Health-care providers often ask me how to tell the difference between a sleep terror and a nightmare. Sleep terrors are probably more frightening to the observer than to the person experiencing it. During a sleep terror, the patient may run through the house screaming and crying with open eyes as if awake. The autonomic nervous system is activated, and the patient may experience sweating, tachycardia, dilated pupils and tachypnea.
Children aged 3- to 12- years are more likely to experience sleep terrors than adults, with boys more affected than girls. Although less common, sleep terrors that occur in adulthood affect both sexes equally.
Patients who experience sleep terrors do not remember the event when they wake up, which is one component that distinguishes the experience from a nightmare.
After a nightmare patients may wake up crying or upset, but they can easily tell you what they were dreaming about and what scared them. This may be because nightmares are more closely linked with psychological trauma.
Another characteristic to remember is that sleep terrors tend to happen earlier in the night, usually an hour or two after bedtime during slow-wave sleep, whereas nightmares tend to occur later in the night, during REM sleep.
Sleep terrors are generally triggered when a child is overly tired, or in adults, when they are overly stressed, sleep deprived or after drinking alcohol.
Also, consider nocturnal seizures as part of the differential diagnosis, as presentation can be similar. If a child exhibits the same behavior pattern each time they appear to be having a sleep terror, think “Nocturnal seizure.” Keep in mind that seizures are usually shorter in duration than a typical sleep terror.
Reassurance is the only available treatment for patients who experience sleep terrors. Since patients do not remember these events, the most important thing is to encourage good sleep hygiene. Make sure children have a regular bedtime each night. If the patient gets up out of bed during the episodes, tell parents to keep the sleeping area safe. Door alarms can be helpful to notify parents that their child has left their room.
For adults with severe sleep terrors, clonazepam can help. Self-hypnosis is also a useful tool for both children and adults who wish to learn techniques to manage the disorder.
Advise the patient’s family to resist any urge to shake or yell at a patient during a sleep terror, as this can prolong the event and upset the patient further. Family members who interact with loved ones experiencing a sleep terror, should be reminded to speak in a calm voice and to lead the affected patient slowly back to bed.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.