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PubMed1990

Sleepwalking, night terrors, and consciousness.

OBJECTIVE: To determine some personality and psychoneurotic characteristics of adults who have the sleepwalking-night terrors syndrome. DESIGN: Prospective assessment of two groups of consecutive patients with a firm diagnosis of either of two specific sleep disorders as established clinically and by polysomnography. SETTING: Outpatient sleep disorders clinic and sleep laboratory in a tertiary referral centre. PATIENTS: 12 Patients referred consecutively to the clinic in whom a diagnosis of sleepwalking (six) or night terrors (six) was confirmed. MAIN OUTCOME MEASURES: Psychological characteristics as measured at the time of clinical assessment by means of the Eysenck personality questionnaire, the hostility and direction of hostility questionnaire, and the Crown-Crisp experiential index. RESULTS: Both groups scored exceptionally highly on the hysteria scale of the Crown-Crisp experiential index and the night terrors group also scored highly on the anxiety scale. The patients with sleepwalking also scored highly on a measure of externally directed hostility. CONCLUSIONS: The physiological and psychological features identified in these patients, possibly reflecting different expressions of a constitutional cerebral characteristic, may be explored in terms of hysterical dissociation. The findings contribute to the debate concerning the nature of sleepwalking, in particular with and without the forensic aspects.

Adult↗
PubMed1987

Treatment of coexistent night-terrors and somnambulism in adults with imipramine and diazepam.

Night-terrors and somnambulism are comparatively rare in adults and are most often associated with stage 4 sleep, especially delta activity. Although the data are limited, reports suggest that imipramine, which may control nocturnal enuresis, a stage 4 sleep disorder, and diazepam, which suppresses stage 4 sleep, may effectively treat the condition. This paper describes two patients with night-terrors and somnambulism who responded to imipramine but not to diazepam. Possible mechanisms of diazepam and imipramine, including effects on stage 4 sleep and pervasive anxiolytic actions, are discussed.

Adult↗
PubMed1983

Efficacy and safety of midazolam in the treatment of night terrors in children.

Midazolam, in an oral dose of 15 mg, and placebo were administered to 15 children aged 6-15 years in treatment of night terrors. After an initial adaptation night, the patients received placebo for 2 nights, followed by 15 mg midazolam for 2 nights and placebo again on the final 2 nights. Eight-hour nocturnal polygraphic recordings were made after the administration of both placebo and midazolam. The patients were continuously monitored by means of closed circuit infra-red television. Ten of the patients manifested simple episodes while five had attacks associated with motor automatisms and EEG anomalies. The total sleep time was lengthened by midazolam in most of the children; sleep architecture was favourably modified, mainly in terms of the amount and proportion of REM sleep (accompanied by dreams) and stage 2 sleep. Night terrors were eliminated by midazolam in all except one patient. REM sleep latency also decreased as did the number of nocturnal arousals (clinical and/or EEG). In the five cases with a background of organic cerebral disorders, the EEG anomalies and these attacks were suppressed by midazolam especially during the first sleep cycles. Patients' subjective assessment of the quality of sleep was favourable. Midazolam was well tolerated with no side-effects.

Adolescent↗
PubMed2001

Is there a dissociative process in sleepwalking and night terrors?

The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only six patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with post-traumatic stress disorder. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility.

Adult↗
PubMed1982

Action of bromazepam on sleep of children with night terrors. I. Sleep organization and heart rate.

Bromazepam was administered in a single dose of 1.5 mg one-half hour before bedtime to study its short-term action and the effect of its discontinuation on the sleep of 6 children suffering from night terrors. On the third night of the drug's administration, a statistically significant reduction in slow-wave sleep was observed which was maintained after the drug had been discontinued. The other sleep parameters were not significantly affected, although a slight increase in REM sleep was seen after discontinuation of bromazepam, with a statistically significant increase in the second third of the night on the first 2 nights 'off medication'. A comparison of the individual nights yielded no significant change in heart rate, although certain internal changes were observed during the second night 'on medication' and during the nights 'off medication'. These changes can be explained by the changing relationship between cardiac variability and sleep organization. There were insufficient episodes of night terror during the short duration of the study to allow any conclusions to be drawn on the effect of the drug on this aspect.

Anti-Anxiety Agents↗
PubMed1975

The treatment of night terrors associated with The posttraumatic syndrome.

The author describes three cases in which the frequency and intensity of night terrors associated with the posttraumatic syndrome were greatly lessened by administration of imipramine; in one case, the night terrors disappeared completely. Possible explanationss for this effect of imipramine are discussed, including the drug's arousal-preventing action. The author believes that the study of sleep EEGs of patients suffering posttraumatic syndrome will prove fruitful.

Administration, Oral↗
PubMed2002

Arousal reactions in sleepwalking and night terrors in adults: the role of respiratory events.

STUDY OBJECTIVES: The aim of the study was to determine the role of respiratory events, assessed by means of esophageal pressure monitoring, during arousals from slow wave sleep in adult patients with parasomnias. DESIGN: N/A. SETTING: N/A. PATIENTS: Ten patients with parasomnias (sleepwalking, night terrors, or both) and 10 control subjects matched for gender and age underwent 3 consecutive nights of polysomnography. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: By increasing sleep fragmentation, esophageal pressure monitoring has a deleterious effect on sleep architecture in patients with parasomnias and in control subjects. Respiratory events occur more frequently in parasomniacs than in controls. Respiratory effort seems to be responsible for the occurrence of a great number of arousal reactions in parasomniacs and is involved in triggering the parasomnia episodes. CONCLUSION: Sleep-disordered breathing seems to be frequently associated with parasomnias during slow wave sleep, emphasizing the utility of performing esophageal pressure monitoring in cases of sleep walking or night terrors.

Adult↗
PubMed2004

Night terrors associated with thalamic lesion.

OBJECTIVE: To describe a case with night terrors (NT) symptomatic of a thalamic lesion. METHODS: Videopolysomnography and brain MRI were used to study a 48 year old woman with a recent onset of brief episodes, occurring exclusively during nocturnal sleep, where she suddenly sat up in bed, screamed and appeared to be very frightened. RESULTS: Videopolysomnography recorded an episode suggestive of NT. Sleep fragmentation with frequent brief arousals or microarousals was also evident mainly during slow wave sleep. The brain MRI showed increased T2 signal from the right thalamus suggestive of a low-grade tumor. CONCLUSIONS: Our case suggests that NT starting in adulthood can, rarely, be symptomatic of neurological disease, and warrant further investigation with MRI. SIGNIFICANCE: A thalamic dysfunction, disrupting at this level the arousal system, may play a role in provoking NT.

Arousal↗
PubMed1979

Behavioral treatment of night terrors in a child with acute leukemia.

A 3-year-old girl diagnosed with acute lymphocytic leukemia presented with a 1-month history of recurrent nightmares. Symptoms of the disturbance conformed to a clinical picture of slow wave arousal night terrors, or pavor nocturnus. Behavioral treatment aimed at reducing anxiety related to maternal separation and medical procedures, and at reinforcing appropriate sleep patterns was effective in reducing and eventually eliminating the symptoms. Follow-up revealed no return of nightmares or existence of new problems. A brief review of descriptive, etiological and treatment aspects of night terrors is presented and the hypothesis is put forth that such episodes represent a psychological reaction to trauma. The importance of being aware of age variables in the expression of children's anxiety is noted as is the value of careful tabulation of outcome data.

Anxiety, Separation↗
PubMed1991

The analysis of an adult with night terror.

The author discusses the analysis of a woman with night terror, a condition rarely seen in adults. The analysis revealed the pathogenicity of splitting mechanisms which had developed under the influence of an overstimulating environment and exposure to the primal scene, followed by the separation and divorce of the patient's parents.

Adult↗
PubMed1987

Sleep disorders: insomnia, sleepwalking, night terrors, nightmares, and enuresis.

All five sleep disorders reviewed in this article can be adequately evaluated in the physician's office by taking a sleep history and conducting a careful general medical and psychiatric assessment. Insomnia, the commonest sleep disorder, is more prevalent among women and elderly and psychosocially disadvantaged persons. Personality factors such as a tendency toward the internalization of emotions and the occurrence of stressful life events also play a major role in the development of chronic insomnia. A multidimensional approach is indicated for the treatment of chronic insomnia; hypnotic drugs should be used only as an adjunct to this treatment. In children, sleepwalking and night terrors (two manifestations of the same pathophysiologic substrate), nightmares, and enuresis are commonly related to developmental factors; counseling and reassurance of the parents is indicated. Psychopathologic disorders are usually present in secondary enuresis, as well as in sleepwalking, night terrors, and nightmares that occur in adulthood. Psychotherapy and the occasional use of psychotropic drugs may be necessary in the treatment given adults with these disorders.

Dreams↗
PubMed1983

Two case reports: night terrors with sleepwalking--a potentially lethal disorder.

Two cases of severe night terrors with sleepwalking in adults are described. In one of these, an episode resulted in three deaths; in the other, there was serious concern of death and bodily harm. Both men were employed, married, and functioning well without serious psychopathology. Neither could be given a definite DSM-III diagnosis, though both had some features of compulsive personality disorder. Both improved considerably with treatment.

Adolescent↗
PubMed1994

Successful treatment of night terrors and somnambulism with paroxetine.

A patient with a 30-year history of somnambulism and night terrors is described. The use of a home ambulatory sleep electroencephalogram (EEG) recording in clarifying the diagnosis and in monitoring the results of treatment is illustrated and successful treatment using a selective serotonin re-uptake inhibitor is reported.

Clonazepam↗
PubMed1991

Psychophysiological aspects of nightmares, night terrors, and sleepwalking.

Monitoring sleep through electroencephalography and electroculography has identified the different sleep stages in which nightmares, night terrors, and sleepwalking occur. Questionnaire surveys have supplemented the findings of case studies of these sleep disorders. Neurotransmitters operative during these sleep disorders have enlarged the knowledge of the psychophysiological dimensions especially of nightmares.

Arousal↗
PubMed1995

The treatment of persistent night terrors with autogenic training: a case study.

This is a case study of a 16-year-old male with a long history of persistent and severe night terrors. After a comprehensive medical and psychological evaluation, the patient was trained in standard autogenic training exercises and an organ-specific formula. By the end of the eight-week treatment, the nocturnal episodes ceased. Information at 11 weeks and 37 weeks follow-up supported the effectiveness of the treatment.

Adolescent↗
PubMed1995

Night terrors in an adult precipitated by sleep apnea.

Parasomnias are generally described as disorders of arousal that arise out of stage 3 and 4 nonrapid eye movement (NREM) sleep without identifiable cause. We present a case of a 35-year-old man who during nasal continuous positive airway pressure (nCPAP) treatment for severe obstructive sleep apnea experienced an intense night terror triggered by a residual obstructive apnea during rebound deep sleep. The role of rebound deep sleep was thought to be essential in creating a state of sleep with a high arousal threshold hypothesized to be important for the occurrence of parasomnias. This case supports the clinical wisdom that identifiable sources of arousal can trigger parasomnias.

Humans↗