Night terrors, or sleep terrors, are a type of parasomnia—an unusual behavior or experience that occurs during sleep. While more commonly associated with children, night terrors in adults are not unheard of and can cause significant distress. These episodes often involve sudden awakenings from sleep accompanied by intense fear, confusion, or physical reactions such as screaming, sweating, or thrashing.
For adults experiencing night terrors, these episodes can disrupt sleep, lead to fatigue, and cause emotional strain, particularly if they occur frequently. Night terrors can also be concerning for loved ones, as the behaviors during an episode can appear alarming and uncontrollable.
In this article, we will explore the causes, symptoms, and risk factors of night terrors in adults and provide a detailed look at treatment options and coping strategies to help manage and mitigate their impact.
Understanding Night Terrors in Adults
What Are Night Terrors?
Night terrors are a type of non-REM parasomnia, meaning they occur during the deep stages of non-rapid eye movement (NREM) sleep, typically in the first half of the night. Unlike nightmares, which happen during the rapid eye movement (REM) stage of sleep and often involve vivid dreams, night terrors are marked by a sudden arousal from sleep with no clear or elaborate dream content.
During a night terror, the person may:
- Sit upright suddenly or bolt out of bed.
- Appear panicked, disoriented, or terrified.
- Scream, cry out, or exhibit physical behaviors such as kicking or thrashing.
- Have difficulty waking up or responding to others.
- Display symptoms of autonomic arousal, such as a racing heart, rapid breathing, or sweating.
How Are Night Terrors Different from Nightmares?
It’s important to differentiate between night terrors and nightmares, as the two have distinct characteristics:
- Night Terrors: Occur during deep NREM sleep, typically involve no dream recall, and are marked by physical and emotional reactions. The person is often unresponsive and unable to remember the episode the next day.
- Nightmares: Occur during REM sleep, involve vivid or disturbing dreams, and the person is usually able to wake up fully and recall the dream in detail.
Night terrors often leave the person with little to no memory of the event, whereas nightmares are typically remembered upon waking.
Causes and Risk Factors of Night Terrors in Adults
What Causes Night Terrors?
The exact causes of night terrors in adults are not fully understood, but they are believed to result from a disruption in the sleep cycle that causes partial arousal from deep, non-REM (NREM) sleep. This disruption prevents the brain from transitioning smoothly between sleep stages, leading to a confused and hyper-aroused state that characterizes night terrors. However, several factors are believed to contribute to their occurence.
1. Stress and Anxiety
Chronic stress, unresolved emotional turmoil, and anxiety disorders are among the most common contributors to night terrors. Stress activates the body’s fight-or-flight response, increasing the release of hormones like cortisol, which can interfere with sleep patterns and quality. Over time, prolonged stress makes it harder for the brain to achieve deep, restorative sleep, leaving individuals more vulnerable to parasomnias like night terrors.
In individuals with generalized anxiety disorder (GAD) or panic disorder, the hyperactive stress response may carry over into sleep, triggering episodes of fear and agitation. Even acute stressors, such as an upcoming work deadline, financial concerns, or personal conflicts, can temporarily increase the likelihood of night terrors.
2. Sleep Deprivation
Sleep deprivation is a well-documented trigger for parasomnias, including night terrors. When the body does not receive enough rest, it struggles to maintain a regular sleep cycle, leading to disorganized transitions between sleep stages. This instability in the sleep process makes it more likely for night terrors to occur.
Irregular sleep schedules—such as those caused by shift work, jet lag, or frequent late nights—can exacerbate the problem by disrupting the body’s natural circadian rhythm. Without a consistent sleep schedule, the brain is more prone to partial arousals during deep sleep, which may result in night terrors.
3. Alcohol or Substance Use
The consumption of alcohol or recreational drugs, particularly in the hours leading up to bedtime, can have a significant impact on sleep quality. Alcohol, for example, initially acts as a sedative, helping individuals fall asleep more quickly, but it also disrupts the natural progression of sleep stages as the body metabolizes it. This interference can lead to fragmented sleep, increasing the likelihood of night terrors.
Similarly, certain medications, such as sedatives, antidepressants, or stimulants, may contribute to parasomnias by altering brain activity during sleep. For example:
- Sedatives: Can suppress REM sleep, increasing the time spent in NREM sleep, where night terrors typically occur.
- Stimulants: Can delay sleep onset and cause restlessness, destabilizing the sleep cycle.
It’s worth noting that withdrawal from substances, such as alcohol or certain medications, may also trigger night terrors due to the sudden changes in the brain’s neurochemical balance.
4. Underlying Medical or Mental Health Conditions
Various physical and mental health conditions can increase the likelihood of night terrors by disrupting normal sleep patterns or causing chronic discomfort.
Mental Health Conditions:
- Post-Traumatic Stress Disorder (PTSD): People with PTSD often experience hyperarousal and intrusive thoughts that carry into their sleep, making night terrors more frequent.
- Depression or Mood Disorders: These conditions often lead to poor sleep quality, difficulty falling asleep, or fragmented sleep, all of which can contribute to night terrors.
Physical Health Conditions:
- Gastroesophageal Reflux Disease (GERD): GERD can cause discomfort and awakenings during sleep, increasing the chance of partial arousals that trigger night terrors.
- Chronic Pain: Conditions like fibromyalgia or arthritis can disrupt deep sleep, leading to an increased risk of parasomnias.
Individuals experiencing night terrors should address any underlying medical or psychological conditions, as treating these issues often reduces the frequency or severity of night terrors.
5. Family History and Genetics
Night terrors often have a genetic component, as they tend to run in families. Research suggests that individuals with a family history of parasomnias—such as sleepwalking, sleep talking, or night terrors—are more likely to develop these conditions themselves.
This genetic predisposition may be linked to how the brain regulates sleep stages or responds to partial arousals. While genetic factors alone do not guarantee the occurrence of night terrors, they can increase susceptibility, especially when combined with other triggers like stress or sleep deprivation.
6. Sleep Disorders
Certain sleep disorders can increase the risk of night terrors, either by directly interfering with the sleep cycle or by causing frequent awakenings that destabilize deep sleep.
- Sleep Apnea: In individuals with obstructive sleep apnea (OSA), repeated pauses in breathing during sleep can cause the brain to wake partially, increasing the likelihood of night terrors. Treating the apnea, such as through a CPAP machine, often reduces episodes of night terrors.
- Restless Legs Syndrome (RLS): RLS causes discomfort in the legs, leading to frequent movements or awakenings that can disrupt deep sleep. These interruptions may indirectly contribute to the development of parasomnias like night terrors.
- Other Parasomnias: Night terrors may occur alongside other parasomnias, such as sleepwalking or REM sleep behavior disorder (RBD). Coexisting parasomnias often share similar triggers and risk factors, such as stress, genetics, or sleep disruption.
Recognizing Symptoms of Night Terrors
Common Signs of Night Terrors in Adults
The hallmark symptoms of night terrors include:
- Sudden Awakening: Sitting upright or leaping out of bed abruptly.
- Intense Fear or Panic: Appearing terrified, screaming, or crying out.
- Physical Reactions: Sweating, flushed skin, rapid heart rate, and heavy breathing.
- Confusion and Incoherence: Being unresponsive to attempts to wake them, mumbling, or showing no awareness of their surroundings.
- Memory Gaps: Little to no recall of the event the following morning.
Episodes can last from a few seconds to several minutes and may occur multiple times in a single night. The severity and frequency can vary widely from person to person.
Treatment Options for Night Terrors in Adults
Managing night terrors often requires a combination of lifestyle changes, stress management, and, in some cases, medical interventions.
1. Improve Sleep Hygiene
Establishing healthy sleep habits can reduce the likelihood of night terrors by promoting a stable sleep cycle.
- Set a Consistent Schedule: Go to bed and wake up at the same time every day, even on weekends.
- Create a Relaxing Bedtime Routine: Engage in calming activities such as reading, meditating, or listening to soothing music before bed.
- Limit Screen Time: Avoid blue light exposure from phones, tablets, or TVs at least an hour before bed.
- Optimize Your Sleep Environment: Keep your bedroom dark, quiet, and cool. Consider blackout curtains, white noise machines, or earplugs if necessary.
2. Address Underlying Stress or Anxiety
Since stress is a common trigger for night terrors, adopting stress management techniques can be highly effective:
- Cognitive Behavioral Therapy (CBT): A structured therapy approach that helps reframe negative thought patterns contributing to anxiety.
- Relaxation Techniques: Practices like deep breathing, progressive muscle relaxation, or mindfulness meditation can help calm the mind before sleep.
- Journaling: Writing down worries or to-do lists before bed can reduce mental clutter and promote relaxation.
3. Scheduled Awakenings
If night terrors tend to occur at the same time each night, scheduled awakenings can interrupt the sleep cycle and prevent episodes. This involves waking the person about 15-30 minutes before the typical time of the night terror, allowing the sleep cycle to reset.
4. Medication
In severe or persistent cases, a doctor may recommend medications to manage night terrors:
- Benzodiazepines: These sedative medications can promote deeper, uninterrupted sleep.
- Antidepressants: Low-dose antidepressants may help regulate sleep patterns and reduce stress-related triggers.
- Melatonin Supplements: Natural melatonin can assist in stabilizing the sleep-wake cycle, though its effectiveness for night terrors varies.
5. Treating Coexisting Sleep Disorders
If a sleep disorder like sleep apnea is identified as a contributing factor, addressing it through CPAP therapy or other treatments can significantly reduce night terrors.
Coping Strategies for Night Terrors
For the Individual
- Educate Yourself: Understanding what night terrors are—and what they are not—can reduce feelings of fear or shame.
- Practice Patience: Recovery takes time. Focus on small, manageable changes to your lifestyle or routine.
- Track Patterns: Keeping a sleep diary can help you identify triggers and patterns related to night terror episodes.
For Partners or Loved Ones
- Stay Calm: During an episode, avoid shouting or shaking the person awake, as this may worsen confusion or distress.
- Create a Safe Environment: Remove sharp objects or furniture edges that could cause injury during a night terror. Secure windows and doors.
- Offer Support: Encourage the individual to seek professional help if the episodes are frequent or severe.
When to Seek Professional Help
Occasional night terrors may not require intensive intervention. However, consider seeking medical attention if:
- Episodes occur frequently (multiple times a week).
- Night terrors lead to physical injury or pose a safety risk.
- Sleep deprivation or fatigue significantly impacts daily functioning.
- There are signs of an underlying medical condition or coexisting sleep disorder.
A healthcare provider or sleep specialist can perform a thorough evaluation, which may include a sleep study to rule out other conditions.
Final Words
Night terrors in adults, while less common than in children, can be deeply distressing and disruptive to one’s quality of life. Understanding the underlying causes, identifying potential triggers, and adopting effective treatment strategies are key to managing this condition.
By focusing on improving sleep hygiene, addressing stress, and seeking professional support when necessary, many individuals can reduce the frequency and severity of night terror episodes. Although it can take time to see improvements, with the right approach, restful and peaceful nights are achievable. For those affected by night terrors—or their loved ones—knowledge and proactive steps are powerful tools in reclaiming a sense of calm and control over sleep.
