What Causes Adult Night Terrors and How to Prevent Them?

What Are Night Terrors?

Night terrors are a type of sleep disturbance characterized by violent movements during sleep, such as kicking, thrashing, screaming or sitting up in bed. Night terrors occur during the first few hours of the night, during deep, slow-wave sleep, a non-rapid eye movement (NREM) sleep stage. Most people who experience night terrors don't remember them when they wake up.

Night terrors can put you or your partner at risk of physical injury. People experiencing night terrors can harm themselves by falling out of bed or bumping into nearby objects. You can harm your partner with your intense movements if they're beside you or try to force you awake.

Night terrors can also disrupt sleep, leading to daytime fatigue and sleepiness. If your night terrors are frequent, they can lead to chronic sleep deprivation, which impacts your daytime functioning, overall health and quality of life.

Can Adults Have Night Terrors?

Yes, adults can have night terrors, but they're more common in kids. A study in the Journal of Clinical Sleep Medicine found that it occurs in 6.5% of children, with a "mean age" of 10.8 years. Meanwhile, the prevalence of sleep terrors in adults is about 1% to 2% of the general population.⁽¹⁾

What Causes Night Terrors in Adults?

The most common causes or triggers of adult night terrors include stress, post-traumatic stress disorder (PTSD), sleep disorders like obstructive sleep apnea (OSA) or periodic limb movement disorder (PLMD), alcohol, sleep deprivation, a disrupted sleep schedule, certain medications, fever and genetics.

Let's explore each of them:

• A disrupted sleep schedule can trigger night terrors by destabilizing your transition through the different sleep stages, including when you come out of deep non-REM sleep, which is when sleep terrors usually occur.

• Stress triggers night terrors by activating your central nervous system and disrupting your sleep architecture, leaving your brain trapped between deep sleep and wakefulness. Stress also heightens norepinephrine levels, which results in sweating, an increased heart rate, and tense muscles, all associated with night terrors.

• PTSD, a mental health disorder, affects how well your brain processes emotions and memories during REM sleep. This, in turn, affects the entire sleep cycle, causing hyperarousal during non-REM sleep, when night terrors usually happen. This hyperarousal leaves your brain in a mixed state of unconsciousness and wakefulness, triggering night terrors.

• Other sleep disorders, like OSA or PLMD, can lead to sleep disorders because they disrupt sleep and increase arousal. Sleep apnea causes breathing pauses, while PLMD causes involuntary movements, both of which disrupt sleep.

• Drinking alcohol can lead to night terrors because it also disrupts sleep. It reduces time spent in restorative rapid eye movement sleep and increases time spent in non-REM sleep. Alcohol can also heighten nerve activity, which increases hyperarousal. This creates conditions where sleep terrors are likely to occur.

• Sleep deprivation can trigger night terrors because when you finally hit the sack, your brain dives into deep sleep more intensely and quickly than it normally does. This is called "sleep rebound," and it increases the likelihood that your brain will get stuck between sleep and wakefulness, where sleep terrors occur.

• Certain medications like beta-blockers for hypertension, benzodiazepines, antidepressants like selective serotonin reuptake inhibitors (SSRIs), some antihistamines, and dementia medicines like donepezil can trigger night terrors.

• Fever can trigger night terrors because it increases body temperature, which disrupts your sleep cycle and causes you to spend more time in slow-wave sleep, where night terrors happen. (It can also cause fever dreams, which often have more vivid, intense and emotionally negative content than normal dreams.)

• Genetic factors can influence night terrors in adults. One study published in the Journal of Clinical Sleep Medicine found that the HLA DQB1*05:01 allele was present in 41% of participants with NREM parasomnias, including night terrors and sleepwalking, compared with the reference population.⁽²⁾

The common denominator between most of these triggers is disturbed sleep, making it one of the primary causes of night terrors.

What Are the Symptoms of Night Terrors in Adults?

Several symptoms indicate night terrors in adults, which can be quite distressing for both the person experiencing a night terror episode and the witness.

Here they are:

• You might suddenly jolt awake, feeling scared for no apparent reason.

• You might feel inexplicably confused or intensely scared when you wake up.

• You might wake up with your heart racing, sweating profusely and breathing heavily.

• You might see your partner sitting up in bed, eyes open and pupils dilated.

• You might hear your partner suddenly scream or shout.

• You might hear your partner crying or talking in their sleep.

• You might see your partner thrashing about in bed or flailing their arms and legs.

• You might see your partner's body become tense or rigid during a sleep terror episode.

• Rarely, you might see your partner jump out of bed and start walking around or out of the bedroom.

• If you try to wake the person experiencing a night terror, you might find them extremely difficult to awaken.

How to Prevent Night Terrors in Adults?

Preventing night terrors in adults involves lifestyle changes, practicing good sleep hygiene, stress management and therapy.

Here are some strategies to consider:

• Maintain a consistent sleep schedule by going to bed and waking up at the same time every day. This helps regulate your internal body clock, lowering your risk of sleep disruptions, which can trigger night terrors.

• Manage stress with a relaxing bedtime routine that includes activities like meditation, deep breathing or yoga. Remember that stress can lead to night terrors by triggering your central nervous system and disrupting your sleep patterns.

• Avoid stimulants like caffeine and alcohol in the hours close to bedtime. Caffeine and alcohol can disrupt the sleep cycle, increasing your risk of night terrors.

• Ensure your bedroom is cool, dark and quiet. The best sleeping environment is a relaxing one. If you have little or no control over the temperature in your bedroom and external light and sound sources, invest in sleep accessories. Try cooling bedsheets, a 100% blackout sleep mask, earplugs or a white noise machine to upgrade your sleep environment.

• Address any underlying sleep disorders that might be triggering night terrors. If you suspect you have them, consult a sleep doctor for proper diagnosis and treatment. They might ask you to keep a sleep diary to track your sleep patterns and identify contributing factors, such as stress or fatigue. Your partner can help by recording when sleep terror episodes start and end, and what you do during them.

• Don't eat large meals right before bed. You should also be aware of what not to eat before bedtime, such as spicy foods and sugary snacks. These can cause discomfort, disrupt sleep, and increase your risk of night terrors.

• Consider therapies such as cognitive-behavioral therapy (CBT) and imagery rehearsal therapy (IRT). CBT can help you address the underlying issues and behaviors that cause night terrors. IRT helps rewrite negative dreams associated with night terrors.

• Your medications might also be contributing to night terrors. Ask your doctor to review your medications to determine if adjustments can be made or if there are any alternatives.

It goes without saying that if your night terrors become frequent, cause you physical harm and lower your daily quality of life, you need to consult a healthcare provider.

Should I Wake My Partner Up if They Are Having a Night Terror?

No, you shouldn't wake your partner if they are having a night terror.

Waking someone up during a night terror can potentially worsen the episode. It might intensify the fear and agitation that they're already experiencing.

They might inadvertently physically harm you or themselves if you startle them while waking them up. Remember that night terrors involve intense movements.

If you're successful in waking someone experiencing a night terror, they might wake up confused or disoriented. Keep in mind that they're partially asleep during an episode.

What Should I Do if My Partner Is Having a Night Terror?

The first thing you should do if your partner is having a night terror is to stay calm. It can be alarming to witness someone having a night terror because it can look like they are suffering.

Instead of shaking them awake, try speaking softly and calmly, using soothing phrases such as "You're safe" or "Everything will be alright." Remove any sharp objects from their vicinity. They might get out of bed and move around. If this happens, gently guide them back to bed.

Finally, let them know what happened when they wake up so they can take steps to prevent it from happening again. Remember, they won't usually remember the sleep terror episode.

The best thing to do when your partner is having a sleep terror is to wait it out. Night terrors usually resolve on their own.

Are Night Terrors the Same As Nightmares?

No, night terrors aren't the same as nightmares. Nightmares and night terrors differ in frequency, the sleep stage at which they occur, the behavior that accompanies them, and whether you remember them.

Nightmares are common in adults, while adult night terrors are less so. Nightmares typically occur during REM sleep. Adults experience night terrors during NREM sleep. Nightmares are bad dreams that cause negative emotions like fear, sadness or even disgust upon awakening. Night terrors involve intense physical movements and vocalizations while you are still partially asleep. People usually remember their nightmares when they wake up, but they won't remember their night terrors.

Conclusion

Adult night terrors tend to be more distressing for those who witness their partner having an episode. The intense movements, screaming, or crying aren't a pretty sight, and most people who have sleep terrors won't even remember having them when they wake up.

Night terror causes include stress, other sleep disorders, medications, and disrupted sleep patterns. Luckily, you don't have to suffer in silence; you can use preventive strategies such as making healthy lifestyle changes, managing stress, and addressing underlying sleep disorders.

If your night terrors persist or become more frequent and severe, consult your doctor. They can identify any underlying health issues and prescribe treatment, which might include therapy.

Have you or someone close to you experienced night terrors? Share your experience and tips below to help others deal with this challenging parasomnia.