Night terrors

Sleep terrors (ST) , also known as night terrors or pavor nocturnus, are conditions characterized by a sudden and unexpected arousal from stage N3, with an abrupt scream and behavioral manifestations of intense fear. They are associated with intense autonomic and motor symptoms, such as crying or screaming. These events can be dramatic and disturbing to the family, yet the patient may be unfazed by the events. The child cannot be consoled or woken and typically has a partial or complete amnesia of the episodes the next day [1, 47]. Prevalence of ST varies with age from 6.5 % in children to 1 % in the elderly [31].

Sleepwalking (SW ) is an arousal disorder culminating in walking around in an altered state with impaired judgment. Sleepwalking occurs most often out of stage N3 sleep and during the first third of the night. SW is an expression of simultaneously activated states of (partial) sleep and (partial) wakefulness, a complex dissociated state, with clinical consequences [48]. Prevalence in childhood is as high as 17 %, with a peak age at 12 years. Sleepwalking typically decreases in frequency until adulthood, but 3 % of adults continue to sleepwalk [49]. SW needs to be differentiated from nocturnal seizures. Safety and legal implications have to be addressed. It is important to make the bedroom as safe as possible to minimize the risk of injury, by sleeping on the ground floor, removing obstructions in the bedroom, and closing doors and windows [50]. Sometimes, SW can become crippling because of its frequency (several times a week or a night), because of the risks associated with the behavior (going outside, manipulating sharp objects, etc.), or violence (throwing objects, using weapons, etc.) or because of its consequences on everyday quality of life (sleepiness, fatigue, insomnia, anxiety, and depressive symptoms). In these situations, treatment is required (Fig. 6.1). These include sleep hygiene, securing the environment for safety, reduction of alcohol consumption, and treatments of precipitating factors like OSA, PLMS , or anxiety that could exacerbate episodes. No large controlled trials of drugs have been conducted in SW. Tricyclic antidepressants or benzodiazepines can be used as good treatment options. If pharmacological approaches are warranted, regular follow-up is recommended to determine continued need for management and then to safely taper or discontinue the medication in a manner that will not result in withdrawal.

Psychotherapy may also be initiated to improve anxiety and sometimes insomnia [51].