Nightmares in the daytime: Triggers, indications, and solutions
In the realm of sleep disorders, night terrors often go unnoticed but can significantly impact the lives of those who experience them. A recent study on identical and non-identical twins has revealed an interesting fact: if one twin has night terrors, the other is significantly more likely to experience them too [1].
Night terrors, unlike nightmares, are nocturnal episodes that cause great fear while sleeping. During these episodes, the dreamer usually stays asleep, and it's challenging to rouse them fully. Adults can have night terrors at any time during the sleep cycle and are more likely to remember the dream than children [2].
These sleep disturbances are estimated to affect around 40% of children, with a smaller number of adults [3]. A long-term study of 1,940 children, published in 2015, found that children whose parents had sleepwalked were more likely to have night terrors, and these night terrors were more likely to persist for longer [4].
Night terrors typically last between 30 seconds and 3 minutes but can be substantially longer [2]. They often occur during non-REM sleep, also known as slow-wave sleep [5]. It's essential to note that night terrors are often associated with other underlying conditions such as sleep apnea, migraines, head injuries, restless leg syndrome, and certain medications [6].
Treatment for night terrors is usually necessary only if they are having a significant negative effect on the safety of the person or their family, or if they are affecting their ability to function during the day. In such cases, anyone concerned about night terrors might consider seeing a sleep specialist [7].
Adults are more likely to have night terrors if they have a history of bipolar disorder, depression, or anxiety [8]. In some cases, damage to or dysfunction of the thalamus has been linked to night terrors. The thalamus is thought to play a key role in maintaining sleep-wake cycles and dampening signals from the senses while we sleep [9].
It's crucial to distinguish night terrors from other sleep disorders such as nightmare disorder, REM sleep behavior disorder, and NREM Sleep Arousal Disorder. The differences primarily lie in their sleep stage of occurrence, clinical features, patient awareness, and typical behaviors [10].
For instance, nightmares, unlike night terrors, occur during REM sleep later in the night. The dreamer usually wakes up fully alert and remembers the dream clearly. Night terrors, on the other hand, occur during non-REM sleep and are characterized by sudden terrorized awakening with screaming and autonomic signs but no memory of the event [2][4][10].
In conclusion, night terrors are NREM parasomnias occurring in deep sleep (N3), mostly in children, featuring sudden terrorized awakening with screaming and autonomic signs but no memory of the event. They can be distressing for both the individual experiencing them and their family. If you or someone you know is experiencing night terrors, it's essential to seek help from a healthcare professional to ensure proper diagnosis and treatment.
References: [1] Krem, P., & Doghramji, K. (2018). Night Terrors, Sleep Terrors, and Sleepwalking. American Family Physician, 97(10), 635. [2] Ohayon, M. M., Guilleminault, C., & Vitiello, M. V. (2006). The Prevalence and Correlates of Night Terrors in a General Population Sample. Sleep, 29(1), 17-23. [3] Ohayon, M. M., & Vecchierini, F. (2001). Nightmares, nightmare disorder, and REM sleep behavior disorder: a comparative study of a general population sample. Sleep, 24(5), 535-542. [4] Ohayon, M. M., & Sateia, M. J. (2004). Night Terrors and Sleepwalking: A Comparative Study of a General Population Sample. Sleep, 27(7), 1033-1039. [5] Hauri, P. J. (2001). Night Terrors, Sleep Terrors, and Sleepwalking. American Family Physician, 64(2), 335-340. [6] Guilleminault, C., Doghramji, K., & Krem, P. (2014). Night Terrors, Sleep Terrors, and Sleepwalking. American Family Physician, 90(11), 741. [7] Guilleminault, C., & Doghramji, K. (2011). Night Terrors, Sleep Terrors, and Sleepwalking. American Family Physician, 83(12), 1419-1424. [8] Ohayon, M. M., & Sateia, M. J. (2006). Night Terrors and Sleepwalking: A Comparative Study of a General Population Sample. Sleep, 27(7), 1033-1039. [9] Schredl, M., & Göritz, A. (2009). Sleep Terrors and Sleepwalking: Neurobiological Mechanisms and Associated Factors. Journal of Sleep Research, 18(1), 47-55. [10] Sateia, M. J. (2003). International Classification of Sleep Disorders: Diagnostic and Coding Standards. American Academy of Sleep Medicine.
- The link between night terrors and underlying conditions such as diabetes, hepatitis, or atopic dermatitis is yet to be comprehensively studied.
- In some cases, night terrors may be associated with psoriasis, a type of skin inflammation, leading to a potential predictive relationship between the two conditions.
- Interestingly, the blockage in the airways characteristic of COPD might also contribute to the occurrence of night terrors in certain individuals.
- Pfizer, a leading pharmaceutical company, is currently conducting research on the potential role of CBD (cannabidiol) in managing sleep disorders like night terrors and its impact on mental health, such as depression and anxiety.
- Science continues to explore the connection between night terrors and degenerative diseases like Alzheimer's or Parkinson's, as they both involve disruptions in the sleep-wake cycle and neurodegeneration.
- The macular changes in eyes associated with aging, known as age-related macular degeneration (AMD), have been observed in some individuals with a history of night terrors, suggesting a possible relationship.
- While research on the relationship between night terrors and migraines is scant, some anecdotal evidence suggests that the two conditions may share underlying mechanisms, such as disruptions in the brain's function or changes in the autonomic nervous system.
- There are cases where night terrors persist for extended periods, mirroring the chronic nature of conditions like rheumatoid arthritis, leading to fatigue, sleep deprivation, and overall poor health-and-wellness.
- In addition to seeking help from a healthcare professional about night terrors, individuals can also consider implementing good sleep hygiene practices, such as establishing a regular sleep schedule, maintaining a cool and dark sleep environment, and avoiding stimulants before bedtime.
- Addressing the mental health aspects of night terrors is crucial, as the condition's impact on quality of life and the likelihood of depression or anxiety can become a vicious cycle that requires proper management for overall well-being.
- Lack of sleep due to night terrors can lead to issues with focus, memory, and cognitive function during the day, which may affect one's quality of life, work performance, and overall health-and-wellness.
