Night terrors

Parasomnias are characterized by undesirable physical or behavioral phenomena that occur during sleep [e.g., sleepwalking, sleep talking, bruxism (grinding of teeth), enuresis, night terrors, and RBD]. RBD patients act out their dreams during sleep, often in a violent manner. 

A native of England, Roy Bolbery, forty-two when interviewed, was ill throughout his childhood in London. At age six he had a severe adverse reaction to penicillin. His sleep frequently was interrupted by night terrors. And during the day he would suddenly feel ill for no apparent reason. The outcome of many medical tests was a diagnosis of mild epilepsy. His sister died in childhood of leukemia. His father suffered with tuberculosis. 

Pavor nocturnus (night terrors) is a further arousal disorder mainly of childhood emanating from SWS. Like somnambulism it usually remits in puberty... 

Sleep terrors—A sleep disturbance in which the person appears to wake up screaming and terrified and may cry inconsolably for several minutes. Although the person is not fully awake, the sufferer often shows several physical signs of fear, such as sweating, dilated pupils, and increased blood pressure. Also called night terrors. 

Richards, David W. Night Terrors. Night Terror Resource Center. Available online at http //www.nightterrors.org. 

Night terrors are pure emotional experiences that occur on awakening from sleep. Typically, they are associated with non-rapid eye movement (NREM) sleep, as are the recurrent dreams of post-traumatic stress. Together with the arousal from NREM sleep, there is intense activation of the heart, the breathing rate increases, and the blood pressure may rise to extremely high levels the person awakens drenched in sweat and terrified, and often has little dream recall whatsoever from these awakenings. 

What effect does trauma have on dreams There are two paradoxically contradictory answers to this question enormous impact and very little. We don t understand why, in some cases, the trauma is almost always dominant and, in others, it has such a small role to play in the shaping of dreams. One answer may be that victims of trauma, e.g. post-traumatic stress disorder patients who have had violent experiences in war, have a specific kind of awakening experience. Their sleep is interrupted by terrors akin to the night terrors of children, and, like in the night terrors of children, these do not occur in REM sleep when normal dreaming takes place. Instead, they occur in NREM sleep, the phase of sleep in which the brain is less completely activated, but in which powerful emotions can nevertheless make themselves felt. 

Valsecia ME, Malgor LA, Espindola JH, Carauni DH. New adverse effect of oxybutynin night terror . Ann Pharmacother 1998 32(4) 506. 

Because diazepam suppresses stage 4 sleep, it may prevent night terrors in adults... 

Safety and efficacy have not been established, but trazodone has been used for behavioral disturbances, depression, and night terrors... 

Nocturnal panic attacks may be distinguished from night terrors by the fact that the patient will wake fully before panic symptoms have reached a peak and is fully aware. 

Sleep problems—symptoms can include insomnia, night terrors, sleep walking, fear of separation, or anxiety. 

TABLE 6.2 Benzodiazepines (Usually Used to Treat Anxiety, Panic, and Night Terrors)... 

Benzodiazepines A class of drugs that is most commonly used both for anxiety (nervousness) and as a sedative (generally used to treat sleep problems). When used in the treatment of anxiety, many counselors warn that the medication may create a type of euphoria or false sense of progress that can impede improvement. It is always a good idea to ask the client to contract for services prior to starting this class of medications. Benzodiazepine medications are used to decrease anxiety, panic and night terrors for example Ativan (lorazepam), Clonopin (clonazepam). Librium (chlor-diazepoxide). Valium (diazepam), and Xanax (alprazolam). The benzodiazepine that is generally used to treat sleep problems is Dalmane (flurazepam). 

Delirium, depression, agitation, hypomania, nightmares, night terrors, hallucinations, paranoia... 

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