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Night terror

night terrors in children, night terrors
Night terror, also known as sleep terror, is a sleep disorder, causing feelings of terror or dread, and typically occurs during the first hours of stage 3-4 non-rapid eye movement NREM sleep1 Night terrors tend to happen during periods of arousal from delta sleep, also known as slow-wave sleep234 Delta sleep occurs most often during the first half of a sleep cycle, which indicates that people with more delta sleep activity are more prone to night terrors3 However, they can also occur during daytime naps5

Night terrors have been known since ancient times, although it was impossible to differentiate them from nightmares until rapid eye movement was discovered4 While nightmares bad dreams that cause feelings of horror or fear are relatively common during childhood, night terrors occur less frequently according to the American Academy of Child and Adolescent Psychiatry6 The prevalence of sleep terror episodes has been estimated at 1–6% among children, and at less than 1% of adults7

Night terrors can often be mistaken for confusional arousal2 Sleep terrors begin in children between the ages of 3 and 12, and usually dissipate during adolescence In adults, they most commonly occur between the ages of 20 to 30 Though the frequency and severity vary between individuals, the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights or multiple times in one night35 This has created a situation in which any type of nocturnal attack or nightmare may be confused with and reported as a night terror4

Contents

  • 1 Signs and symptoms
    • 11 Children
    • 12 Adults
  • 2 Causes
  • 3 Diagnosis
  • 4 Treatment
  • 5 Research
  • 6 See also
  • 7 References
  • 8 External links

Signs and symptomsedit

The universal feature of night terrors is inconsolability, very similar to that of a panic attack8 During night terror bouts, people are usually described as "bolting upright" with their eyes wide open and a look of fear and panic on their faces They will often scream Furthermore, they will usually sweat, exhibit rapid breathing, and have a rapid heart rate autonomic signs In some cases, individuals are likely to have even more elaborate motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury5 Although people may seem to be awake during a night terror, they will appear confused, be inconsolable and/or unresponsive to attempts to communicate with them, and may not recognize others familiar to them Occasionally, when a person with a night terror is awakened, they will lash out at the one awakening them, which can be dangerous to that individual3 Most people who experience this do not remember the incident the next day2 Sleepwalking is also common during night terror bouts,49 as sleepwalking and night terrors are different manifestations of the same parasomnia4

During lab tests, subjects are known to have very high voltages of electroencephalography EEG delta activity, an increase in muscle tone, and a doubled increase in heart rate, if not more Brain activities during a typical episode show theta and alpha activity when using an EEG It is also common to see abrupt arousal from NREM sleep that does not progress into a full episode of a night terror These episodes can include tachycardia Night terrors are also associated with intense autonomic discharge of tachypnea, flushing, diaphoresis, and mydriasis8 – that is, unconscious or involuntary rapid breathing, reddening of the skin, profuse sweating, and dilation of the pupils

In children with night terrors, there is no increased occurrence of psychiatric diagnoses10 However, in adults who suffer from night terrors there is a close association with psychopathology or mental disorders There may be an increased occurrence of night terrors—particularly among those suffering or having suffered from post-traumatic stress disorder PTSD and generalized anxiety disorder GAD It is also likely that some personality disorders may occur in individuals with night terrors, such as dependent, schizoid, and borderline personality disorders10 There have been some symptoms of depression and anxiety that have increased in individuals that have suffered from frequent night terrors Low blood sugar is associated with both pediatric and adult night terrors511 A study of adults with thalamic lesions of the brain and brainstem have been occasionally associated with night terrors12 Night terrors are closely linked to sleepwalking and frontal lobe epilepsy13

Childrenedit

Night terrors typically occur in children between the ages of three and twelve years, with a peak onset in children aged three and a half years old14 An estimated 1–6% of children experience night terrors Boys and girls of all backgrounds are affected equally They usually resolve during adolescence14 Sleep disruption is parents’ most frequent concern during the first years of a child’s life Half of all children develop a disrupted sleep pattern serious enough to warrant assistance of a physiciancitation needed In children younger than three and a half years old, peak frequency of night terrors is at least one episode per week Among older children, peak frequency of night terrors is one or two episodes per month Children experiencing night terrors may be helped by a pediatric evaluation During such evaluation, the pediatrician may also be able to exclude other possible disorders that might cause night terrors14 The children will most likely have no recollection of the episode the next day Most children will outgrow sleep terrors15

Adultsedit

Night terrors in adults have been reported in all age ranges16 Though the symptoms of night terrors in adolescents and adults are similar, the cause, prognosis and treatment are qualitatively different These night terrors can occur each night if the sufferer does not eat a proper diet, get the appropriate amount or quality of sleep eg sleep apnea, is enduring stressful events, or if he or she remains untreated Adult night terrors are much less common, and often respond to treatments to rectify causes of poor quality or quantity of sleep Night terrors are classified as a mental and behavioral disorder in the ICD17 A study done about night terrors in adults showed that other psychiatric symptoms were prevalent in most patients experiencing night terrors hinting at the comorbidity of the two18 There is some evidence of a link between night terrors and hypoglycemia19

When a night terror happens, it is typical for a person to wake up screaming and kicking and to be able to recognize what he or she is saying The person may even run out of the house more common among adults which can then lead to violent actions20 It has been found that some adults who have been on a long-term intrathecal clonidine therapy show side effects of night terrors, such as feelings of terror early in the sleep cycle21 This is due to the possible alteration of cervical/brain clonidine concentration16 In adults, night terrors can be symptomatic of neurological disease and can be further investigated through an MRI procedure22

Causesedit

There is some evidence that a predisposition to night terrors and other parasomnias may be congenital Individuals frequently report that past family members have had either episodes of sleep terrors or sleepwalking In some studies, a ten-fold increase in the prevalence of night terrors in first-degree biological relatives has been observed—however, the exact link to inheritance is not known5 Familial aggregation has been found suggesting that there is an autosomal mode of inheritance18 In addition, some laboratory findings suggest that sleep deprivation and having a fever can increase the likelihood of a night terror episode occurring7 Other contributing factors include nocturnal asthma, gastroesophageal reflux, and central nervous system medications18 Special consideration must be used when the subject suffers from narcolepsy, as there may be a link There have been no findings that show a cultural difference between manifestations of night terrors, though it is thought that the significance and cause of night terrors differ within cultures Evidence suggests that nightmares and night terrors are more common among women than men23

Also, older children and adults provide highly detailed and descriptive images associated with their sleep terrors compared to younger children, who either cannot recall or only vaguely remember Sleep terrors in children are also more likely to occur in males than females; in adults, the ratio between sexes is equal5 A longitudinal study examined twins, both identical and fraternal, and found that a significantly higher concordance rate of night terror was found in identical twins than in fraternal1824

Though the symptoms of night terrors in adolescents and adults are similar, their causes, prognoses, and treatments are qualitatively different There is some evidence that suggests that night terrors can occur if the sufferer does not eat a proper diet, does not get the appropriate amount or quality of sleep eg, because of sleep apnea, or is enduring stressful events Adults who have experienced sexual abuse are more likely to receive a diagnosis of sleep disorders, including night terrors25 Overall, though, adult night terrors are much less common and often respond best to treatments that rectify causes of poor quality or quantity of sleep

Diagnosisedit

The DSM-IV-TR diagnostic criteria for sleep terror disorder requires:7

  • recurrent periods where the individual abruptly wakes from sleeping with a scream
  • the individual experiences intense fear and symptoms of autonomic arousal, such as increased heart rate, heavy breathing, and increased perspiration
  • the individual cannot be soothed or comforted during the episode
  • the individual is unable to remember details of the dream or details of the episode
  • the occurrence of the sleep terror episode causes clinically significant distress or impairment in the individual's functioning
  • the disturbance is not due to the effects of a substance or general medical condition

Treatmentedit

In most children, night terrors eventually subside and do not need to be treated It may be helpful to reassure the child and their family that they will outgrow this disorder26

Psychotherapy or counseling can be helpful in many cases There is some evidence to suggest that night terrors can result from lack of sleep or poor sleeping habits In these cases, it can be helpful to improve the amount and quality of sleep which the child is getting26 If this is not enough, benzodiazepines such as diazepam or tricyclic antidepressants may be used; however, medication is only recommended in extreme cases27

Researchedit

A small study of paroxetine found some benefit28 Another small trial found benefit with L -5-hydroxytryptophan L -5-HTP29

See alsoedit

  • Ephialtes illness
  • Sleep paralysis
  • Horror and terror

Referencesedit

  1. ^ Hockenbury, Don H Hockenbury, Sandra E 2010 Discovering psychology 5th ed New York, NY: Worth Publishers p 157 ISBN 978-1-4292-1650-0 
  2. ^ a b c Bjorvatn, B; Grønli, J; Pallesen, S 2010 "Prevalence of different parasomnias in the general population" Sleep Medicine 11 10: 1031–1034 doi:101016/jsleep201007011 PMID 21093361 
  3. ^ a b c d Guzman,, C; Wang, Y 2008 "Sleep terror disorder: A case report" Revista Brasileira De Psiquiatria 115 11: 169 doi:101590/S1516-44462008000200016 
  4. ^ a b c d e Szelenberger, W; Niemcewicz, S; Dąbrowska, A 2005 "Sleepwalking and night terrors: Psychopathological and psychophysiological correlates" International Review of Psychiatry 32 12: 263–270 doi:101080/09540260500104573 
  5. ^ a b c d e f Association, published by the American Psychiatric 2000 DSM-IV-TR : diagnostic and statistical manual of mental disorders 4TH ed United States: AMERICAN PSYCHIATRIC PRESS INC DC ISBN 978-0-89042-025-6 
  6. ^ American Academy of Child and Adolescent Psychiatry "Facts for Families No 34: Children's Sleep Problems" AACAP Retrieved Dec 20, 2011 
  7. ^ a b c American Psychiatric Association 2000 Diagnostic and Statistical Manual of Mental Disorders 4th ed, text revision ed Washington, DC 
  8. ^ a b Nguyen, B; Pérusse, D; Paquet, J; Petit, D; Boivin, M; Tremblay, R E; Montplaisir, J 2008 "Sleep terrors in children: A prospective study of twins" Pediatrics 122 6: e1164–e1167 doi:101542/peds2008-1303 PMID 19047218 
  9. ^ Oudiette, D; Leu, S; Pottier, M; Buzare, M; Brion, A; Arnulf, I 2009 "Dreamlike mentations during sleepwalking and sleep terrors in adults" Sleep: Journal of Sleep and Sleep Disorders 32 12: 1621–1627 
  10. ^ a b "Night Terrors Follow-up - Prognosis" Medscape reference Retrieved 2013-05-26 
  11. ^ Blog from Fountia, "Things You Didn’t Know About Night Terrors"
  12. ^ Di Gennaro, G; Autret, A; Mascia, A; Onorati, P; Sebastiano, F; Quarato, P 2004 "Night terrors associated with thalamic lesion" Clinical Neuropsychology 115 11: 2489–2492 doi:101016/jclinph200405029 
  13. ^ "Night Terrors - Pathophysiology" Medscape reference Retrieved 2013-05-26 
  14. ^ a b c Connelly, Kevin "Night Terrors" WebMD Retrieved July 20, 2011 
  15. ^ licht, deborah 2016 presenting psychology new york: worth publisher p 146 ISBN 9781319016371 
  16. ^ a b Bevacqua, BK; Fattouh, M; Backonja, M 2007 "Depression, Night Terrors, and Insomnia Associated With Long-Term Intrathecal Clonidine Therapy" Pain Practice 11 1: 36–38 doi:101111/j1533-2500200700108x 
  17. ^ "Mental and behavioural disorders" 
  18. ^ a b c d Nguyen, B; Pérusse, D; Paquet, J; Petit, D; Boivin, M; Tremblay, R E; Montplaisir, J 2008 "Sleep terrors in children: A prospective study of twins" Pediatrics 122 6: e1164–e1167 doi:101542/peds2008-1303 PMID 19047218 
  19. ^ McMillan, Julia A 2006 Oski's pediatrics : principles & practice 4th ed Philadelphia: Lippincott Williams & Wilkins p 2353 ISBN 9780781738941 
  20. ^ Kuhlmann, David "Sleep Terrors" The American Academy of Sleep Medicine Retrieved July 5, 2011 
  21. ^ Snyder, D; Goodlin-Jones, B L; Pionk, M; Stein, M T 2008 "Inconsolable night-time awakening: Beyond night terrors" Journal of Developmental and Behavioral Pediatrics 29 4: 311–314 doi:101097/DBP0b013e3181829f4c PMID 18698194 
  22. ^ Guzman,, C; Wang, Y 2008 "Sleep terror disorder: A case report" Revista Brasileira De Psiquiatria 115 11: 169 doi:101590/S1516-44462008000200016 
  23. ^ Schredl, Michael April 2011 "Gender differences in nightmare frequency: A meta-analysis" Sleep Medicine Reviews 15: 115–121 doi:101016/jsmrv201006002 
  24. ^ Poblano, A; Poblano-Alcalá, A; Haro, R 2010 "Sleep-terror in a child evolving into sleepwalking in adolescence Case report with the patient's point of view" Revista Brasileira De Psiquiatria 32 3: 321–322 doi:101590/S1516-44462010000300022 PMID 20945027 
  25. ^ Chen, Laura July 2010 "Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis" Mayo Clinic Proceedings 85: 618–629 doi:104065/mcp20090583 PMC 2894717  PMID 20458101 
  26. ^ a b Carter, KA; Hathaway, NE; Lettieri, CF 1 March 2014 "Common sleep disorders in children" American family physician 89 5: 368–77 PMID 24695508 
  27. ^ Fleetham, JA; Fleming, JA 13 May 2014 "Parasomnias" CMAJ : Canadian Medical Association 186 8: E273–80 doi:101503/cmaj120808 PMC 4016090  PMID 24799552 
  28. ^ Wilson, SJ; Lillywhite, AR; Potokar, JP; Bell, CJ; Nutt, DJ 19 July 1997 "Adult night terrors and paroxetine" Lancet London, England 350 9072: 185 PMID 9250190 
  29. ^ Bruni, Oliviero; Ferri, Raffaele; Miano, Silvia; Verrillo, Elisabetta 2004-05-14 "l -5-Hydroxytryptophan treatment of sleep terrors in children" European Journal of Pediatrics 163 7: 402–407 doi:101007/s00431-004-1444-7 ISSN 0340-6199 PMID 15146330 

External linksedit

  • Night Terror Resource Center
  • National Institutes of Health, Medline Plus: Night Terrors
  • National Library of Medicine - Medical Subject Headings: Night Terrors

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    29.10.2014


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