Q. What suggestions do you have for night terrors? I have an 11-year-old male, bipolar client who has terrible night terrors that includes screaming, yelling, hitting, etc. Any advice will help! It has gotten to the point where neighbors are calling the police from all of the yelling in the middle of the night. Should he be woken up? Or should he sleep through it?

A. Night terrors or sleep terrors, as you know, are arousal disorders that occur during stage 3 and stage 4 (delta) sleep, usually during the first 3 hours of the night. The episode typically begins with a loud cry, and the onset of intense anxiety. The typical episode lasts about 6 minutes, and attempts to awaken the individual may lead to disorientation.

Usually, the sufferer calms down quickly after the episode has run its course, and returns to sleep [see Reite et al, Evaluation & Management of Sleep Disorders, 2nd ed., 1997]. The diagnosis of night terrors is not always clear-cut, and in doubtful cases, a neurological evaluation and/or polysomnogram may be warranted; e.g., sometimes apparent night terrors may actually be due to a seizure disorder (Lombroso et al, Epilepsia 2000 Sep;41(9):1221-6) or be related to sleep-disordered breathing (Guilleminault et al, Pediatrics 2003 Jan;111(1):e17-25).

The hitting you describe might point to another sleep disorder called REM (rapid eye movement) sleep behavior disorder (REMSBD), in which sufferers basically act out the movements of their dreams; however, this would be rare in a child, and is usually seen in men in their 60s or 70s. Most children with sleep terrors will outgrow them with time; however, if this child's problems are literally waking the neighbors, I would recommend an evaluation by a sleep disorders specialist ASAP.

Reite et al report that sleep terrors in adults may respond to brief psychotherapy--I'm not sure that is true in children, but it might be considered. Medications ranging from benzodiazepines to dopamine agonists might be useful, but obviously, these have side effects as well. I would therefore start by referring this child to a specialist in sleep disorders. In the mean time, if his behaviors are causing huge problems, a short course of treatment with a low dose of a benzodiazepine might be considered by the child's pediatrician, until a definitive diagnosis and treatment regimen can be determined.

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July 2003

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