night Terrors. Some of these medications fall under the ANTI-DEPRESSANTS category. If your doctor has prescribed something different, most likely it is a generic of the below or in the same class, you should be fine. If you don't want to take a prescription drug to control night terrors be sure to check out St Johns Wort.
|
The following are currently being tested :
- Ambien
- Lunestra
- Rozerem
- Sonata
Please check the message board for the current status. | |
Also check out Darlene's cure for childhood Night Terrors.
It takes about one to two weeks of experimenting with the dosages of the above medications to find a happy medium between having an episode free night and getting up in the morning! Whatever you do don't give up after a couple of days. You have to give it a chance. A number of the readers of this page have had some success in controlling night terrors by using a mask to cover the eyes at night. I have heard about an article that outlines the results of using a mask for night terrors, but I have not been able to locate the article. I have not tried this approach for the simple fact that I have a hard enough time as it is getting up in the morning. But don't let me stop you from trying this approach. Remember what doesn't work for one person may work for another.
ANTI-DEPRESSANTS & PSYCHOTHERAPEUTIC DRUGS
Tricyclics and Tetracyclics (TCA's)
Monoamine Oxidase Inhibitors (MAOI's)
Serotonin-specific Reuptake Inhibitors ( SSRI's)
Sedatives and Hypnotics (including barbituates and benzodiazepines)
Tricyclics and Tetracyclics (TCA's) These, along with the MAOI's, are considered the classic antidepressant drugs; they are also effective in a wide range of other disorders, including panic disorder, generalized anxiety disorder, posttraumatic stress disorder, obsessive-compulsive disorder, eating disorders, and pain disorder. Enuresis and ADHD are the most common established indications for the tricyclics in children.
Monoamine Oxidase Inhibitors (MAOI's) These drugs are generally accepted as being equal in efficacy to other antidepressant drugs but are currently used less frequently because of the dietary precautions that must be followed (total avoidance of tyramine-containing foods) and the interactions with numerous other medications. They are often used as an alternative for patients who do not respond to the tricyclics and tetracyclics, or in atypical depressions. In addition to depression, MAOI's are used to treat: Bipolar Disorder, Panic Disorder with Agoraphobia, Posttraumatic Stress Disorder, Eating Disorders, Social Phobia and Pain Disorder.
Serotonin-specific Reuptake Inhibitors ( SSRI's) These drugs, along with the tricyclic and tetracyclic drugs and the MAOI's, are considered the major antidepressant drugs; they are also effective in a wide range of disorders, including bipolar I disorder, dysthymic disorder, eating disorders, panic disorder, obsessive-compulsive disorder, and borderline personality disorder. Because they generally have fewer adverse side effects than other classes of antidepressants they are more widely prescribed; one SSRI, fluoxetine (Prozac), the least cardiotoxic of all antidepressants, has become the most widely prescribed antidepressant and is one of the top ten most prescribed drugs in the US.
Sedatives and Hypnotics (including barbituates and benzodiazepines)This class includes the barbituates, which are among the first drugs to be used in clinical psychiatric treatment, being introduced in the US in 1903. One of the oldest sedative-hypnotic drugs still in use, chloral hydrate, has been used since 1869. Because of their high abuse potential and lower therapeutic index, the barbituates are now less commonly prescribed than the newer anxiolytic compounds, such as the benzodiazepines and buspirone, which are considered much safer. Four others of the class, carbamates, piperidinediones, cyclic ethers, and tertiary carbinols, are still available for use, but are used so rarely because of their high abuse potential and toxic effects.
|
|
Links to Sleep Related Sites and other misc. information
Most links will open in a new window
- EDS (Excessive Daytime Sleepiness) Information Site.
- Phantom Sleep Page Jerry Halberstadt, author of the book "Phantom of the Night" on sleep apnea, has info on snoring and other sleep problems as well
- Quietsleep dental practice dedicated to the recognition and non-invasive treatment of snoring and Obstructive Sleep Apnea
- The Sleep Home Pages: Bisleep Provides a comprehensive resource for individuals who are involved in the research or treatment of sleep) -- Can provide in depth information on various topics in sleep, suggested for the "advanced" sleep seeker.
- Sleep Medicine Home Page Lists resources regarding all aspects of sleep
- SleepNet All you wanted to know about sleep but were too tired to ask -- The Sandman continues to add new and exciting things such as The SnoozePaper and ratings of various sleep sites and informational tidbits.
- Sleep, Dreams and Wakefulness Michel Jouvet's page that include dozens of complete articles describing the mechanisms of sleep and dreams. In English and French.
- Lucidity Just go there and check it out..
- Sleep/Wake Disorders Canada A national voluntary organization dedicated to helping people suffering from sleep/wake disorders. (temporarily down)
- JAMA The Journal of the American Medical Association
- BMJ The British Medical Journal
- Hypericum (St. John's Wort) & Depression Home Page. The most information you will ever find in one place about St Johns Wort.
| Other Disorders |
|
Parasomnias... The term parasomnia refers to a wide variety of disruptive sleep-related events. These behaviors and experiences occur usually while sleeping, and most are often infrequent and mild. They may, however, happen often enough to become so bothersome that medical attention is required.
The most common type of parasomnias are disorders of arousal, which include confusional arousals, sleepwalking (somnambulism), and sleep terrors. Experts believe the various types of arousal disorders are related and share some characteristics. These arousals occur when a person is in a mixed state of being both asleep and awake, and usually coming from the deepest stage of nondreaming sleep.This means the person is awake enough to act out complex behaviors but still asleep and not aware or able to remember these actions.
Parasomnias are very common in young children and do not usually indicate significant psychiatric or psychological problems. Such disorders tend to run in families and might be made worse when a child is overly tired, has a fever, or is taking certain medications. They may occur during periods of stress and may increase and decrease with good and bad weeks.
CONFUSIONAL AROUSALS
Confusional arousals often occur in infants and toddlers, but may also be seen in adults.These episodes may begin with a person crying and thrashing around in bed. The individual may appear awake, confused and upset, yet resists attempts by others to comfort or console. It is also difficult to awaken a person having a parasomnia. The episodes may last up to half an hour and usually end with the person calming, waking briefly, and then only wanting to return to sleep.
Because disorders of arousal are less common in older people, adults suffering from these disorders should seek evaluation. In some cases these events are triggered by other conditions such as sleep apnea, heartburn, or periodic limb movements during sleep. A sleep specialist s hould evaluate the person's behavior and medical history.
In typical childhood occurences of arousal disorders, medical evaluation is rarely needed. However, you should contact your physician if a child experiences disturbed sleep that causes;
- potentially dangerous behavior that is violent or may result in injury
- extreme disturbances of other household members
- excessive sleepiness during the day. In these cases, formal evaluation at a sleep center is warranted.
Using simple safety measures can prevent serious injury to those with arousal disorders. Clearing the bedroom of obstructions, securing the windows, sleeping on the first floor, and installing locks or alarms on windows and doors will add a degree of security for the individual and the family. In severe cases, medical intervention may be needed with prescription drugs, behavior modification through hypnosis or relaxation/mental imagery.
Other Parasomnias
NOCTURNAL SEIZURES
These seizures, which occur only during sleep, can cause the victim to cry, scream,walk, run about, or curse. Like other seizures, these are usually treated with medication.
RAPID EYE MOVEMENT (REM) BEHAVIORAL DISORDER
All body muscles (except those used in breathing) are normally paralyzed during REM sleep. In some people, usually older men, this paralysis is incomplete or absent, allowing the person to act out dreams. Such dream-related behavior may be violent and cause injury to the victim or bedpartner. Unlike those who experience sleep terrors, the victim will recall vivid dreams. REM sleep behavior disorder can be controlled with medication.
SLEEP STARTS
Most people have experience the common motor sleep start - a sudden, often violent, jerk of the entire body that occurs upon falling asleep. Other forms of sleep starts also occur just as sleep begins such as;
visual sleep start - usually a sensation of blinding light coming from inside the eyes or head
auditory sleep start - a loud snapping noise that seems to come from inside the head
The different types of sleep starts can be frightening, but these occurences are harmless.
RHYTHMIC-MOVEMENT DISORDER
This condiion is seen most frequently in young children but may also occur in adults. It takes the form of recurrent headbanging, headrolling, or bodyrocking. The individual also may moan or hum. These activities may occur just before falling asleep or during sleep. Medical or psychological problems are rarely associated with rhythmic-movement disorder. Behavior treatment may be effective in severe cases.
SLEEP TALKING (SOMNILOQUY)
Sleep talking is a normal phenomenon and is of no medical or psychological importance.
TEETH GRINDING (BRUXISM)
Grinding teeth during sleep is a very common occurrence and little evidence suggests that teeth grinding is associated with any significant medical or psychological problems. However, severe bruxism may be associated with sleep disruption. A sleep study can determine the degree of disruption. In severe cases, mouth devices may help or reduce dental injury.
Sleep Paralysis
The characteristics of sleep paralysis are as follows:
- Inability to move or speak for 30 seconds - 3 minutes
- Speech is difficult or almost impossible
- Happens before falling asleep or just after waking up
- Can be hereditary
- Can be brought on by stress
Sleep paralysis is the experience of waking up (usually form a dream) and feeling paralyzed, except for being able to breathe and move the eyes. Hypnogogic hallucinations and sleep paralysis may occur together. These conditions are common in people with narcolepsy but can also effect others, particularly people who are sleep-deprived. Although a pretty terrifying event, these events are not physically harmful. There are two major types of sleep paralysis: common (typical) also known as CSP and hallucinatory (hypnagogic) sleep paralysis known as HSP.
Differences between CSP and HSP.
- CSP is common and universal, HSP is rare and seems to be geographically episodic.
- CSP is only unnerving for the sleeper but HSP is accompanied by a nightmare like hallucination.
- CSP is of relatively short duration where HSP can last as long as seven or eight minutes.
One of the most important differences between Night Terrors and CSP is that CSPs occurs in Stage one of sleep and Night Terrors occur in stage four.
Different cultures throughout time have interpreted HSPs as different spirits or events.
- Ancestral ghosts - Southeast Asians
- Hag - Irish and Scottish
- Cats - Chinese
- Spectral foxes - Japanese
- Djinn - Arabs
- Guilt - Romans and the Egyptians
- Witchcraft - Mexicans
- Vampires - Europeans
- Demons - Medieval Europe
HSPs are usually a vision of a small creature that sits on the victims chest. The creature then either compresses the chest or attempts to strangulate the victim. Almost all attacks have been reported by people sleeping on their backs. For additional information check: Trionic Research Institute, http://www.trionica.com
| FAQ |
|
Personal Questions
- Who are you?
My name is David W. Richards born 1970 in Palm Springs California. I have lived all over the United States and currently live in Connecticut working as the Director of Information Technologies for a large town. So, I am obviously not a doctor. I do not have any formal training in sleep disorders, however I have been researching night terrors since 1985. This site was started in March, 1996 as a result of my research. I have received help in my research from various physicians that specialize in sleep disorders in the US and Canada. Since this site was started, it has been featured in Magazine and Newspaper articles as well as shown on local news and the Discovery Channel.
- Why do you do this?
My motives for this site are simple, I want people to know they aren't alone and I want to provide a resource for people to come to and get the medical answers they need. I was tired of all of the "quacks" telling people that they must have been abused, or that they are not religious enough or satan was behind it all.
I am not looking to make money from this site, if anything I have spent thousands of dollars on maintenance, hosting and HTML programs.
- You say you aren't trying to make money but I see ads on each page. Why?
I have had a paypal donate link on the site for three years and only three people have ever bothered to make a contribution. I am trying ads to see if it will help defray the cost of running this site.
|
|
|
|
|
|
|
|
|
|
|
