Night Terrors: Symptoms, Causes, & How to Cope

What Are Night Terrors?

A night terror, also called a sleep terror or pavor nocturnus, is a type of parasomnia: a sleep disorder defined by episodes of screaming, fear, and physical thrashing or crying out while the person is still asleep. Clinically it is classified as a disorder of arousal from NREM sleep. Someone experiencing night terrors can be observed to thrash around in the bed, as if “acting out” the terrifying experience, or they can even get up from the bed and walk around, but they will often have no memory of doing this.

What Is the Difference Between Night Terrors and Nightmares?

Although often confused with nightmares, night terrors are actually different. Nightmares usually occur during REM (rapid eye movement) sleep, the stage tied to vivid dreaming. Night terrors instead arise out of deep, slow-wave N3 (NREM) sleep, most often in the first third of the night.¹

What Are the Symptoms of Night Terrors?

Night terrors can often look like a nightmare to others who are in the room or the same household as the person experiencing them. They are usually not a cause for concern. Knowing what to look for will help you provide support.

Symptoms of night terrors include:

• Having episodes of screaming and flailing while still asleep
• Sit up in bed appearing afraid or confused
• Breathing heavily, appearing flush, racing heartbeat
• Jumping out of bed, running around the room or even interacting with others
• May become aggressive if someone tries to approach or touch them
• Appearing confused if woken up
• Difficult to waken or arouse
• Have little to no memory of the episode
• Tossing blankets and pillows on the floor
• Waking up sweaty, as if you had been exerting energy
• Waking with a feeling of panic

What Causes Night Terrors?

The exact cause of night terrors is not fully understood, but researchers have identified several consistent triggers, including sleep deprivation, stress, fever, alcohol, and other sleep disorders such as sleep apnea. There is also a link between PTSD and night terrors.

It has also been shown that there might be a genetic link to night terrors, as well as a link between the serotonin levels in the brain.¹ Some other common causes are included in the items explained below.

Possible causes of night terrors include:

1. Other Sleep Disorders

Some of my clients who experience night terrors in adulthood reported that they were later found to have sleep apnea. This is likely due to the fact that restricted breathing contributes to arousal and could contribute to night terrors.²

There are also other parasomnia disorders associated with night terrors such as narcolepsy or sleep paralysis.

2. Mental Health Conditions

Although not all night terrors are linked to mental health concerns, especially when they happen in childhood, there is a link between mental health conditions such as trauma, depression and PTSD and the propensity to experience night terrors.

3. Stress or Trauma

Experiencing daytime stress can make night terrors more likely in people of all ages. There are many different types of stress, including work and relationship stress, as well as toxic stress. Children are especially sensitive to stresses in their environment such as a divorce or recent move, or anxiety at their school or daycare.

4. Low Serotonin Levels

Some researchers have proposed a link between serotonin activity and night terrors, and medications such as SSRIs or benzodiazepines are sometimes prescribed for frequent or dangerous episodes. Medication is not a first-line treatment, and most cases, especially in children, resolve without it.¹

5. Family History

There is a link between having parents or extended family members who experienced sleep terrors or other parasomnias, and experiencing them yourself. First-degree relatives of someone with sleep terrors have up to a 10-fold higher chance of experiencing them, according to the DSM-5-TR.¹

6. Eating or Drinking Triggering Foods

Some people have reported that their night terrors are triggered by their diet- specifically what they consume before bed. Having a full bladder or stomach will make your body uncomfortable, which might trigger night terrors in some. Others find that they are triggered by eating sugary or difficult to digest foods before bed, or consuming alcohol.

7. Caffeine or Any Stimulants

Some of us are more sensitive to caffeine than others. While some people can drink a large coffee right before bed, others need to make sure to stop around lunchtime- or it drastically affects their sleep! Being mindful of how your body processes stimulants like caffeine or medications that are known to have stimulant effects can help avoid night terrors.

8. Change in Environment or Living Situation

Children are especially sensitive to change. Moving to a different home, or experiencing a change or shift in family roles might make them more likely to experience sleep related difficulties such as night terrors.

9. Sleep Deprivation

When we are sleep deprived, our mind and body are under stress, which might make us more likely to experience night terrors- especially in childhood.

10. Watching Stimulating or Scary Movies Before Bed

Watching horror or suspense movies before bed might activate and stimulate your mind in such ways that make you more likely to experience night terrors.

How Common Are Night Terrors, and Who Gets Them?

Night terrors are far more common in young children than adults. Research summarized by StatPearls estimates that roughly 30% of children have at least one night terror, with episodes peaking between ages 3 and 7 and usually fading by age 10. In adults they are uncommon: a general-population study by Maurice Ohayon and colleagues at Stanford, published in the Journal of Clinical Psychiatry in 1999, found that about 2.2% of adults reported sleep terrors, and that the rate falls steadily with age. Among children the episodes affect boys and girls about equally, while family history matters at every age. First-degree relatives of someone with sleep terrors have up to a 10-fold higher chance of experiencing them, according to the DSM-5-TR.

Formally, the American Academy of Sleep Medicine (ICSD-3-TR) and the American Psychiatric Association (DSM-5-TR) both classify sleep terrors as a disorder of arousal from deep NREM sleep, not as a nightmare or an anxiety disorder. The DSM-5-TR lists them under Non-Rapid Eye Movement Sleep Arousal Disorders, sleep terror type (307.46 / F51.4), and its preferred term is sleep terrors. That distinction matters for treatment. Because episodes come out of deep sleep rather than dreaming, the person is not having a bad dream and usually cannot be reasoned with mid-episode. For most children it is a normal, self-limiting phase, while new onset in an adult with no childhood history is worth a medical review.

Who Is Affected by Night Terrors?

Night terrors often occur in childhood. “Night terrors are most often seen between the ages 3 to 7 years of age, and they often subside by 10 years of age.”¹However, they can happen at any age.

People who are affected by night terrors include:

Night Terrors in Children

Night terrors are common in children and are often not a cause for concern. In children, the common causes are environmental changes or environmental stress, but can also be due to an underlying medical condition. Night terrors are most common in childhood, and can occur in children of all genders.  “For most children, this behavior is temporary and does not cause significant problems.”³

Night Terrors in Adolescents

Although most children grow out of night terrors by puberty, it can still happen in adolescence. It can occur in children of all ages and genders, and are usually not a cause for concern. If the adolescent experienced night terrors in childhood, then it might be more common to experience them in adolescence or teenage years. However, if the night terrors are new, it is a good idea to get a medical exam to rule out any underlying medical or mental health concerns.

Night Terrors in Adults

Night terrors in adults are uncommon, affecting about 2% of adults, and are most often triggered by sleep deprivation, stress, alcohol, or an underlying sleep disorder such as sleep apnea. Less commonly, they can be a sign of another medical issue such as narcolepsy.

If you experienced night terrors as a child, you might be more likely to experience them as an adult. However, if you experience night terrors in adulthood and have no history of them, get a medical exam just to rule out any underlying issues or concerns. Sleep studies are commonly recommended if night terrors persist in adulthood.

How Do You Stop Night Terrors?

Unfortunately, it can be quite difficult to control when and where your night terrors may occur. However, there are some basic sleep hygiene tips that are known to improve sleep quality such as decreasing stress and improving the sleep environment. These, and the other tips listed below, will potentially reduce the frequency or severity of night terrors.

Tips for coping with and reducing night terrors include:

• Maintaining a healthy sleep schedule: Being consistent about the time you go to bed, and preparing your sleep environment are all ways to maintain consistent sleep hygiene.
• Stay physically active: Keeping our body active is essential. Not only is it beneficial to health, and there are many mental health benefits of exercise.
• Do calming activities before bedtime: Avoid cell phone use before bed! Instead, engage in something calming or self-soothing instead to prepare for sleep.
• Pay attention to what you eat and drink before bed: Be mindful of any food sensitivities or triggers such as sugar or heavy meals before bed.
• Practice relaxation techniques: Practicing relaxation techniques such as breathwork and progressive muscle relaxation can help prepare the body for restful and relaxing sleep.
• Use healthy coping mechanisms: When we ignore stress, it is more likely to creep up in our body and our health such as nightmares, insomnia, or night terrors. Acknowledging any stress can help decrease its effect. Using healthy coping mechanisms can improve sleep by reducing stress.
• Avoid caffeine or alcohol before bed: Stimulants such as coffee, and substances such as alcohol will affect your sleep and exacerbate any already present sleep issues.
• Reducing noise in the environment: This will help improve sleep by decreasing unintentional waking events.
• Choose a comfortable pillow and bedding: A comfortable bed will help with relaxation and improve sleep.
• Use a fan or humidifier: Improving breathing can help decrease night terrors, as some studies have shown that there is a link between breathing issues and arousal during sleep, which could trigger sleep terrors or other types of parasomnia.²
• Keep a sleep journal for the timing of awakenings: Some people, particularly children, tend to have night terrors around the same time. Setting an alarm or waking them up before this time might help to avoid or decrease the night terrors.

How Are Night Terrors Treated?

Treatment for night terrors focuses on safety, addressing triggers, and behavioral strategies rather than medication. If you’ve tried the tips above and still have night terrors, you may benefit from professional support, often a sleep specialist who can perform a sleep study. Scheduled awakenings, a technique of gently waking the sleeper about 30 minutes before a typical episode, has evidence for reducing frequency in children.

However, if you feel stress or underlying mental health issues may be contributing to them, such as depression or PTSD, you may benefit from seeing a therapist with expertise in sleep issues. Many people have success with CBT for issues such as insomnia and improving sleep hygiene, which can be done with online therapy services.

In My Experience

In my experience, night terrors are more common in children, and those who have experienced traumatic events. When they happen in childhood, it can be common for children to “grow out” of them, and find that they decrease in frequency and might eventually stop altogether. When they appear for the first time in adulthood, it is worth paying attention to. Adult-onset episodes are more often tied to sleep deprivation, stress, alcohol, sleep apnea, or certain medications than to anything sinister, though they can sometimes be linked to unresolved trauma or an underlying medical condition. New or frequent night terrors in an adult with no childhood history are worth reviewing with a doctor.