Sleep Screaming Mystery: Why Do I Do This?

Screaming in your sleep can be a symptom of night terrors, a sleep disorder that is more common in children but can also occur in adults. Night terrors are characterised by partial awakening from slow-wave sleep, usually in the first few hours after falling asleep, and often involve signs of extreme stress such as screaming, shouting, or waving your limbs. People experiencing night terrors rarely remember the episode the next day, but they may feel embarrassed or ashamed upon finding out. Other symptoms include dilated pupils, a racing heart, sweating, and confusion. If you are concerned about screaming in your sleep, it is recommended to consult a healthcare professional or therapist, especially if it is causing sleep disruption, danger, or embarrassment.

Night terrors, or sleep terrors, are a common cause of screaming in sleep

Night terrors are characterised by:

• Sudden wake-ups involving yelling and screaming
• Violent movements and thrashing about
• Increased heart rate, sweating, and hyperventilation
• Dilated pupils
• A frightened facial expression

Night terrors usually occur during the first few hours of sleep and can last from 20 minutes to upwards of 90 minutes. They are fairly common in children, with 30% experiencing them at some point, but rare in adults, affecting only 1-4%. They tend to run in families and can be triggered by various factors, such as illness, fever, sleep deprivation, physical activity, stress, caffeine and alcohol consumption, certain medications, and other sleep disorders.

If you or someone you know is experiencing frequent night terrors that interfere with sleep or cause distress, it is recommended to seek professional help. Treatment options may include addressing underlying conditions, improving sleep hygiene, reducing stress, and making lifestyle changes.

Nightmares are intense dreams that may cause feelings of terror, anger or disgust

Nightmares are usually remembered, unlike night terrors, which are not technically dreams. Night terrors are sudden fearful reactions that occur during transitions from one sleep phase to another. They are more dramatic than nightmares and often cause children to kick, scream and thrash about. They occur during non-REM sleep, when the brain is less active, and are usually forgotten the next day.

Nightmares can arise for a number of reasons, including stress, anxiety, irregular sleep, medications and mental health disorders. Post-traumatic stress disorder (PTSD) is the most studied cause of nightmares. Trauma and nightmares are closely linked, with around half of people seeking treatment for PTSD suffering from replicative nightmares. These recurrent dreams force the person suffering to re-experience the trauma that caused their PTSD.

People who are deeply affected by nightmares can be treated in a number of ways. The cause of the stress must be determined, and if a stressor is identified, effective ways to manage it should be found. For medication-induced nightmares, dosages might need to be altered or different drugs administered. Psychological therapy or medication can also be used to treat people with post-traumatic or chronic nightmares.

Sleep-related eating disorder can cause people to eat and drink while partially awake

Sleep terrors, or night terrors, are a common cause of screaming during sleep. They are a type of parasomnia, or sleep disorder, that occurs during non-rapid eye movement (REM) sleep, when you are in a state between dreaming and waking. People experiencing night terrors are not fully conscious and typically do not remember the incident. They may scream, shout, thrash about, and exhibit violent movements, with dilated pupils and an increased heart rate.

Now, sleep-related eating disorder (SRED) is a parasomnia characterised by unusual eating behaviours during sleep. People with SRED may eat and drink while partially awake, often consuming foods they would not normally eat, such as raw meat or slabs of butter, in large quantities and at a rapid pace. They may also eat toxic or inedible substances and are at risk of injuries from handling knives and utensils or starting fires. SRED episodes can occur multiple times per night and are not driven by hunger or thirst. People with SRED often have no memory or only a vague recollection of the event.

SRED is more common in women, who make up about 65-80% of patients, with an average onset age of 22-29 years. It is often associated with other sleep disorders, particularly sleepwalking, and certain medications can increase the risk of developing SRED. Treatment involves addressing safety hazards, improving sleep hygiene, and sometimes, medication.

Sleepwalking, or somnambulism, involves getting out of bed and moving about with eyes open, while being asleep

Sleep terrors, or night terrors, are a common cause of screaming in one's sleep. They are a type of parasomnia, or sleep disorder, that usually occurs during non-rapid eye movement (REM) sleep, when one is in a state between dreaming and waking. People experiencing night terrors are not fully conscious and rarely remember the incident. They are more common in children, with about 30% of children experiencing night terrors, but rare in adults, with only 1-4% experiencing them.

Now, sleepwalking, or somnambulism, is a sleep disorder that involves getting out of bed and moving about with eyes open, while being asleep. Sleepwalking usually occurs during a period of deep sleep, typically in the first few hours after falling asleep. It can start at any age but is more common in children, with an estimated 1 in 5 children sleepwalking at least once. Most people grow out of it by puberty, but it can sometimes persist into adulthood.

During sleepwalking, individuals may just sit up in bed and look around, appearing briefly confused. Others may get out of bed, walk around, open cupboards, get dressed, or eat, and they may seem agitated. In extreme cases, sleepwalkers may walk out of the house and perform complex activities such as driving. While their eyes are usually open, they do not recognise people and often move well around familiar objects. Sleepwalkers may partially respond or say things that don't make sense if spoken to. Episodes typically last less than 10 minutes but can be longer. At the end of each episode, the sleepwalker may wake up or return to bed and fall asleep. They usually don't remember what happened and may feel confused if woken during an episode.

The exact cause of sleepwalking is unknown, but it appears to have a genetic component, with children of sleepwalkers being more likely to sleepwalk. Other factors that can trigger sleepwalking include:

• Sleep deprivation
• Infection with a high temperature, especially in children
• Alcohol consumption
• Certain medications, such as sedatives
• Being startled by sudden noises or touch, causing abrupt waking from deep sleep
• Other sleep disorders, such as obstructive sleep apnea and restless leg syndrome

REM sleep behaviour disorder involves acting out dreams, often violently

There are several reasons why you may scream in your sleep and not remember it. One possible explanation is sleep terrors, which are characterised by frightening screams, thrashing, and kicking. Sleep terrors usually occur during non-rapid eye movement (Non-REM) sleep, and individuals experiencing them are often difficult to wake up. Another possibility is nightmare disorder, which involves vivid dreams that cause feelings of fear and anxiety. People with nightmare disorder can usually recall their dreams in detail when awakened.

Additionally, REM sleep behaviour disorder (RBD) could be a factor. RBD is a parasomnia, which is a sleep disorder characterised by unusual and undesirable physical events or experiences that disrupt sleep. During RBD, individuals may yell, shout, grunt, talk, swear, laugh, or shout, as well as make aggressive movements such as punching, kicking, or grabbing. The disorder is more common among older adults, particularly those with neurodegenerative diseases such as Parkinson's disease, Lewy body dementia, or multiple system atrophy.

People with RBD are often unaware of their actions during sleep and may only learn about their behaviour from their bed partner or roommate, or by waking up with injuries. The movements involved in RBD can be violent and cause injury to oneself or one's bed partner, hence the importance of seeking treatment. Treatment options include safety measures such as removing sharp objects from the bedroom and medication such as melatonin, clonazepam, and pramipexole.

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