Like clockwork, every night at 2 a.m. the house would ring out with gasps for air, cries for help, and screams. My parents, all too familiar with these frightening sounds, would brace themselves for what would be one of many sleepless nights. Those nights filled with terrifying images and haunting sounds never went away for me.
Fourteen years later, I found myself within the confines of the Sleep Disorder Institute in New York, looking for answers to why I still wake myself up screaming in terror.
Night Terrors Exposed
The rare sleep disorder goes by many names: night terrors, sleep terrors, pavor nocturnus, or AXIS I: 307.46 (The DSM’s code). It remains a medical mystery. What medical researchers do know is that night terrors are caused by an over-arousal of the central nervous system (CNS) during sleep. In children, this may be the result of the CNS still maturing — it has long been believed that the CNS’s maturation process ends in early childhood (although several recent studies suggest it may continue to develop through around age 25).
They also have been able to isolate when night terrors occur in the sleep cycle. Typically, these sleep episodes occur during the transition from stage 3 non-rapid eye movement (REM) sleep to stage 4 non-REM sleep. During stage 3, delta waves are produced from the brain and the waves gradually become slower as the sleep cycle begins. This is also the point in the night where a sleeper’s heart rate, blood pressure, and arousal tend to decline — and, perhaps counter intuitively, when night terrors are most likely to occur.
The Profile Of A Parasomniac
Occasionally as an adult, for days on end, months at a time, I wake to find myself in a state of panic, clutching my chest, gasping for air, drenched in sweat. This is typical of those who suffer night terrors; most report some or all of the following: tachycardia (increased heart rate), tachypnea (increased breathing rate), and sweating during episodes.
Night terrors are rare but are more common in kids, especially those who are overtired or ill, stressed, or fatigued, taking a new medication, or sleeping in a new environment or away from home. “Three to six percent of children, between the ages of 4 to 11 years old, get night terrors,” says Donna Housman, a clinical psychologist in Weston, Mass. “It’s a scary thing for parents.” About 80 percent of kids who have night terrors have a family member who also experienced them, or sleep walking, indicating there might be a genetic component.
One family that has had their share of sleepless nights are the Hurds, in Burleson, Texas. Tiffany Hurd has a family history of various arousal disorders including sleep terrors, sleepwalking, and various other “parasomnias.” (Parasomnia is an umbrella term used to describe sleep disorders that include abnormal movements, behaviors and emotions during sleep.) Hurd says that both she and her sister Trista suffered “pure terror” at night when they were young; her brother sleepwalked.
Hurd’s two children, daughter McKenzie, 10, and son Maverick, 9, both suffered from night terrors from an early age, initially leaving Hurd feeling helpless. “[McKenzie] started having them when she was 2 and a half years old, and it was terrifying because we didn't know what was going on,” she says. “We thought she woke up from a bad dream and was throwing a fit.” They feared McKenzie’s night terrors would lead to self-harm; even after her mother tried to console her, she would continue to scream and hit her bed.
Night Terrors Vs Nightmares
Night terrors are often mistaken for nightmares, but doctors warn parents that there are telltale signs that can help distinguish the two. Nightmares often occur during the second half of the night when dreaming is most intense during REM sleep. They are “horrific dreams that we recall after awakening, and originate from dream sleep, so dream images are vivid and specific,” says Dr. Peter Fotinakes, medical director of St. Joseph Hospital's Sleep Disorders Center in Orange County, Calif. Night terrors on the other hand, are often not remembered on waking. That’s because in most cases, non-REM dreams (such as night terrors) primarily consist of brief, fragmented impressions that, compared to REM-state dreams (such as nightmares), are less emotional and less likely to involve visual images.
Despite the common belief that children just “grow out of it,” sleep terrors can persist well into adulthood. Dennis Palumbo, a psychotherapist in Los Angeles, Calif., has several adult patients who report night terrors. He believes more adults are suffering from chronic fatigue and emotional fatigue, which may account for the upsurge in sleep episodes he’s seen in his private practice. Anxiety suppressed during work life, or deep-seeded issues, takes a toll on a patient’s sleep quality.
The literature on night terrors in adults is scarce since the parasomnia is commonly associated with children. The American Academy of Sleep Medicine estimates 6.5 percent of all children are affected by night terrors, followed by 2.2 percent of adults, while it remains a rare occurrence for those over the age 65. In adulthood, the sleeping disorder is suspected to be triggered by a strong genetic and family link, but there has yet to be clear empirical evidence to establish this link.
A 2014 study published in the journal Sleep found although nightmares and night terrors are a normal part of childhood development, it may also be an early indicator of mental health issues in adolescence. Children who have a frequency of nightmares before age 12 are about four times more likely to have psychotic experiences during adolescence, while those who have experienced night terrors in this group double the risk of these problems, according to the study. The researchers suggest nightmares or night terrors that occur over a prolonged period of time that persist into adolescence can be an early indicator of something more significant later in life, but that has yet to be known.
Adult Night Terrors: My Case Study
After suffering from night terrors throughout my adolescence and into young adulthood, I decided to get some answers. A self-diagnosis wasn’t good enough; I needed professional confirmation as to why my sleep had been plagued by this disorder. Feburary of last year, I found myself seated inside the office of Dr. Maha Ahmad, the associate director and attending physician for adults and children at the Sleep Disorders Institute.
As I twiddled my thumbs, I answered Ahmad’s row of evaluation questions with either “yes,” “no,” or “I’m not sure.” I had no history of depression or anxiety — known to trigger night terrors — nor have I, or anyone in my family, ever sleepwalked. Based on my answers, Ahmad was convinced my sleep terrors are benign, and told me that they’re not caused by a psychological issue. However, she did want to delve deeper into the root of my sleep terrors, and so suggested that I sleep overnight at a lab being observed by sleep specialists.
I agreed, and on the Friday night of my planned sleep study, I hesitantly walked into a different wing of the Sleep Disorders Institute lab, where I was greeted by lab personnel. They escorted me down a long, narrow hallway and soon I was staring at an overwhelmingly bright red digital clock next to “Room 1.” I anxiously entered what was to be my bedroom, and I was quickly overcome with a feeling of calmness and familiarity—the laboratory bedroom felt, more or less, like a standard hotel room.
A sleep technician joined me to apply the two dozen electrodes — small metal sensor discs —to my body. These sensors would monitor my body’s activities while I slept. Nine out of the 24 wires were gently placed on my head, followed by flexible elastic belts around my chest and abdomen to measure my breathing. Throughout this process, a ringing noise filled my ears as I began to feel light-headed and dehydrated — I was already anxious about what the night would bring.
After being hooked up to two dozen wires, a finger pulse oximeter, and soft silicone plugs in my nostrils — which act as as a device to detect breathing difficulties — I received the go-ahead from the sleep technician to fall asleep. Despite the electrodes and wires all over my body, I assumed my customary sleep position on my back, and closed my eyes to get what I hoped would be a good night’s sleep. Two hours or so into sleep, I was still only half awake and half asleep.
But the next thing I knew, I was being awakened by the sleep technician who said, “Good morning Liz, the sleep study is now over,” via intercom. It was 5:50 a.m. Saturday morning, and I could only think one thing: “I want more sleep.” The analysis and interpretation of the sleep study would be evaluated by a sleep specialist who reviews 1000 pages of data including: brain waves, muscle movements, and eye movements. My results would be made available in three to seven days.
Though day to day the night terrors don’t keep me from living a normal life, the long-term effects of the disorder may be cause for concern. The National Sleep Foundation suggests a normal, healthy adult needs seven to nine hours of sleep each night, and untreated sleep disorders that keep you from it can raise the risk of heart disease, high blood pressure, stroke, and other medical conditions.
So I was pleasantly surprised when, two days later, Ahmad called to tell me that I had “beautiful sleep architecture.” Sleep architecture is based on the percentage of time a sleeper spends in each stage of sleep, and it’s a model used to determine if an individual is getting enough REM sleep. Atypical sleep architecture is usually exhibited when patients experience frequent arousals — like those seen in night terrors — during sleep, that cause a disturbance in the normal distribution of sleep stages. An insufficient amount of REM sleep that can cause health issues ranging from depression to a decrease in cognitive skills.
What Ahmad did tell me was that they had seen an abrupt change from a deeper stage of sleep to a lighter stage during Stage N3, or slow-wave sleep. In this stage, parasomnias such as night terrors can occur, due to the abnormally high levels of brain activity during the sleeper’s mixed state of being both asleep and awake. The reasoning behind these arousals are not entirely clear, Ahmad said, but they can be triggered by sleep deprivation, stress, fever, a new sleep environment, or even run in the family. Ahmad told me it was pretty benign and the National Sleep Foundation agrees: sleep-related behaviors due to arousal disorders are not considered medically significant, nor do they indicate psychiatric or psychological problems.
But the truth is that doctors have yet to determine the underlying mechanism in these frequent night disturbances or why they occur during the deepest stage of sleep. Night terrors are underreported — many who suffer simply accept the disorder as a part of their life, and many others are children, who have to rely on parents to report any problems. As a result, extremely limited data is available. And the bottom line is good sleep hygiene may not be enough to ward off these bouts of terror that fill people with fear and horror in their most vulnerable act of all, sleep.
My Life With Night Terrors, One Year Later
Now a year has passed since my sleep study, and although I don’t always get a good night’s rest, the night terror episodes have slowly subsided. There is no magic bullet for this sleeping disorder, but there is the modification in lifestyle such as diet, exercise, and time management. Practicing yoga four to five times a week before bed has helped keep my episodes at bay, as I am able to rid of any stress and anxiety I have built up from the day.
Sometimes reducing the occurrence of night terrors may be as simple as taking a deep breath in and a deep breath out.