Today, we'll be right back. You may have heard of night terrors or know someone who experiences them. Unlike nightmares, which most of us have had, night terrors are much less common and they present very differently. They are essentially intense episodes that disrupt sleep both for the individual and for the family of that individual. And in today's show, I'm going to explain what night terrors are, what causes them, how they differ from nightmares and perhaps other sleep disturbances.
And I'll also cover some practical tips for managing night terrors if you or someone you know is affected by night terrors. So let's start with the definition. Night terrors, also called sleep terrors, are a type of what we call a parasomnia. So para means around, somnia, sleep. So it is a disorder that seems to occur around sleep, but not necessarily in sleep itself. because it's an unusual behavior that occurs during, essentially, the pseudo-state of wake and sleep.
And they typically happen from an injection out of deep non-REM sleep. And it is that transition between deep sleep up into light sleep, up into wakefulness, and you almost get stuck somewhere in the middle on the sort of 13th floor, as it were. And so firstly, it's important to know that when someone is having a night terror, they're not having a nightmare and they are not dreaming.
Because if someone comes out of a night terror and you ask them, what was going through your mind before I woke you up? They typically don't have anything to say because they weren't dreaming, because they weren't in REM sleep. They were coming out of deep sleep. And so nightmares, those are the things that happen during rapid eye movement sleep. But night terrors happen as we're coming out of deep non-REM sleep.
And these episodes of Night Terrorists, they're really quite frightening because they can involve screaming or sweating, they can involve sleepwalking, and they're essentially just... periods of really quite intense distress for the individual themselves and certainly anyone nearby. So if that's a bit of the definition that night terrors are coming from deep non-REM sleep, not dream sleep, they're not individuals having nightmares.
And they often involve really quite distressing behaviors of things like screaming. What are the prevalence rates? Well, it turns out that night terrors are relatively rare, especially compared to nightmares. And night terrors are most often seen in children. And about 1-6% of children will experience them at some point during their childhood.
And we see the greatest intensity of night terrors occurring somewhere between ages of 3 and 12 years old. And gradually, as people get older, the night terrors gradually dissipate. So as you get into adulthood, if you've been someone who has been having frequent night terrors as a child, you are far more unlikely to have them anymore, or at least have them at anywhere near the frequency rate. that you had when you are a child.
And in terms of a really discreet window, if you had to sort of focus it down, it seems to peak between the ages of three and five. And we think it's got something to do with a special window of brain development that is occurring there. And as I said, most children will outgrow night terrors even by adolescence as their sleep matures. And in adults, they are far... less common and they affect in fact less than 1% of the population.
And when adults experience them, they are often tied to stress and mental health conditions and certain medications as well. So that's a little bit about their prevalence. What are the consequences? What is the impact on daily life? Well, the impact of night terrors can vary depending on age and how often they are occurring. So for children, the disruption usually affects the family more than the child themselves. This is because the child will often have just no memory of these events.
however, will be typically really quite startled by the episodes because they involve the child in such extreme distress, such as screaming or thrashing. And goodness, to see a child in that kind of state, it leads to significant anxiety and distress for the parent the following day. The other thing in terms of the child themselves, if these night terrors are occurring quite repetitively and frequently each night,
It can interfere with the child's sleep. And here what I'm talking about is the continuity of their sleep or the efficiency of their sleep. And it can reduce that continuity because they're waking up so frequently. And as a consequence, that causes daytime fatigue. When they're not getting sufficient sleep, they become more irritable and they have more trouble in terms of concentration.
I would say however that adult night terrors, even though they are far less prevalent and far less frequent, they can have a bigger impact on daily life. and adults may have some awareness or fragmented memories of these episodes, and it can lead to things like embarrassment and distress. It can even lead to fear of going to sleep. And persistent night terrors in adults can cause chronic sleep disruption, which can affect overall well-being, cognitive function, and even mental health.
And of course, pragmatically, when you think about it, night time socially, as it were, night terrors can be challenging in a shared living situation, an assured sleeping situation. And that just only adds to the strategy. Now, it turns out that night terrors aren't night terrors aren't night terrors. What I mean by that is there are different types of night terrors.
Night terrors can differ depending on whether they occur in children or in adults. And for children, night terrors are typically isolated and they happen really quite sporadically and they happen with no clear pattern. They're often outgrown, as I said, by adolescence, and they are rarely linked to any underlying mental health issues.
parents listening to this you shouldn't worry just because your child is having a night terror it doesn't mean that there is anything certainly wrong with them doesn't mean that they're going through abnormal brain development it doesn't mean that they have any kind of mental health condition we don't see those strong associations However, in adults night terrors are often more complex.
and they can be connected very frequently to conditions like PTSD, post-traumatic stress disorder, as well as generalized anxiety or even sleep disorders. In fact, we see... higher rates of night terrors in individuals who suffer from sleep apnea. And adult episodes relative to children, they're usually much more intense as well and they last longer and therefore they probably require a much more multifaceted treatment approach. Alongside Podcast is Element, spelt L-M-N-T.
Element is a sugar-free electrolyte mix. And for me, it was the sugar-free part of that that made me start using it quite some time ago. Beyond having the electrolytes in the right balance, The other reason I'm a fan of Element is that it's scientific. And if you look at the people who created the company, you'll find some pretty heavy hitting physiology, biochemistry, and pharmacology knowledge that is baked into the product. and again all of that comes without any sugar
I am a devotee of their product. I really do use them. I know people will say that on these entries. I use it every single day for my workout. I put it in my protein shakes afterwards. I do use it. Also, by the way, Element has just recently brought back the chocolate medley range, which you can have essentially your electrolytes hot.
And in the trio of flavors, there is chocolate mint, chocolate chai, and also my favorite, chocolate raspberry. And by the way, I happily badgered them to agree to give you fine folk. a free sample pack with any purchase of Element. If you just use the link lmnt.com forward slash Matt Walker, that's lmnt.com forward slash. of Night Terrors, but let me give you some more specifics in terms of the key symptoms to look out for.
Night terrors stand out from nightmares because they don't involve vivid dream recollection, as we mentioned. And the key symptoms include sudden awakenings with intense reactions like intense sweating, a very rapid heartbeat, very rapid respiration, and usually loud screaming as well. And the person may appear confused or even panicked, and they will often struggle to recognize their own surroundings. They lose the sense of the context around them.
And of course, these symptoms can be problematic. You can think of the thrashing and the movement, the motor activity that occurs by way of that thrashing or even the sleepwalking. it can pose significant risk for physical harm. If the person for example bumps into objects or moves outside of their sleeping area you can imagine how potentially dangerous a set of steps is if you're sleepwalking. beyond the main symptoms of the distress and the anxiety.
screaming and the frenetic thrashing and the sleepwalking. Beyond those main symptoms, other signs of night terrors can occur and they can be especially persistent. Perhaps one of the most common is something I just touched on with children. This is sleep related amnesia, which is where the person retains little or no memory of the events, even if they seemed partially awake as they were happening.
And in fact, what's interesting is if you look at these studies where we bring people into the sleep laboratory and if they are frequently having these sleepwalking or sleep talking events, Because it's so frequent, you can bring them in with high probability that they will have one of those inside of the sleep laboratory. what we can see is that they are moving around as if they are consciously awake. They are typically repeating very rote behaviors.
Sort of like lifting a glass up to their mouth and back or looking around startled or moving their arms as if they're trying to flail and shake. But what's interesting is that the brainwave patterns that we're recording at that time... show signs of deep non-REM sleep. And as I said, it's this almost mixed state of consciousness. You're halfway between the trance and window of wakefulness and sleep.
So the brain is showing signs of these deep, slow brainwaves, yet the body is enacting some type of motor routines that are very indicative of wakefulness. And it's usually had together with this amnesia, with incoherent or nonsensical speech during these episodes. That's another dead giveaway if someone is sitting up in bed.
and they're staring at the wall almost as though they're startled, and they're mumbling with words and jumbled up speech patterns that don't seem to make any sense at all. That is a prototypical sign of one of these night terrors. And by the way, if it's your partner, for example, or your child, You can imagine how disorienting that can be. It's really very unsettling because all of a sudden the vessel in front of you is the person that you recognize, your child or your wife, for example.
but yet the behaviors and the words and the way that they're behaving is completely not consistent with who they are. It's another person entirely, it seems. That's why it's so unsettling for the person who is witnessing it. So then let's move on to the diagnosis. The diagnosis of night terrors starts with firstly understanding the individual's medical and sleep history.
So for children, diagnosis often relies on the observations from the parents and caregivers, since, of course, children themselves usually have no memory of those episodes. In adult cases or in severe cases, usually we will do a polysomnographic study. In other words, a sleep laboratory study, as I described. This overnight study will monitor the brainwave activity and the heart rate and the muscle movements, and that will identify underlying sleep disorders, not only things like sleep apnea.
but to identify the prototypical sleep terror attack. Now, I should also note that in rare cases, we will sometimes conduct something called a multiple sleep latency test or an MSLT. And that may be used not during the night time to assess the events themselves, but instead to assess the extent of daytime sleep impairment, specifically daytime sleepiness.
because these multiple sleep latency tests will have you trying to fall asleep and then stay asleep for, let's say, a short while, and then we wake you back up, and then we ask you to try to fall back asleep again, and then you sleep for a while, and then we wake you up, and we ask you to fall back asleep again, and then you sleep for a while, and we do that over and over.
Because in most people who are very well slapped, Once they have maybe one nap and they fall asleep and they wake up after a short while, it's very hard for them to fall back asleep because they've discharged all of that sleep pressure because they've been sleeping so well at night. But if you don't sleep well at night and you have excessive daytime sleepiness, you can fall back asleep time and time and time again across many hours.
And that's an indication for a potential connection to nighttime sleep disruption. A partner and sponsor of today's podcast is Shopify. Let me share the link right away. Shopify.com slash Matt Walker. As someone who spends his days researching sleep, the idea of selling merch felt Well, rather daunting. But I kept getting asked if I had t-shirts or gear. So I finally said, Okay, Matt, get your act together and give it a try. And we have them coming. But the big question was,
How on earth was someone like me, a scientist, going to get these items into your hands? Everyone said the same thing. Use Shopify. It turns out. Even me, an analogue man in a digital world, was able to do it without any learning curve. Shopify is the commerce platform behind millions of businesses around the world and 10% of all e-commerce in the U.S. From household names like Mattel and Gymshark to brands just getting started.
With hundreds of ready-to-use templates, you can build a really impressive online store that matches your brand style. Oh, and if you need artificial intelligence-powered help writing product descriptions or touching up images, Shopify's got that too. All of which is to say that if you're ready to sell, just try Shopify. So if you are interested, turn your business idea into reality with Shopify.
Sign up for your $1 per month trial and start selling today at shopify.com slash matt walker. Once more, that's shopify.com slash matt walker. What are the causes of night terrors? Turns out we don't fully understand the causes. They seem to result from some combination of genetics. from your environment and your physiological state of the body in terms of biological stress, as well as your mental state of chronic stress or anxiety.
Because first, we often find a pretty strong familial history of parasomnias, meaning these disorders around sleep, of which night terrors or sleep terrors are one of those things. So that strongly suggests that there is some type of genetic predisposition for developing these things called night terrors or sleep terrors. And when a child or an adult is undergoing higher levels of stress, that typically increases quite significantly the risk of having these night terrors or these sleep terrors.
For adults, as I mentioned, if they have what we call comorbid mental health conditions, if they have things like depression or anxiety, or bipolar disorder, those things will also increase the risk of having these night terrors. I should also probably note that things like alcohol for adults will increase the probability and when we have adults in the clinic who typically have highly prevalent or very frequent night terrors.
A reduction or an abstinence in terms of alcohol is typically recommended. The final thing, is sleep deprivation. That if you are undergoing a debt in terms of your sleep, then that also significantly increases the likelihood of these sleep terror episodes occurring. Which then brings us on to treatment options. For children night terrors usually don't require treatment unless they are really quite severe and very very frequent. Instead, it's really all about focusing on good sleep hygiene.
Things like a consistent bedtime routine, a quiet and dark sleep environment, and a cool sleep environment. All of those things can really help stabilize sleep. And when you stabilize sleep, you reduce the likelihood of the night terror. In adults where you have more severe cases of night terrors,
Treatment may include things like behavioral therapies such as cognitive behavioral therapy for insomnia to manage underlying anxiety and stress. You'll remember that anxiety disorders increase the likelihood of these sleep terrors. and the psychological state of stress increases it, and therefore working on those two things to bring them back down into manageable levels, therefore brings back down the likelihood of having the night terrors.
Another interesting technique that has been used, and there is some actually scientific data behind it, It's what we call scheduled awakening treatment. and this is where the person is briefly woken up before the typical onset of a night terror. and that can sometimes prevent the episode. So you have these staggered awakening thresholds if it's really severe. And by artificially terminating sleep, you're almost trying to just keep that night terror from manifesting.
In very rare cases, I should say medications like benzodiazepines or low-dose antidepressants may be prescribed if you look at the literature. Again, Here on this show, we are not medically prescriptive. We are simply scientifically descriptive. And in terms of the literature, you can see some of these treatment approaches like benzos or low-dose antidepressants.
that have been prescribed. Although, as I said, especially because of the side effects of things like benzodiazepines, they are typically a last resort due to the side effects. What about future treatments and research? Well, research into night terrors, it's growing, particularly in our understanding of the genetic and the neurological factors.
And we're still trying to explore how sleep stages are regulated in individuals with night terrors and whether therapies that can help stabilize deep sleep. Because don't forget we mentioned at the start that these night terrors are happening as you're sort of getting artificially ejected out of deep sleep and you're racing up to wakefulness, which is something that you would almost never naturally do from deep sleep.
And this gets you stuck on that sort of mystical 13th floor stuck between the basement and the penthouse. and therefore, as a consequence, trying to find ways to, once we get you into deep sleep, keep you in that deep sleep in a stable fashion before you're naturally ready to exit it back up into the lighter stages of sleep. in a normative way rather than going into deep sleep and then being quickly injected out, going up into wakefulness, therefore having one of these night terrors.
And so I think there are possibilities. of methods such as non-invasive brain stimulation, things like transcranial direct current stimulation are on the event horizon certainly for optimizing sleep in many conditions and I think this could be one of them. And then, as I said, as we start to understand the genetics, can we develop treatments based on the genetics and what those genes are doing that tries to placate the prevalence of these night terrors? So...
There you have it. In summary, night terrors are essentially a complex sleep disorder and it primarily affects children and it dissipates as age progresses. Doesn't mean though that it doesn't occur in adults too. It does. and the adult occurrence often comes with many more challenges too.
And it's also really important, again, to reference the fact that night terrors are not nightmares. Night terrors are not coming from dream sleep. It's not a child or an adult having a bad dream. They are having a night terror. and they typically have no memory of anything that was going on in their head beforehand or anything that they were doing during the occurrence.
And whilst most children outgrow it and therefore they never require any treatment, adults, based on the severity of the night terrors, they may require some forms of treatment and that can include certain types of medication. The management goes beyond just those medications though, and it's really about promoting optimal sleep routines. trying to practice all of those things of sleep hygiene, regularity, things like getting enough darkness at night.
trying to keep your bedroom cool, staying away from alcohol and excessive caffeine, and also not staying in bed awake for too long. All of these things can help try to lessen that because it improves the quantity and the quality of sleep. So I hope that's been a helpful, at least, exploration into these things called Night Terrors. They are fascinating and they are an important aspect of awareness, I think, throughout the general public. There are so many misconceptions around night terrors.
All of which is to say, you can see why sleep, gosh, it's such a delicate balance, isn't it? And any disruptions that occur can create these. really quite peculiar conditions like night terrors. And to me, it just reminds me of the fragility or at least the complexity of this thing that we call a night of sleep architecture. And with that, I will simply say until next time, sleep well, be well, and thank you so much for listening. Take care.