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Sleep Terrors in Childhood

2005; Elsevier BV; Volume: 147; Issue: 3 Linguagem: Inglês

10.1016/j.jpeds.2005.06.042

1097-6833

Thornton B.A. Mason, Allan I Pack,

Neuroscience of respiration and sleep

Sleep terrors are dramatic events that represent a partial arousal state from deep sleep. Over the years, these episodes have also been referred to as night terrors, parvor nocturnus (in children), and incubus attacks (in adults). Sleep terrors are characterized by marked autonomic nervous system activation: tachycardia, tachypnea, tremulousness, mydriasis, and sweating are often present. Facial expressions of terror or intense fear are associated with uncontrollable shouting, screaming, gasps, moans, and agitation. 1 American Academy of Sleep Medicine. The International Classification of Sleep Disorders, 2nd ed.: Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine, 2005. p. 145-7. Google Scholar Although the respiratory rate is mildly increased, tidal volume is increased tremendously. 2 Fisher C. Kahn E. Edwards A. Davis D.M. A physiological study of nightmares and night terrors, the suppression of stage 4 night terrors with diazepam. Arch Gen Psychiatr. 1973; 28: 252-259 Crossref PubMed Scopus (68) Google Scholar Some semipurposeful movements can occur, yet both speech and motor activities are perseverative and confused. The full-blown sleep terror is a fight-flight episode. Although some children with sleep terrors may remain in bed, others may walk or run during attacks. Bodily injury and property damage are possible. 3 Malow B.A. Paroxysmal events in sleep. J Clin Neurophysiol. 2002; 19: 522-534 Crossref PubMed Scopus (34) Google Scholar The duration of sleep terrors is usually brief, often from less than a minute to several minutes; however, some sleep terrors may last as long as a half hour. 4 Pesikoff R.B. Davis P.C. Treatment of parvor nocturnus and somnambulism in children. Am J Psychiatr. 1971; 128: 134-137 Google Scholar Attempts to awaken a child fully during a sleep terror may increase the child's agitation, and the sleep terror may actually be prolonged 5 Cooper A.J. Treatment of coexistent night-terrors and somnambulism in adults with imipramine and diazepam. J Clin Psychiatr. 1987; 48: 209-210 PubMed Google Scholar ; indeed there is a “curious paradox” with endogenous arousal coexistent with external unarousability. 6 Mahowald M.W. Arousal and sleep-wake transition parasomnias. in: Lee-Chiong T.L. Sateia M.J. Carskadon M.A. Sleep medicine. Hanley and Belfus, Philadelphia2002: 207-213 Google Scholar Episodes cease rather abruptly, 2 Fisher C. Kahn E. Edwards A. Davis D.M. A physiological study of nightmares and night terrors, the suppression of stage 4 night terrors with diazepam. Arch Gen Psychiatr. 1973; 28: 252-259 Crossref PubMed Scopus (68) Google Scholar with the child rapidly returning to a deep sleep.