By: Catherine Joachin
Introduction
Night terrors are sleep disturbances in which a person experiences panic while only partially awake. As opposed to nightmares, which happen later in the night, night terrors typically occur in the early morning, during non-rapid eye movement (NREM) sleep. (Cleveland Clinic, 2024). Moreover, they lack the wakefulness and dream recall components characteristic of nightmares (Mayo Clinic, 2025).
Symptoms and Causes
Night terrors are a type of parasomnia, meaning they belong to a category of sleep disorders characterized by unusual movements or disturbing behaviors (Mayo Clinic, 2025). Otherwise referred to as sleep terrors, these recurrent episodes of arousal trigger intense fear and autonomic arousal responses (APA, 2013). Children aged 1 to 12 are far more likely to experience this condition than adults (Mayo Clinic, 2025). People usually have no recollection of these experiences in the morning.
The most common features of night terrors include:
- Sweating
- Screaming
- Persistent state of fear or terror
- Mydriasis (dilatation of pupils)
- Hyperventilation (rapid breathing)
- Tachycardia (rapid heart rate)
- Thrashing and kicking of limbs
- Inability to wake up
- Difficulty being comforted
- Confusion
(APA, 2013; Mayo Clinic, 2025)
The cause of night terrors remains unknown; however, they may be triggered as a result of a fever, sleep deprivation, stress, alcohol abuse, or changes to sleep schedules (Cleveland Clinic, 2024; Mayo Clinic, 2025).
Treatment and Management
Treatment is seldom needed as most children outgrow night terrors by adolescence, however, it may be required in cases where night terrors represent a safety risk, become recurrent, or persist over time (Mayo Clinic, 2025). Treatment options include addressing any underlying conditions or sleep disorders such as obstructive sleep apnea, reducing stress, and practicing anticipatory awakening, a method which involves waking up 15 minutes before the usual night terror time frame (Mayo Clinic, 2025).
How do night terrors relate to epilepsy?
Sleep disorders are common in people with epilepsy. NREM arousal parasomnias, including night terrors, are frequently associated with childhood epilepsies, with a strong comorbidity between the former and nocturnal frontal lobe epilepsy (Manni & Terzaghi, 2010).
Night terrors bear a close resemblance to nocturnal seizures, a form of epilepsy that manifests during sleep. Due to the concurrent occurrence of both illnesses and their similar clinical presentations, diagnosis is difficult (Manni & Terzaghi, 2010). A key difference between these two events is that nocturnal seizures are triggered by abnormal brain electrical activity, while night terrors are not epileptic. However, this distinction may be difficult to demonstrate using traditional diagnostic tools as surface EEG findings fail to detect epileptiform activity during sleep-related seizures (Manni & Terzaghi, 2010). Hence, video-polygraphic monitoring (videotaped overnight sleep study) is better suited to distinguish nocturnal parasomnias from epilepsies (Manni & Terzaghi, 2010).
Conclusion
Night terrors are NREM episodes of confusional arousal marked by intense terror, strange movement, and vocalization, particularly panic screaming, during sleep. Though these sleep disturbances do not stem from epileptiform activity, they shares common traits with sleepwalking, nightmares and nocturnal epileptic seizures. Night terrors are generally transient experiences that require no treatment, but addressing underlying condition may help alleviate symptoms if they persist or endanger a person’s safety.
References
American Psychiatric Association, American Psychiatric Association. DSM-5 Task Force., & Rutter, M. (2013). Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). American Psychiatric Association.
Cleveland Clinic. (2024). Night terrors. https://my.clevelandclinic.org/health/diseases/night-terrors#symptoms-and-causesm
Manni, R., & Terzaghi, M. (2010). Comorbidity between epilepsy and sleep disorders. Epilepsy Research, 90(3), 171–177. https://doi.org/10.1016/j.eplepsyres.2010.05.006
Mayo Clinic. (2025). Sleep terrors (night terrors) – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/sleep-terrors/symptoms-causes/syc-20353524
Mayo Clinic. (2025). Sleep terrors (night terrors) – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sleep-terrors/diagnosis-treatment/drc-20353529
