Night terrors and recurring nightmares

Specialty: Pediatrics.

• Non-REM awakening parasomnia
• childish nightmares
• arousal disorders

Why it occurs

• Immaturity of the central nervous system and sleep pattern (difficulty in making the smooth transition between phases of deep non-REM sleep and more superficial phases)
• Chronic sleep deprivation or extreme physical fatigue (accumulated fatigue increases the proportion of deep delta sleep, facilitating the onset of terrors)
• Fever or concurrent acute infectious diseases (alter sleep architecture and lower the threshold for parasomnias)
• Psychological stress, anxiety or significant life changes (school conflicts, moving, starting school or viewing terrifying audiovisual content)
• Pediatric obstructive sleep apnea (microawakenings due to hypoxia fragment sleep, inducing episodes of terror)

Initial workup

The differential diagnosis is based on a detailed anamnesis with a sleep diary and home video recording of the episodes made by the parents (night terrors occur in the first third of the night, the child is inconsolable, does not recognize the parents, has total amnesia of the event the next day; nightmares occur in the second half of the night, associate complete awakening and vivid memory of the dream). In case of diagnostic doubt with epilepsy or suspicion of sleep-disordered breathing: Complete nocturnal polysomnography (PSG) with extended electroencephalographic and respiratory monitoring.

Standard management

• Drugs are generally not recommended for benign night terrors; The pillar of treatment is sleep hygiene and the "scheduled awakenings" technique. — gently wake the child 15-30 minutes before the usual time of the episode for 2 weeks). Clonazepam or Diazepam (benzodiazepines indicated only in extremely severe cases with risk of physical self-harm, refractory to behavioral measures and that seriously affect family dynamics; dose of clonazepam of 0.01 to 0.03 mg/kg/day orally before bedtime, prescribed temporarily
• Sedating antihistamines such as Alimemazine or hydroxyzine (not recommended for this purpose due to the risk of further altering sleep architecture or causing paradoxical agitation).