Table of Contents

Definition of Sleep Terrors

Sleep terrors, also known as night terrors, are a type of sleep disorder characterized by episodes of intense fear, screaming, or thrashing during sleep. They are classified as a parasomnia, a category of sleep disorders that involve abnormal behaviors, movements, emotions, perceptions, and dreams during sleep.

During a sleep terror episode, an individual may suddenly sit up in bed, appear frightened, and experience symptoms such as rapid heart rate, sweating, and rapid breathing. They might also exhibit behaviors like screaming or crying out, although they typically remain asleep and are unaware of their surroundings. Sleep terrors often occur during non-REM (rapid eye movement) sleep, usually within the first few hours of falling asleep.

These episodes can be distressing for both the individual experiencing them and for those around them, but they usually do not require medical treatment unless they occur frequently, disrupt sleep significantly, or pose a risk of injury. Children are more likely to experience sleep terrors than adults, and most individuals tend to outgrow them as they age. Management strategies may involve improving sleep hygiene, reducing stress, and sometimes, in severe cases, medication or therapy may be recommended.


History of Sleep Terrors

Sleep terrors have been recognized for centuries, although the understanding of these episodes has evolved over time. Here’s a brief historical overview:

Ancient Times:

References to sleep disturbances resembling what we now call sleep terrors can be found in ancient texts. In ancient civilizations such as Egypt and Greece, there were descriptions of individuals experiencing terrifying dreams or nocturnal disturbances.

19th Century:

Sleep disorders, including sleep terrors, began to be systematically studied and documented. Researchers and clinicians started to differentiate between different types of sleep disturbances, recognizing that sleepwalking, nightmares, and sleep terrors were distinct phenomena.

20th Century:

Sigmund Freud, the famous psychoanalyst, contributed to the understanding of dreams and sleep disturbances. He explored the relationship between dreams, unconscious thoughts, and mental health conditions but did not specifically focus on sleep terrors.

Advancements in Sleep Medicine:

The late 20th century and early 21st century saw significant advancements in sleep medicine and the understanding of various sleep disorders. Sleep terrors were classified under the umbrella of parasomnias, a category that includes abnormal behaviors during sleep.

Research and Treatment:

Ongoing research has focused on understanding the causes, triggers, and treatments for sleep terrors. Studies have revealed associations with genetics, stress, sleep deprivation, and irregular sleep schedules. Treatment strategies have evolved to include behavioral interventions, improving sleep hygiene, and sometimes medication in severe cases.

Throughout history, cultural interpretations of sleep disturbances have varied. Some cultures have attributed sleep terrors and other sleep phenomena to supernatural causes or spiritual influences, while others have recognized them as medical conditions related to sleep. Overall, the understanding of sleep terrors has progressed significantly over time, from ancient descriptions of nocturnal disturbances to modern scientific research, allowing for better recognition, diagnosis, and management of this sleep disorder.

DSM-5 Criteria of Sleep Terrors

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), sleep terrors fall under the category of parasomnias, which are characterized by abnormal behaviors or physiological events that occur during sleep. The DSM-5 outlines specific criteria for diagnosing sleep terrors:

The essential features of sleep terrors include:

Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode.

Episodes typically begin with a panicky scream or cry and signs of intense fear or terror.

During an episode, the individual exhibits autonomic arousal, such as rapid heart rate, rapid breathing, sweating, and flushing of the skin.

During an episode, the individual is difficult to fully awaken and is unresponsive to efforts to comfort them.

There is no or very little dream imagery reported by the individual upon awakening.

The individual has amnesia for the episode or only vague recall.

To meet the criteria for sleep terrors, the episodes must cause significant distress or impairment in social, occupational, or other important areas of functioning. They cannot be better explained by another mental disorder, the effects of a substance (e.g., drugs or medications), or a medical condition.

The diagnosis of sleep terrors is primarily clinical and is based on a thorough evaluation of the individual’s history, sleep patterns, and the presence of the specific criteria outlined in the DSM-5.

It’s important to note that diagnosing sleep terrors requires careful consideration of the individual’s symptoms and ruling out other potential causes for the episodes of disrupted sleep and intense fear during the night.

Etiology of Sleep Terrors

The precise causes of sleep terrors are not entirely understood, but several factors and potential contributors have been identified through research. The etiology of sleep terrors can involve a combination of genetic, neurological, environmental, and psychological factors. Some of the key factors that may contribute to the occurrence of sleep terrors include:


There appears to be a genetic component to sleep terrors, as they often run in families. Individuals with a family history of sleep terrors or other parasomnias may have a higher likelihood of experiencing them.

Immature Nervous System:

Sleep terrors are more common in children and tend to decrease with age. They may be linked to the immaturity of the central nervous system in children, particularly during certain stages of development.

Sleep Disruptions:

Sleep deprivation, irregular sleep schedules, insufficient sleep, or disruptions in the sleep cycle can increase the likelihood of experiencing sleep terrors. Stressful life events, changes in sleep patterns, or sleep disorders like sleep apnea can also trigger episodes.

Increased Arousal during Sleep:

Sleep terrors often occur during non-REM sleep stages, especially during the transition from deep sleep to lighter stages. Heightened arousal during these stages may contribute to the occurrence of sleep terrors.

Psychological Factors:

Stress, anxiety, and emotional disturbances can exacerbate or trigger sleep terrors in susceptible individuals. Traumatic experiences or significant life changes may also be associated with an increased incidence of parasomnias.

Neurological Factors:

Some research suggests that abnormalities or imbalances in neurotransmitters or brain chemicals involved in sleep regulation and arousal may play a role in the development of sleep terrors.

Other Medical Conditions:

Certain medical conditions such as fever, migraines, restless leg syndrome, and sleep-related breathing disorders can sometimes be associated with an increased likelihood of experiencing sleep terrors.

Understanding the specific cause of sleep terrors for an individual can be complex, as multiple factors often contribute to their occurrence. Identifying triggers and addressing underlying issues such as improving sleep hygiene, managing stress, and maintaining regular sleep schedules can be helpful in managing sleep terrors. In some cases, medical or psychological intervention may be necessary, especially if sleep terrors significantly impact an individual’s quality of life or well-being.

Theories related to Sleep Terrors

Several theories attempt to explain the occurrence of sleep terrors. While the exact cause remains unclear, these theories provide insights into potential mechanisms underlying this sleep disorder:

Immature Nervous System Theory:

Sleep terrors are more prevalent in children and tend to decrease with age. One theory suggests that the immature nervous system in children might play a role. As the central nervous system develops and matures, the frequency of sleep terrors typically diminishes.

Arousal Disorders Theory:

Sleep terrors are considered arousal disorders because they involve partial awakenings during non-REM sleep stages. There is a theory that suggests an abnormality in the arousal system of the brain, leading to incomplete transitions between sleep stages. This could cause a person to become partially awake while still experiencing aspects of deep sleep, resulting in episodes of terror.

Genetic Predisposition Theory:

There appears to be a genetic component to sleep terrors. Research has indicated that individuals with a family history of sleep terrors or other parasomnias may have a higher likelihood of experiencing them. This suggests a genetic predisposition or susceptibility to these sleep disturbances.

Stress and Anxiety Theory:

Stressful life events, anxiety, or emotional disturbances are often associated with an increased likelihood of experiencing sleep terrors. Some theories propose that heightened emotional arousal or unresolved psychological distress might trigger these episodes during sleep.

Sleep Disruptions Theory:

Irregular sleep patterns, sleep deprivation, or disruptions in the sleep-wake cycle can increase the incidence of sleep terrors. Disturbances in the natural sleep rhythm, such as jet lag or inconsistent sleep schedules, may contribute to the occurrence of these episodes.

Neurological Factors Theory:

Research suggests that abnormalities or imbalances in neurotransmitters or brain chemicals involved in sleep regulation and arousal, such as serotonin or dopamine, might influence the occurrence of sleep terrors.

Overlap with Other Sleep Disorders Theory:

Sleep terrors can sometimes coexist with other sleep disorders such as sleepwalking, nightmares, or sleep-related breathing disorders. Some theories suggest an overlap or interplay between different sleep disorders, contributing to the occurrence of sleep terrors.

While these theories offer potential explanations, it’s important to note that sleep terrors are likely multifactorial, involving a combination of genetic, neurological, psychological, and environmental factors. Further research is needed to gain a deeper understanding of the mechanisms and causes underlying sleep terrors.

Risk factors of Sleep Terrors

Several factors can increase the likelihood of experiencing sleep terrors. These risk factors can vary from individual to individual and may include:


Sleep terrors are more common in children, particularly between the ages of 3 and 12. They often decrease in frequency and severity as children grow older, although some individuals may continue to experience them into adulthood.

Family History:

There appears to be a genetic predisposition to sleep terrors. Individuals with a family history of sleep terrors or other parasomnias are at a higher risk of experiencing these episodes themselves.

Stress and Anxiety:

Emotional stress, anxiety, or psychological disturbances can contribute to the occurrence of sleep terrors. Traumatic experiences, major life changes, or ongoing stressors may increase the likelihood of these episodes.

Sleep Deprivation or Disruptions:

Lack of adequate sleep, irregular sleep patterns, or disrupted sleep due to factors like shift work, jet lag, or poor sleep hygiene can increase the risk of experiencing sleep terrors. Sleep disturbances interrupt the natural sleep cycle and may trigger episodes.

Other Sleep Disorders:

Certain sleep-related disorders, such as sleep apnea, restless leg syndrome, sleepwalking, or nightmares, can be associated with an increased risk of sleep terrors. These disorders may disrupt sleep patterns and contribute to the occurrence of parasomnias.

Medications or Substances:

Some medications or substances, such as certain antidepressants, stimulants, or drugs that affect the central nervous system, may increase the likelihood of experiencing sleep terrors as a side effect.

Fever or Illness:

Sleep terrors may be more frequent during periods of illness or fever. These physiological stressors can disrupt sleep and increase the risk of parasomnias.

Trauma or PTSD:

Individuals who have experienced trauma or have post-traumatic stress disorder (PTSD) may be at a higher risk of experiencing sleep terrors. Traumatic experiences can impact sleep quality and increase the likelihood of parasomnias.

Identifying and managing these risk factors can be important in reducing the frequency and severity of sleep terrors. Improving sleep hygiene, addressing stressors, maintaining a regular sleep schedule, and seeking appropriate treatment for underlying sleep disorders or psychological conditions may help in managing and minimizing the occurrence of sleep terrors.

Treatment for Sleep Terrors

Treatment for sleep terrors typically involves a combination of strategies aimed at reducing the frequency and severity of episodes. Here are some approaches commonly used to manage sleep terrors:

Reassurance and Safety Measures:

For children experiencing sleep terrors, reassurance from parents or caregivers can be helpful. Creating a safe sleep environment by removing potential hazards from the bedroom and ensuring the child’s safety during episodes is essential.

Improving Sleep Hygiene:

Establishing a regular sleep schedule, maintaining a relaxing bedtime routine, and promoting good sleep habits can help reduce sleep disturbances and the likelihood of sleep terrors. This includes avoiding stimulating activities before bedtime and ensuring a comfortable sleep environment.

Stress Management:

Minimizing stressors and addressing underlying stress or anxiety through relaxation techniques, counseling, or therapy can be beneficial in reducing the occurrence of sleep terrors, especially in adults.

Treating Underlying Sleep Disorders:

Addressing other sleep-related disorders, such as sleep apnea, restless leg syndrome, or insomnia, can improve overall sleep quality and reduce the frequency of sleep terrors.

Hypnosis or Psychotherapy:

In some cases, hypnosis or cognitive-behavioral therapy (CBT) may be used to manage stress, anxiety, or trauma-related factors that contribute to sleep terrors.


Medication is not typically the first line of treatment for sleep terrors. However, in severe cases or when other strategies have been ineffective, a doctor might consider prescribing medications such as benzodiazepines or antidepressants to help manage sleep terrors.

Monitoring and Support:

Keeping a sleep diary or journal to track patterns and triggers of sleep terrors can be useful for understanding and managing the condition. Support groups or counseling may also provide individuals and their families with valuable information and emotional support.

It’s important to consult with a healthcare professional or sleep specialist to determine the most appropriate treatment plan based on the individual’s specific situation. Treatment for sleep terrors often involves a personalized approach that considers the underlying causes, age of the individual, severity of episodes, and any coexisting conditions. Most children outgrow sleep terrors as they get older, while adults may benefit from different management strategies tailored to their needs.

Therapies for Sleep Terrors

Several therapeutic approaches can be employed to manage sleep terrors, especially when these episodes significantly impact an individual’s well-being. Here are some therapeutic interventions commonly used for addressing sleep terrors:

Cognitive-Behavioral Therapy (CBT):

CBT techniques, particularly those aimed at stress reduction, anxiety management, and relaxation training, can be beneficial for individuals experiencing sleep terrors. This therapy focuses on identifying and changing negative thought patterns and behaviors that may contribute to sleep disturbances.

Imagery Rehearsal Therapy (IRT):

IRT involves reimagining the content of nightmares or distressing dreams in a more positive or less frightening way during waking hours. This technique aims to reshape the content of dreams, potentially reducing the occurrence of sleep terrors or nightmares.

Mindfulness-Based Stress Reduction (MBSR):

Mindfulness techniques, including mindfulness meditation and stress reduction practices, can help individuals manage stress, anxiety, and improve overall sleep quality, potentially reducing the frequency of sleep terrors.

Relaxation Techniques:

Various relaxation methods such as progressive muscle relaxation, deep breathing exercises, guided imagery, and meditation can help calm the mind and body, promoting better sleep and reducing the likelihood of sleep terrors.


Hypnotherapy sessions conducted by a trained professional may be used to address underlying stress, anxiety, or trauma that could be contributing to sleep terrors. Hypnosis aims to induce a state of relaxation and heightened suggestibility to promote positive changes in behavior or thought patterns.


Biofeedback techniques involve monitoring physiological indicators like heart rate, muscle tension, or skin temperature and teaching individuals to control these bodily responses. Biofeedback can assist in relaxation and stress reduction, potentially impacting sleep terrors.

Psychoeducation and Counseling:

Understanding the nature of sleep terrors through psychoeducation can help individuals and their families cope better with these episodes. Counseling sessions can provide support, guidance, and strategies for managing stressors or emotional triggers related to sleep terrors.

These therapies are often used in conjunction with other management strategies, such as improving sleep hygiene, addressing underlying sleep disorders, and creating a safe sleep environment. It’s crucial to work with qualified healthcare professionals or therapists specializing in sleep disorders to determine the most suitable therapeutic approach based on an individual’s specific needs and circumstances.

Preventions of Sleep Terrors

Preventing sleep terrors entirely might not always be possible, especially if there is a strong genetic predisposition or underlying factors that are challenging to control. However, several strategies can help reduce the frequency and severity of sleep terrors:

Establish a Consistent Sleep Routine:

Maintain a regular sleep schedule by going to bed and waking up at the same time every day, even on weekends. Consistency helps regulate the sleep-wake cycle and can reduce the likelihood of sleep disturbances.

Create a Relaxing Bedtime Routine:

Establish a calming routine before bedtime to signal to the body that it’s time to wind down. Activities such as reading, taking a warm bath, or practicing relaxation techniques can promote better sleep quality.

Ensure a Comfortable Sleep Environment:

Create a sleep-conducive environment that is cool, dark, and quiet. Use comfortable bedding and eliminate potential disturbances (e.g., noise, excessive light) that could interrupt sleep.

Manage Stress and Anxiety:

Practice stress-reducing techniques such as mindfulness, meditation, deep breathing exercises, or yoga to alleviate stress and anxiety, which can contribute to sleep disturbances.

Limit Stimulants and Screen Time:

Avoid consuming stimulants like caffeine and limit screen time (e.g., smartphones, tablets, computers) close to bedtime, as these can interfere with the ability to fall asleep.

Promote Physical Activity:

Engage in regular physical activity or exercise during the day, but avoid vigorous exercise right before bedtime, as it may be stimulating and disrupt sleep.

Address Underlying Sleep Disorders:

Seek treatment for any underlying sleep disorders such as sleep apnea, restless leg syndrome, or insomnia, as these conditions can contribute to sleep disturbances, including sleep terrors.

Avoid Overstimulation Before Bed:

Avoid activities or experiences that might be emotionally upsetting or stimulating before bedtime. This includes exposure to frightening movies, intense discussions, or stressful situations.

Encourage Relaxation Techniques:

Teach and practice relaxation techniques with children, such as deep breathing exercises or guided imagery, to help them relax before bedtime.

Keep a Sleep Diary:

Tracking sleep patterns and episodes of sleep terrors in a sleep diary can help identify triggers or patterns, allowing for better management and understanding of the condition.

While these preventive measures may help reduce the frequency or severity of sleep terrors, it’s important to note that individual responses can vary. Consulting with a healthcare professional or sleep specialist can provide tailored advice and guidance based on an individual’s specific situation and needs.

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