Treatment Approach to Sleep Terror: Two Case Reports

Abstract

Parasomnias are a group of disorders characterized by abnormal behaviors, physical activities, and autonomic arousal symptoms while transition to sleep or continuation of sleep. Sleep terror (ST) is classified under parasomnias characterized by sudden fear attacks beginning with crying attacks or high-frequency screams and continuing with increased autonomic symptoms. ST occurs in the first few hours of sleep during the delta phase. Further, the lifetime prevalence of ST in adults is less than 1%. It is important to obtain; anamnesis from patients' bed partner for a clinical evaluation of ST. Methods, such as evaluating sleep diaries and video recordings, can help ST diagnosis. It is also important to evaluate patients' medical history, history of substance or alcohol abuse, psychological traumatic experiences, primary or secondary incomes, and detailed neurological aspects. Physician can select some serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCADs) as medical treatment if patients have a high frequency of attacks. Because of addiction and relapse of ST episodes, benzodiazepines are not preferred as the first-line treatment. In this study, we will discuss ST, which is rare in adulthood, and use of long-acting benzodiazepine based on two cases.

Parasomnias in Post-Secondary Students: Prevalence, Distress, and Coping Strategies

“…Sleep Terrors. Better sleep habits, stress management, scheduled awakenings, creating a safe environment so that it poses minimal danger if such an episode occurs (e.g., closing and/or locking windows and doors, removing tripping hazards, making sure fragile objects are not in reach) [37], and antidepressants [38].…”

Sleep Terrors: An Updated Review

“…Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age [ 20 - 22 ]. It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age, although a prevalence of 14% or higher has also been reported [ 5 , 17 , 21 - 28 ]. The wide variation in prevalence can be attributed to differences in definitions of a sleep terror, methodology, and studied population.…”

“…In addition, a child with nightmares is more easily and completely aroused [ 63 ]. On awakening, the child is fully alert and can recall details of the nightmare [ 28 , 63 ]. Most sleep terrors occur in the first two to three hours of sleep and arise out of stages three and four of NREM sleep.…”

“…Underlying conditions should be treated if possible and precipitating factors should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment [ 28 ]. The American Academy of Sleep Medicine recommends infants 4 months to 12 months, children 1 to 2 years of age, children 3 to 5 years of age, children 6 to 12 years of age, and teenagers 13 to 18 years of age to have 12 to 16 hours, 11 to 14 hours, 10 to 13 hours, 9 to 12 hours, and 8 to 10 hours, respectively, of sleep per 24 hours on a regular basis to promote optimal health in children and adolescents [ 77 ].…”

“…Consideration should be given to factors that may disturb sleep or half awaken the child, such as discomfort of a distended bladder, pets jumping on the child’s bed, and environmental sounds. Objects in the surrounding area that could potentially harm the patient should be removed [ 28 ]. Safety precautions are recommended [ 78 ].…”