Sleep Terrors.

Sleep terrors, categorized under disorders of arousal, more prevalent in pediatric population, generally are self-limited but sometimes can persist or occur in adulthood. These are primed by factors enhancing homeostatic drive on backdrop of developmental predisposition and are precipitated by factors increasing sleep fragmentation resulting in dissociated state of sleep with some cerebral regions showing abnormal slow wave activity and others fast activity. This phenotypically evolves into abrupt partial arousal with individual arousing from N3 or N2 sleep with behaviors representing intense fear such as crying with autonomic hyperactivity. There is no recollection of the event, and lack of vivid dream mentation although fragmented imagery may be noted. Behavioral management is of prime importance including addressing precipitating factors, family reassurance, safety measures, and scheduled awakenings. Pharmacologic agents such as clonazepam and antidepressants are used infrequently in case of disruptive episodes.

Parasomnias and Associated Factors Among University Students: A Cross-Sectional Study in Saudi Arabia.

Background and aim Parasomnias are a group of sleep-related movements or emotions like sleepwalking, sleep talking, teeth grinding (Bruxism), nocturnal enuresis (sleep enuresis), sleep terrors (night terrors), sleep-related eating disorder (SRED), nightmare disorder, REM Sleep Behavior Disorder (RBD), and confusional arousals. Parasomnias are more common in children than in adults. This study aimed to estimate the prevalence of different parasomnias among university students in Saudi Arabia. Additionally, it aimed to study the relationship between different parasomnias and gender-associated sleep disorders, mental disorders, and other medical diseases, stress, substance use, and medications. Methods This study is a descriptive cross-sectional survey-based study. The target population for this study is university students from different regions of Saudi Arabia. Parasomnia was defined as having at least one of the 11 disorders (over the past six months). Data was collected through an online survey. The survey was distributed on different online platforms to collect data from other regions of Saudi Arabia. The study took place between August and November 2022. Results Among 1,296 participants, 934 (72.1%) were female, and 1,071 (82.6%) were aged 19-24 years. A total of 1054 (81, 3%) participants reported having at least one parasomnia disorder. The most prevalent parasomnias were sleep talking 656 (50.6%), nightmares 650 (50.2%), and confusional arousals 524 (40.4%). The least prevalent parasomnia was sleep-related eating disorder 98 (7.6%). Among participants, 580 (44.8%) had a family history of parasomnia, 439 (33.9%) were diagnosed with sleep disorders, 296 (22.8%) were diagnosed with mental illnesses, and 92 (7.1%) had other medical diseases. Conclusion Parasomnias are prevalent among university students in Saudi Arabia. Parasomnias were higher in female students and in students with a family history of parasomnia. Parasomnias in adults might be a chronic or recurrent disorder. Parasomnias are significantly associated with psychological stress, depression, and anxiety disorders.

Sleep Terrors: An Updated Review.

BACKGROUND: Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE: To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. METHODS: A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS: It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. CONCLUSION: Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.

Adrenergic reactions during N3 sleep arousals in sleepwalking and sleep terrors: The chicken or the egg?

To understand the mechanisms of N3 sleep interruptions in patients with sleepwalking episodes and/or sleep terrors (SW/ST), we evaluated whether autonomic reactions preceded or accompanied behavioural arousals from NREM sleep stage N3. In 20 adult patients with SW/ST and 20 matched controls without parasomnia, heart rate and pulse wave amplitude were measured beat-to-beat during the 10 beats preceding and during the 15 beats succeeding a motor arousal from N3 sleep. Respiratory rate and amplitude were measured during the same 25 successive beats. In patients with SW/ST, the N3 arousals were associated with a 33% increase in heart rate, a 57% decrease in pulse wave amplitude (indicating a major vasoconstriction), a 24% increase in respiratory rate and a doubling of respiratory amplitude. Notably, tachycardia and vasoconstriction started 4 s before motor arousals. A similar profile (tachycardia and vasoconstriction gradually increasing from the 4 s preceding arousal and post-arousal increase of respiratory amplitude, but no polypnea) was also observed, with a lower amplitude, during the less frequent 38 quiet N3 arousals in control subjects. Parasomniac arousals were associated with greater tachycardia, vasoconstriction and polypnea than quiet arousals, with the same pre-arousal gradual increases in heart rate and vasoconstriction. Autonomic arousal occurs 4 s before motor arousal from N3 sleep in patients with SW/ST (with a higher adrenergic reaction than in controls), suggesting that an alarming event during sleep (possibly a worrying sleep mentation or a local subcortical arousal) causes the motor arousal.

Effects of acupuncture therapy on 83 cases of infants with night terrors / 全日本鍼灸学会雑誌

[Objective] For six consecutive years, we investigated 83 cases of the effect of acupuncture therapy on children with night terrors.[Subjects and Methods] The number of subjects was 83 (38 boys and 45 girls, mean age: 2.2 ± 2.8 years old). Acupuncture therapy for infants was defined as pattern identification/syndrome differentiation and treatment. The acupuncture therapy used spoon needles and moxibustion; skin stimulation was applied to the acupuncture point. Infant needles in the Daishi style and moxibustion of the incense stick were used as a method to approach the hole. Therapeutic effect was judged by a self-written evaluation form certified by the Japan Society of Pediatric Acupuncture. One major item, "sleep disorder (broad sense of night terrors)," three minor items ('night terror' in a narrower sense), 'difficulty in falling asleep,' 'nocturnal awakening,' number of nocturnal awakenings at night, and satisfaction with acupuncture therapy in infants were investigated. Evaluations were made at the time of the first treatment and before the fifth treatment. In the statistical analysis, the change in the score of the evaluation slip and the number of partial awakenings were tested by the Wilcoxon signed-rank-sum test. The level of significance was set at 5%.[Results] Significant improvement was observed in the score for the major item, minor items, and number of partial awakenings. The degree of satisfaction was 90.4%.[Conclusion] It was suggested that acupuncture therapy in infants is effective for ameliorating symptoms of "sleep disorder."

Transient Central Sleep Apnea Runs Triggered by Disorder of Arousal in a Child.

ABSTRACT: We report the case of a 5-year-old girl with frequent nocturnal episodes of disorder of arousal (confusional arousals, sleep terrors, and sleep walking), occurring at the end of periods of slow wave sleep, followed by return to sleep accompanied by the occurrence of periodic breathing with a run of approximately 10 to 20 central events. The duration of the central events and oxyhemoglobin desaturation were both maximum at the beginning of each run and became progressively less prominent with the development of the sequences. Night episodes disappeared with bedtime clonazepam but behavioral problems occurred as a paradoxical response; thus, clonazepam was stopped. Sleep extension and melatonin were then started, which were followed by a reduction of night episode frequency and intensity. This observation appears to be the first report of central sleep apnea sequences triggered by parasomnia and, if confirmed by additional reports, it might be considered to be a possible new classification of "complex parasomnia."

Scalp and Source Power Topography in Sleepwalking and Sleep Terrors: A High-Density EEG Study.

STUDY OBJECTIVES: To examine scalp and source power topography in sleep arousals disorders (SADs) using high-density EEG (hdEEG). METHODS: Fifteen adult subjects with sleep arousal disorders (SADs) and 15 age- and gender-matched good sleeping healthy controls were recorded in a sleep laboratory setting using a 256 channel EEG system. RESULTS: Scalp EEG analysis of all night NREM sleep revealed a localized decrease in slow wave activity (SWA) power (1-4 Hz) over centro-parietal regions relative to the rest of the brain in SADs compared to good sleeping healthy controls. Source modelling analysis of 5-minute segments taken from N3 during the first half of the night revealed that the local decrease in SWA power was prominent at the level of the cingulate, motor, and sensori-motor associative cortices. Similar patterns were also evident during REM sleep and wake. These differences in local sleep were present in the absence of any detectable clinical or electrophysiological sign of arousal. CONCLUSIONS: Overall, results suggest the presence of local sleep differences in the brain of SADs patients during nights without clinical episodes. The persistence of similar topographical changes in local EEG power during REM sleep and wakefulness points to trait-like functional changes that cross the boundaries of NREM sleep. The regions identified by source imaging are consistent with the current neurophysiological understanding of SADs as a disorder caused by local arousals in motor and cingulate cortices. Persistent localized changes in neuronal excitability may predispose affected subjects to clinical episodes.

Bullying and parasomnias: a longitudinal cohort study.

BACKGROUND AND OBJECTIVES: Environmental factors such as serious trauma or abuse and related stress can lead to nightmares or night terrors. Being bullied can be very distressing for children, and victims display long-term social, psychological, and health consequences. Unknown is whether being bullied by peers may increase the risk for experiencing parasomnias such as nightmares, night terrors, or sleepwalking. METHODS: A total of 6796 children of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were interviewed at elementary school age (8 and 10 years) about bullying experiences with a previously validated bullying interview and at secondary school age (12.9 years) about parasomnias such as nightmares, night terrors and sleepwalking by trained postgraduate psychologists. RESULTS: Even after adjusting for pre-existing factors related to bullying and parasomnias, being bullied predicted having nightmares (8 years odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.44; 10 years OR, 1.62; 95% CI, 1.35-1.94) or night terrors (8 years OR, 1.39; 95% CI, 1.10-1.75; 10 years OR, 1.53; 95% CI, 1.18-1.98) at age 12 to 13 years. Especially being a chronic victim was associated with both nightmares (OR, 1.82; 95% CI, 1.46-2.27) and night terrors (OR, 2.01; 95% CI, 1.48-2.74). Being a bully/victim also increased the risk for any parasomnia at ages 8 or 10 years (8 years OR, 1.42; 95% CI, 1.08-1.88; 10 years OR, 1.75; 95% CI, 1.30-2.36). In contrast, bullies had no increased risk for any parasomnias. CONCLUSIONS: Being bullied increases the risk for having parasomnias. Hence, parents, teachers, school counselors, and clinicians may consider asking about bullying experiences if a child is having parasomnias.

Childhood parasomnias and psychotic experiences at age 12 years in a United Kingdom birth cohort.

STUDY OBJECTIVES: To examine associations between specific parasomnias and psychotic experiences in childhood. DESIGN: Birth cohort study. Information on the presence of frequent nightmares in children was obtained prospectively from mothers during multiple assessments conducted when children were aged between 2.5 and 9 y. Children were interviewed at age 12 y about nightmares, night terrors, sleepwalking, and psychotic experiences (delusions, hallucinations, and thought interference) occurring in the previous 6 mo. SETTING: Assessments were completed in participants' homes or a University clinic within the UK. PATIENTS OR PARTICIPANTS: There were 6,796 children (3,462 girls, 50.9%) who completed the psychotic experiences interview. MEASUREMENTS AND RESULTS: Children who were reported by their mothers as experiencing frequent nightmares between 2.5 and 9 y of age were more likely to report psychotic experiences at age 12 y, regardless of sex, family adversity, emotional or behavioral problems, IQ and potential neurological problems (odds ratio (OR) = 1.16, [95% confidence intervals (CI) = 1.00, 1.35], P = 0.049). Children reporting any of the parasomnias at age 12 y also had higher rates of concurrent psychotic experiences than those without such sleeping problems, when adjusting for all confounders (OR = 3.62 [95% CI = 2.57, 5.11], P < 0.001). Difficulty getting to sleep and night waking were not found to be associated with psychotic experiences at age 12 y when controlling for confounders. CONCLUSION: Nightmares and night terrors, but not other sleeping problems, in childhood were associated with psychotic experiences at age 12 years. These findings tentatively suggest that arousal and rapid eye movement forms of sleep disorder might be early indicators of susceptibility to psychotic experiences.

Sleep terrors antecedent is common in adolescents with migraine / O antecedente de terror noturno é frequente em adolescentes com migrânea

Migraines and sleep terrors (STs) are highly prevalent disorders with striking similarities. The aim of this study was to evaluate the effect of the antecedent of STs by comparing adolescents suffering from migraines with healthy controls in a large consecutive series. METHODS: All patients were subjected to a detailed headache questionnaire and were instructed to keep a headache diary during a two-month period. The age range was 10 to 19 years. The diagnosis of STs was defined according to the International Classification of Sleep Disorders. RESULTS: A total of 158 participants were evaluated. Of these participants, 50 suffered from episodic migraines (EMs), 57 had chronic migraines (CMs) and 51 were control subjects (CG). Participants who had a history of STs had significantly more migraines than participants who did not. CONCLUSIONS: Migraine is strongly associated with a history of STs in the adolescent population independent of demographics and pain intensity.

Migrânea e terror noturno (TN) são transtornos de alta prevalência que compartilham muitas similaridades. O objetivo desse estudo foi avaliar a ocorrência do antecedente de TN, comparando adolescentes com migrânea e adolescentes saudáveis. Métodos: Todos os pacientes foram submetidos a um questionário detalhado sobre sua cefaleia e foram instruídos a preencher um diário durante um período de dois meses. A idade dos sujeitos variou entre 10 e 19 anos. O diagnóstico de TN foi definido de acordo com a Classificação Internacional dos Transtornos do Sono. Resultados: Foram avaliados 158 sujeitos. Desses indivíduos, 50 apresentavam migrânea episódica, 57 migrânea crônica e 51 eram controles. Participantes que tinham o antecedente de TN apresentavam significativamente mais crises de migrânea do que aqueles que não tinham. Conclusões: Migrânea esteve fortemente associada ao antecedente de TN na população de adolescentes independentemente de variáveis demográficas e intensidade da dor.

Noite: escuridão sem tempo / Noche: oscuridad sin tiempo / Night: timeless darkness

Por meio da análise do material clínico de uma criança de quatro anos e de uma jovem de vinte e quatro, procuro desenvolver ideias a respeito das representações da noite e seus desdobramentos: insônia, pesadelos, terrores noturnos, angústias de morte. Analisando por um lado, a produção gráfica da criança e por outro, os sonhos da jovem, procuro estabelecer uma equivalência entre as diferentes formas de expressão que ambas encontram. Questões referentes ao tempo e atemporalidade do mundo psíquico são abordadas. Evidenciam-se situações de rivalidade fraterna, ataques ao corpo materno e configurações edípicas, vistos ora pelo prisma da menina, ora da moça, como se ambas teatralizassem a mesma personagem em momentos diferentes da existência.

La autora, por medio del análisis del material clínico de una niña de cuatro años y de una joven de veinticuatro, busca desarrollar ideas al respecto de las representaciones de la "noche" y sus desdobles: insomnio, pesadillas, terrores nocturnos y angustia de muerte. Por un lado, analiza la producción gráfica de la niña y, por otro, los sueños de la joven, buscando establecer una equivalencia entre las diferentes formas de expresión que ambas encuentran. En este trabajo se plantean cuestiones referidas al tiempo y a la intemporalidad del mundo psíquico. Se pueden evidenciar situaciones de rivalidad fraterna, ataques al cuerpo materno y configuraciones edípicas, todo eso visto ya sea o desde el prisma de la niña, o el de la joven, como si ambas mujeres teatralizaran al mismo personaje, pero en momentos diferentes de la existencia.

By analyzing the clinical samples of a four year-old child and of a twenty-four year-old woman, my attempt is to develop ideas in relation to night representations and its consequences, such as insomnia, nightmares, night terrors, and death anguish. While analyzing the child’s graphic production, on the one hand, and the young woman’s dreams, on the other, I try to establish a similarity among the different ways of expression used by both of them. Issues of the psychic world, related to time and to timelessness, are approached. Sibling rivalry situations become evident, as well as attacks to the mother’s body and oedipal configurations. These are viewed in the child and in the woman as if both play same character in different points in life.

Noite: escuridão sem tempo / Noche: oscuridad sin tiempo / Night: timeless darkness

Por meio da análise do material clínico de uma criança de quatro anos e de uma jovem de vinte e quatro, procuro desenvolver ideias a respeito das representações da noite e seus desdobramentos: insônia, pesadelos, terrores noturnos, angústias de morte. Analisando por um lado, a produção gráfica da criança e por outro, os sonhos da jovem, procuro estabelecer uma equivalência entre as diferentes formas de expressão que ambas encontram. Questões referentes ao tempo e atemporalidade do mundo psíquico são abordadas. Evidenciam-se situações de rivalidade fraterna, ataques ao corpo materno e configurações edípicas, vistos ora pelo prisma da menina, ora da moça, como se ambas teatralizassem a mesma personagem em momentos diferentes da existência.(AU)

La autora, por medio del análisis del material clínico de una niña de cuatro años y de una joven de veinticuatro, busca desarrollar ideas al respecto de las representaciones de la "noche" y sus desdobles: insomnio, pesadillas, terrores nocturnos y angustia de muerte. Por un lado, analiza la producción gráfica de la niña y, por otro, los sueños de la joven, buscando establecer una equivalencia entre las diferentes formas de expresión que ambas encuentran. En este trabajo se plantean cuestiones referidas al tiempo y a la intemporalidad del mundo psíquico. Se pueden evidenciar situaciones de rivalidad fraterna, ataques al cuerpo materno y configuraciones edípicas, todo eso visto ya sea o desde el prisma de la niña, o el de la joven, como si ambas mujeres teatralizaran al mismo personaje, pero en momentos diferentes de la existencia.(AU)

By analyzing the clinical samples of a four year-old child and of a twenty-four year-old woman, my attempt is to develop ideas in relation to night representations and its consequences, such as insomnia, nightmares, night terrors, and death anguish. While analyzing the child’s graphic production, on the one hand, and the young woman’s dreams, on the other, I try to establish a similarity among the different ways of expression used by both of them. Issues of the psychic world, related to time and to timelessness, are approached. Sibling rivalry situations become evident, as well as attacks to the mother’s body and oedipal configurations. These are viewed in the child and in the woman as if both play same character in different points in life.(AU)

Noite: escuridão sem tempo / Noche: oscuridad sin tiempo / Night: timeless darkness

Por meio da análise do material clínico de uma criança de quatro anos e de uma jovem de vinte e quatro, procuro desenvolver ideias a respeito das representações da noite e seus desdobramentos: insônia, pesadelos, terrores noturnos, angústias de morte. Analisando por um lado, a produção gráfica da criança e por outro, os sonhos da jovem, procuro estabelecer uma equivalência entre as diferentes formas de expressão que ambas encontram. Questões referentes ao tempo e atemporalidade do mundo psíquico são abordadas. Evidenciam-se situações de rivalidade fraterna, ataques ao corpo materno e configurações edípicas, vistos ora pelo prisma da menina, ora da moça, como se ambas teatralizassem a mesma personagem em momentos diferentes da existência.(AU)

La autora, por medio del análisis del material clínico de una niña de cuatro años y de una joven de veinticuatro, busca desarrollar ideas al respecto de las representaciones de la "noche" y sus desdobles: insomnio, pesadillas, terrores nocturnos y angustia de muerte. Por un lado, analiza la producción gráfica de la niña y, por otro, los sueños de la joven, buscando establecer una equivalencia entre las diferentes formas de expresión que ambas encuentran. En este trabajo se plantean cuestiones referidas al tiempo y a la intemporalidad del mundo psíquico. Se pueden evidenciar situaciones de rivalidad fraterna, ataques al cuerpo materno y configuraciones edípicas, todo eso visto ya sea o desde el prisma de la niña, o el de la joven, como si ambas mujeres teatralizaran al mismo personaje, pero en momentos diferentes de la existencia.(AU)

By analyzing the clinical samples of a four year-old child and of a twenty-four year-old woman, my attempt is to develop ideas in relation to night representations and its consequences, such as insomnia, nightmares, night terrors, and death anguish. While analyzing the child’s graphic production, on the one hand, and the young woman’s dreams, on the other, I try to establish a similarity among the different ways of expression used by both of them. Issues of the psychic world, related to time and to timelessness, are approached. Sibling rivalry situations become evident, as well as attacks to the mother’s body and oedipal configurations. These are viewed in the child and in the woman as if both play same character in different points in life.(AU)

Successful treatment of severe parasomnias with paroxetine in a 12-year-old boy.

Night terrors and somnambulism are parasomnias associated with non-REM sleep. Medical treatment is only considered in severe cases with persistent and extended symptoms where there is a high risk of self-injury. We report the case of a 12-year-old boy with severe night terrors and somnambulism whose symptoms completely remitted under medication with the selective serotonin re-uptake inhibitor paroxetine. Its impact on sleep remains unclear as we were not able to show any significant changes in the polysomnographic sleep macroarchitecture. Paroxetine might be an alternative to benzodiazepines or tricyclic antidepressants because it permits subchronic medication, necessitates little dose titration and is well tolerated, with few side-effects, and, in particular, has low sedating properties.