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Anight terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder, causing feelings of terror or dread, and typically occurring in the first few hours of Sleep during stage 3 or 4 Non-rapid eye movement NREM sleep.[1] However, they can occur during slow-wave sleep periods or even daytime naps. [2] Night terrors should not be confused with nightmares, which are bad dreams that cause the feeling of horror or fear. According to the American Academy of Child and Adolescent Psychiatry, nightmares are relatively common during childhood.[3] However, night terrors may occur less frequently.An estimated 1%-6% of children and less than 1% of adults will experience a night terror episode within their lifetime. [4] Sleep terrors begin between ages 4 and 12 years and then usually dissipates during adolescents. The most common age for sleep terrors in adults are ages 20 and 30 years which are chronic in severity and frequency with the episodes waning over time. Though the frequency varies between individuals the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights. [2]
According to the American Academy of Child and Adolescent Psychiatry, nightmares are relatively common during childhood.[3] However, night terrors may occur less frequently.
Children who have night terrors are usually described as 'bolting upright' with their eyes wide open and a look of fear and panic on their face. They will often scream. Further, they will usually sweat, breathe fast and have a rapid heart rate (autonomic signs).The individual in some cases are likely to have even more elaborate motor activity. These motor functions could exhibit punching, swinging, fleeing. There is a sense that the individual is trying to protect themselves of escape from a possible threat which can lead to physical injury of the individual. [2] Although it seems like children are awake during a night terror, they will appear confused, be inconsolable, and will not always recognize others.
During lab tests subjects are known to have very high voltages of Electroencephalography (EEG) delta activity, an increase in muscle tone, and a doubled increase in heart rate if not more. Brain activities during a typical episode show theta and alpha activity when using an EEG. It is also common to see abrupt arousals from NREM sleeps that don’t progress into a full episode of a night terror. These episodes can include tachycardia.
There is a close association with psychopathologyormental disorders in adults that suffer from Sleep Terror Disorder. There may be an increased occurrence of Sleep Terror Disorder particularly with those that have suffered from Post-traumatic stress disorder or PTSD and Generalized Anxiety Disorder. It is also likely that some Personality Disorders may occur in individuals with Sleep Terror Disorder such as Dependent, Schizoid, and Borderline Personality Disorders are common. There have been some scores for depression and anxiety that have increased in individuals that have suffered from Sleep Terror Disorder. [2]
There is some evidence that a predisposition to night terrors and other parasomniac disorders can be passed genetically. . Individuals frequently report that past family members have had either episodes of sleep terrors or sleepwalking. In some studies a 10-fold increase of prevalence of the disorder in first-degree biological relatives, however the exact link to inheritance in not known.[2] In addition, some laboratory findings suggest that sleep deprivation and having a fever can increase the likelihood of a night terror episode occurring. [5] Special consideration must be used when the subject suffers from narcolepsy, as there may be a link between the disorders. There have been no findings that can be supported by evidence that shows a cultural difference between manifestations of Sleep Terror Disorder. It is thought that significance and cause of sleep terrors differ within cultures. Also, older children and adults provide highly detailed and descriptive images associated with their sleep terrors than younger children, who completely forget through amnesia or vaguely remember. Sleep terrors in children are also more likely to occur in males than females; As adults the ratio between sexes are the same. [2]
Though the symptoms of night terrors in adolescents and adults are similar, the Etiology, Prognosis, and treatment are qualitatively different. There is some evidence that suggests that night terrors can occur if the sufferer does not eat a proper diet, get the appropriate amount or quality of sleep (e.g. Sleep apnea), or is enduring stressful events in his or her life. Adult night terrors are much less common, and often respond best to treatments that rectify causes of poor quality or quantity of sleep. There is no scientific evidence of a link between night terrors and mental illness. There is some evidence of a link between adult night terrors and hypoglycemia.[6] According to Carranza and Dill (2004), some adult night terror sufferers share some characteristics with depressed individuals, for example, "inhibition of aggression, self-directed anger, passivity, anxiety, impaired memory, and the ability to ignore pain."[7]
The DSM-IV-TR diagnostic criteria for Sleep Terror Disorder requires recurrent periods where the individual abruptly wakes from sleeping with a scream (Criterion A), the individual experiences intense fear and symptoms of autonomic arousal (see Autonomic nervous system) such as increased heart rate, heavy breathing, and increased perspiration, (Criterion B), the individual cannot be soothed or comforted during the episode (Criterion C), the individual is unable to remember details of the dream or details of the episode (Criterion D), the occurrence of the sleep terror episode causes clinically significant distress or impairment in the individual's functioning (Criterion E), and the disturbance is not due to the effects of a substance or general medical condition (Criterion F). [8]
There is some indication that night terrors can result from being overtired, in which case interventions such as creating a bedtime schedule can increase the chances of restful sleep. If the night terrors are more chronic, however, some evidence suggests that the sufferer should be awakened from sleep just before the time when the terrors typically occur to interrupt the sleep cycle. In some cases, a child who has night terrors will require additional comfort and reassurance during the day and before bedtime. Psychotherapy or counseling can be helpful in many cases. Benzodiazepine medications (such as Diazepam) used at bedtime will often reduce the occurrence of night terrors; however, medication is rarely recommended to treat this disorder.[9]
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Sleep and sleep disorders
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| Stages of sleep cycles |
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| Brain waves |
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| Sleep disorders |
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| Daily life |
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Category:Parasomnias Category:Sleep disorders Category:Psychiatric diagnosis
