Approach Considerations
In view of the benign and self-limited nature of sleep terrors, most affected individuals require no specific medical intervention other than reassurance, establishing environmental safety, and education.
The use of scheduled awakenings has been suggested as a possible means of reducing sleep terror occurrences. [27] This involves noting what time the episodes usually occur for five nights in a row, then waking the child up 10 to 15 minutes before that time, keeping the child awake for 4 to 5 minutes, then allowing the child to resume sleep. [28]
During episodes, efforts should be made to keep affected individuals from harming themselves or others. These efforts can be supported by removing hazardous objects from the sleep area, securing windows, and impeding exit from the sleep area. Affected children are typically resistant to interference in the midst of a sleep terror event, but patient surveillance to avert injury as permitted may be all that is required.
When the episode has terminated, parents should assist the child back to bed. Discussion of the event immediately or the following day is usually not helpful, because the experience either is not remembered or is only vaguely recalled.Associated comorbid conditions, particularly sleep breathing disorders, should be appropriately treated; this may or may not affect the frequency of sleep terrors. [9] General efforts to promote a stable environment with adequate regular sleep habits are encouraged but may not alter the occurrence of sleep terrors.
Hypnosis has proven to be effective in some children. [2, 8]
Long-Term Monitoring
Routine follow-up and developmental assessment are indicated for all children, including those affected by sleep terrors.
Continued support and reassurance can be helpful for affected families. Surveillance for deviation from classic sleep terror characteristics or increasing severity of behavior during episodes may prompt reconsideration of the diagnosis or increased protective interventions.
Tables
| Features | DSM-5-TR | ICSD-3-TR |
|---|---|---|
| Frequency | Recurrent episodes | Recurrent episodes |
| Awakening | Abrupt arousal from sleep | Incomplete awakening from sleep |
| Responsiveness | Relative unresponsiveness | Inappropriate or absent responsiveness |
| Recall | Little or no recall of dream imagery | Little or no associated cognition or dream imagery |
| Amnesia | Amnesia of the episode | Partial or complete amnesia of the episode |
| Functional Impact | Significant distress or impairment in social, occupational, or other areas of functioning | |
| Differential | Symptoms cannot be explained by another mental disorder, medical condition, or the effects of drugs of abuse or medication | Symptoms cannot be explained by another mental disorder, medical condition, or the effects of drugs of abuse or medication |
| Initial Expression of Fear | Panicked scream | Alarming vocalization, such as a frightened scream |
| Autonomic Symptoms | Autonomic arousal | Mydriasis, tachycardia, tachypnea, diaphoresis during an episode |
| Feature | Sleep Terror | Nightmare |
|---|---|---|
| Categorization | Disorder of arousal | REM parasomnia |
| Timing | Usually occurs during the first half of the night and typically out of stage N3 slow-wave sleep | Begins out of REM sleep and typically occurs in the last third of the night |
| Family history | Frequently positive | May be positive |
| Behavior semiology | Sudden arousal with intense screaming, inconsolable crying, agitation, heightened autonomic discharge | Paroxysmal awakenings with anxiety dream recall |
| Event duration | Few seconds to minutes | Few seconds to minutes |
| Age at onset | Typically < 10 years old | Typically < 10 years old |
| Triggers | Sleep deprivation, febrile illness, anxiety, stress, sleep apnea, motor disorders of sleep | Sleep deprivation, febrile illness |
| Frequency | Few times per month/week; very rarely >1 episode in a single night | Few times per month/week; very rarely >1 episode in a single night |
| Post-spell | Limited to no recall of the events with confusion | Recall is typical at times with vivid detail |
| PSG changes | Abrupt arousal from slow-wave sleep (stage N3) with expression of confusion/ambulation/intense fright in all three arousal types, followed by return to sleep; increased cyclic alternating pattern | Dense eye(phasic) movements during REM sleep |
