Sleep Terrors

What Causes Sleep Terrors?

The exact cause of sleep terrors is unknown, but they are often associated with medical conditions, stress, hormonal conditions, and other external situations.

Some potential risk factors for sleep terrors include:

• Lack of adequate sleep
• Bad sleep environment (e.g., an unfamiliar place or one that is too noisy or bright)
• Ongoing emotional stress
• Digestive issues
• Sleep apnea
• Other sleep disorders
• Fever
• Alcohol use
• Overactive thyroid
• Premenstrual hormone fluctuations
• Migraines
• Encephalitis
• Stroke

Sleep terrors in adults may be associated with mental health-related issues such as bipolar disorder, anxiety disorders, or depression.

Are Sleep Terrors Hereditary?

Research suggests a strong genetic component to sleep terrors and sleepwalking. Most children who experience sleep terrors also have a close family member who has experienced them, and both sleep terrors and sleepwalking tend to run in families.

Scientists have not yet identified a gene or genetic mutation associated with sleep terrors. It’s likely that some people are genetically predisposed to experiencing the disorder, but some external environmental factor usually triggers the terrors.

How Are Sleep Terrors Detected?

Sleep terrors, especially those experienced by children, may not require any intervention by a doctor, therapist, or sleep specialist. However, you should seek professional help if the episodes are severe. Warning signs that you should consult a doctor include:

• Terrors occur two or more times a week.
• Terrors are accompanied by sleepwalking.
• The person engages in dangerous behavior or injures themselves during the episode.
• The episodes cause impairment of function during the day.
• Terrors are experienced by an adolescent or adult.

How Are Sleep Terrors Diagnosed?

Doctors may take several different diagnostic steps when a patient is experiencing sleep terrors.

• Physical exam. A basic physical exam will screen for indications of medical conditions that could be causing the episodes.
• Blood tests. The doctor may order laboratory blood tests to rule out conditions, such as thyroid dysfunction, that may be causing the problems.
• Sleep diary. The doctor may ask for a sleep log over two weeks to look for patterns in sleep behavior. Tracking other habits possibly impacting sleep, such as caffeine use, may also be recorded.
• Sleep study. A study of sleep patterns, which may be conducted at a sleep center, may be recommended if the doctor suspects that a condition such as sleep apnea could be causing the sleep terrors.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Are Sleep Terrors Treated?

Most cases of sleep terrors in children do not require treatment. Symptoms usually resolve on their own by adolescence. However, in adults and children with underlying sleep or mental-health disorders, treatment of the underlying condition may help relieve the symptoms of sleep terrors. Treatment may also be necessary if the episodes are frequent.

Parents and caregivers of people experiencing sleep terrors can take steps to minimize the likelihood of episodes and prevent potentially harmful situations during them.

• Ensure the person is practicing good sleep hygiene, including keeping to a regular sleep schedule and maintaining a sleep space conducive to a good night’s sleep.
• Don’t attempt to wake a person experiencing sleep terrors. This may prolong the episode and cause potentially harmful behavior.
• Ensure the bedroom is free of potential hazards, such as sharp-edged furniture.
• Stay with the person until the episode is over.
• In the case of frequent episodes, waking a person gently about 30 minutes before they are likely to experience sleep terrors may help prevent episodes.

In some cases that do not respond to other interventions, doctors may recommend medications such as sedatives or antidepressants.

How Do Sleep Terrors Progress?

Sleep terrors usually do not have long-term complications. Children who experience them typically outgrow them by late childhood; studies have not found any consistent association between sleep terrors in children and subsequent mental health problems.

However, sleep terrors in adults may indicate underlying mental health conditions that require treatment. Untreated chronic sleep terrors and other sleep disturbances can lead to a wide variety of medical problems, quality-of-life complications, and mental health-related issues, including:

• Problems at work or school
• Relationship difficulties
• Accidents caused by fatigue or mental fogginess
• Anxiety or depression
• Substance abuse
• Weight gain
• Diabetes
• High blood pressure
• Heart disease

How Are Sleep Terrors Prevented?

Good sleep habits and a healthy lifestyle can help prevent sleep terrors and other sleep disorders. Steps you can take to ensure better sleep include:

• Stick to a regular sleep schedule (even on weekends)
• Don’t eat or drink close to bedtime
• Avoid stimulating activities (e.g., watching TV, using electronics) 30 minutes before bedtime
• Use your bedroom only for sleep
• Keep your bedroom dark and cool
• Get plenty of exercise
• Limit consumption of caffeine and alcohol
• Quit smoking
• Don’t take naps
• Try meditation or relaxation techniques

Sleep Terrors Caregiver Tips

Some people with sleep terrors also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with sleep terrors:

• Depression is more common in adults who experience sleep terrors.
• Anxiety disorders are also commonly co-morbid with sleep terrors in adults.
• People with bipolar disorder are at increased risk of sleep terrors.

Sleep Terrors Brain Science

Sleep terrors usually occur when a person is transitioning to deep sleep. Scientists believe that the episodes result from a mixed state in which part of the brain is asleep, and another part is awake. In the case of night terrors, it’s possible that parts of the brain that control rational thought and memory, such as the neocortex and the hippocampus, are asleep, and the parts responsible for the fear response, including the amygdala and hypothalamus, are awake. These fear-producing areas of the brain activate the sympathetic nervous system, which kicks the body into a “fight-or-flight” state.

The mixed-state theory would help explain why people generally don’t remember their sleep terror episodes. During nightmares, the brain’s higher-level functions are more active, allowing for the creation of vivid dream narratives and memories. However, those parts of the brain are inactive during sleep terrors, resulting in a bout of intense fear that leaves no lasting impression.

Sleep Terrors Research

Title: Parents Advancing Toddler Health (PATH)

Stage: Recruiting

Principal investigator: Amanda R. Tarullo, PhD

Boston University

Boston, MA

Children living in poverty have a high incidence of early-developing sleep and behavior problems, which are often co-morbid. Early sleep and behavior problems are prevalent and persistent risk factors for lifelong poor mental and physical health outcomes. They may be key mechanisms underlying early and enduring socioeconomic health disparities. While effective interventions exist, low-income families have low enrollment and retention in these interventions. The stigma of treating behavior problems creates an additional barrier to treatment. This RCT aims to address these barriers to treatment for low-income children with co-morbid sleep and behavior problems. Sleep and behavior problems and family dysfunction transact across time, increasing in severity, while healthy sleep, positive child behaviors, and effective parenting can support each other across development. Thus, researchers posit that intervention in one domain, either sleep or behavior, may improve outcomes both within and across domains.

Although early interventions can improve health equity in young children living in poverty, this promise often is not realized because of barriers to family engagement. The proposed study will target co-morbid behavior and sleep problems in early childhood, comparing child outcomes and family response to sleep and behavior interventions and investigating the novel strategy of letting families select their intervention. Researchers will enroll 500 low-income toddlers with co-morbid sleep and behavior problems, randomized to 4 parent coaching interventions: sleep, behavior, family choice (sleep or behavior), and an active control. At baseline and 1, 5, and 9 months post-intervention, researchers will assess the child’s sleep and behavior and family functioning. In addition, researchers will measure family preference, engagement, and perceived value of each intervention. The goals of the study are: (1) to examine the effects of evidence-based sleep and behavior interventions in young low-income children with co-morbid sleep and behavior problems on child sleep and behavior and family functioning; (2) to determine whether parents prefer, engage with, and value a sleep or behavior intervention more; and (3) to examine if giving families a choice of intervention results in higher engagement, higher perceived value and better family and child outcomes than assignment to intervention. By informing best practices for engaging low-income families to treat co-morbid sleep and behavior problems, results will be critical to reducing health disparities for children living in poverty.

Title: Feasibility Study of Personalized Trials to Improve Sleep Quality

Stage: Not Yet Recruiting

Principal investigator: Karina Davidson, PhD, MASc

Northwell Health

New Hyde Park, NY

This pilot study aims to assess the feasibility of using N-of-1 methods in a virtual research study of melatonin intervention for poor sleep quality. Participants (N=60) will be sent a Fitbit device and three smart pill bottles, with one containing 3 mg of melatonin, one containing 0.5 mg of melatonin, and the final bottle containing a placebo pill. The first two weeks will be a baseline period, where no supplement is assigned, but data are collected, including self-report of sleep quality and duration and accelerometer-derived sleep and activity data. After successfully completing the baseline period, participants will be randomized to six 2-week intervention blocks of a 3 mg dose of melatonin, a 0.5 mg dose of melatonin, and a placebo. At the end of the trial, participants will be asked to complete the System Usability Scale, a satisfaction survey (electronic or phone/video call if they are non-responders), and participate in a virtual interview (such as over Microsoft Teams or a phone call) to inform feasibility and acceptability of protocol requirements, study materials, and personalized reports.

Title: Telehealth Delivery of Treatment for Sleep Disturbances in Young Children With Autism Spectrum Disorder

Stage: Recruiting

Principal investigator: Cynthia Johnson, PhD

The Cleveland Clinic

Cleveland, OH

Ninety children with Autism Spectrum Disorder (ASD), between the ages of 2 and seven years, and their parents will be recruited for this ten-week randomized clinical trial. Participants will be randomized to five individually delivered sessions of Sleep Parent Training (SPT) or five individually delivered sessions of Sleep Parent Education (SPE). Delivery of the programs will be via a telehealth platform that includes parent-child coaching in real-time. In addition to baseline, outcome measures will be collected at week 5 (midpoint of trial) and week 10 (endpoint of trial), as well as follow-up at week 16, to determine the durability of the treatment.

This study will deliver an already initially tested manualized parent training program especially targeting bedtime and sleep disturbances, but delivered via a telehealth platform and enhancing the program using live parent coaching at bedtime. Utilizing REDCap automated survey invitations feature, investigators will provide reminders of the intervention recommendations and data collection requirements. In a randomized clinical trial of 90 children with ASD, ages 2 to less than seven years, a parent training program targeting sleep disturbance (Sleep Parent Training; SPT) will be compared to Sleep Parent Education (SPE). The investigators hypothesize that SPT will be superior in improving child sleep, child daytime functioning as well as parent well-being compared to SPE.