What causes night terrors in adults

What are Night Terrors?

Night terrors, also known as sleep terrors or abrupt arousal disorders, are episodes of screaming, intense fear, and flailing while still asleep. Unlike nightmares, which occur during REM sleep and are remembered upon waking, night terrors happen during the deeper stages of non-REM sleep (specifically stage N3). This means that individuals experiencing night terrors often have no memory of the event upon waking, or only recall fragmented images or feelings of fear.

Causes of Night Terrors in Adults

While night terrors are more commonly associated with children, they can also affect adults. The underlying causes in adults are often multifactorial and can include:

1. Psychological Factors:

Stress and Anxiety: High levels of stress and anxiety are among the most frequent triggers for night terrors in adults. The mind may struggle to fully switch off during sleep, leading to a physiological arousal response that manifests as a sleep terror.

Trauma and PTSD: Individuals with post-traumatic stress disorder (PTSD) may experience night terrors as a symptom of their condition, often linked to recurring traumatic memories.

2. Sleep Deprivation and Irregular Sleep Schedules:

Lack of Sleep: Insufficient sleep can disrupt the normal sleep architecture, making the body more prone to entering deeper sleep stages more abruptly and increasing the likelihood of parasomnias like night terrors.

Shift Work and Jet Lag: Irregular sleep-wake cycles caused by shift work or frequent travel across time zones can throw off the body's internal clock, leading to sleep disturbances.

3. Medical Conditions:

Fever: In some cases, a high fever, particularly in adults, can trigger night terrors.

Sleep Apnea: Obstructive sleep apnea (OSA) is a condition where breathing repeatedly stops and starts during sleep. The body's struggle to breathe can lead to abrupt awakenings and arousal states that can manifest as night terrors.

Restless Legs Syndrome (RLS): While not a direct cause, the discomfort and urge to move associated with RLS can disrupt sleep and potentially contribute to night terrors.

4. Medications and Substances:

Certain Medications: Some medications have been linked to an increased risk of night terrors. These can include certain antidepressants (especially SSRIs), stimulants, and medications used to treat high blood pressure or asthma.

Alcohol and Drug Use: Excessive alcohol consumption, especially before bedtime, can disrupt sleep patterns and lead to fragmented sleep, increasing the chance of night terrors. Withdrawal from certain substances can also be a trigger.

5. Other Sleep Disorders:

Other Parasomnias: Night terrors can sometimes co-occur with other parasomnias, such as sleepwalking or REM sleep behavior disorder.

Distinguishing Night Terrors from Nightmares

It's crucial to differentiate night terrors from nightmares. Nightmares are vivid, frightening dreams that occur during REM sleep and are usually remembered upon waking. The person experiencing a nightmare can often recall the content of the dream. In contrast, night terrors happen during deep non-REM sleep. The person may sit up, scream, thrash, sweat, and appear terrified, but they are not truly awake and typically have no memory of the event afterward. If awakened, they are often confused and disoriented, rather than fully alert.

When to Seek Medical Advice

While occasional night terrors may not require medical intervention, persistent or severe episodes in adults warrant a consultation with a healthcare professional. This is especially important if the night terrors are accompanied by other symptoms such as:

• Excessive daytime sleepiness
• Snoring or pauses in breathing during sleep
• Frequent awakenings
• Significant distress or fear that impacts daily life
• Concerns about safety due to thrashing or movement during sleep

A doctor can help identify underlying causes, such as sleep disorders or medication side effects, and recommend appropriate treatment strategies, which might include cognitive behavioral therapy for insomnia (CBT-I), stress management techniques, or adjustments to medication.