Night Terrors: Why Do I Wake Up Screaming?

Waking up screaming is usually associated with night terrors, a parasomnia or sleep disorder that involves abnormal physical movements, behaviours, emotions, perceptions, and dreams. Night terrors are characterised by feelings of fear and panic, screaming, crying, fast heart rate, dilated pupils, violent movements, and sleepwalking. They are often mistaken for nightmares, but people with night terrors do not wake up and often have little to no recollection of the event. While night terrors are most common in children, they can also occur in adults, especially those with depression, bipolar disorder, or anxiety. If you or someone you know is experiencing night terrors, it is important to seek professional help to manage the symptoms and address any underlying causes.

Night terrors

The cause of night terrors is unknown, but they are believed to happen when an individual's consciousness is stuck between deep stages of sleep and wakefulness. This results in a state of partial awakening where the person is not fully awake, making it challenging for others to comfort or wake them. Night terrors may be triggered by various factors, including sleep deprivation, fever, sleep apnea, stress, anxiety, emotional tension, alcohol consumption, and intrinsic sleep disorders.

While the prevalence of night terrors is unknown, they tend to affect children more frequently than adults. It is estimated that 36.9% of small children experience night terror episodes at 18 months, decreasing to 19.7% at 30 months. In adults, the prevalence is lower, at 2.2%. Night terrors usually decrease with age, and children typically grow out of them as they reach adolescence or adulthood.

If you or someone you know is experiencing frequent night terrors, it is recommended to consult a healthcare provider. They can help identify potential causes, avoid triggers, and manage any underlying conditions that may be contributing to the night terrors.

Sleepwalking

The exact causes of sleepwalking are not fully understood, but researchers have identified a few factors that may contribute to this condition. One of the most significant factors is genetics. If one parent has a history of sleepwalking, their child has a 47% chance of inheriting the trait, and this likelihood increases to 62% if both parents are sleepwalkers. Additionally, a specific gene mutation, HLA-DQB1*05, is associated with a higher risk of sleepwalking in people of white ethnicity.

Other factors that may trigger sleepwalking episodes include sleep deprivation, stress, anxiety, emotional tension, and drinking alcohol. Sleepwalking itself usually does not require direct treatment, but if it is causing injuries or disrupting the sleep of others, certain measures can be taken to manage the condition. It is recommended to create a safe environment by removing potential hazards, securing dangerous items, and blocking access to stairs. Maintaining a consistent sleep schedule, limiting caffeine intake, and practicing relaxation techniques before bedtime can also help reduce the likelihood of sleepwalking episodes.

In rare cases, sleepwalking can be an indication of an underlying medical condition, such as obstructive sleep apnea, rapid eye movement behavior disorder, or neurological conditions like Parkinson's disease or multiple sclerosis. If sleepwalking is frequent, there is a risk of self-injury or injury to others, or it is causing significant disruption to daily life, it is advisable to consult a healthcare professional for further evaluation and guidance.

Sleep disorders

Waking up screaming could be a symptom of a sleep disorder known as night terrors. Night terrors are a kind of parasomnia, or a sleep disorder, that involves abnormal physical movements, behaviours, emotions, perceptions, and dreams. They are characterised by screaming, flailing, or experiencing intense fear while sleeping. They are often mistaken for nightmares, but unlike nightmares, people do not wake up during night terrors and often don't remember them the next day.

Night terrors are more common in children, with 30% experiencing them, but they can also occur in adults. They usually occur during the first third of the night, often between midnight and 2 am, but they can also happen during naps. They tend to happen during the third and fourth stages of non-rapid eye movement (NREM) sleep, which is when you are in a state between dreaming and waking. During a night terror, a person may suddenly bolt upright and scream, or they may sleepwalk, cry, or move around violently.

The causes of night terrors are not fully understood, but they are associated with age, environment, and triggers. They may be genetic, as they tend to run in families, and they are more likely to occur during times of illness, fever, sleep deprivation, or physical exhaustion. Emotional conflict, heightened stress, and anxiety can also make people more vulnerable to night terrors. If night terrors are frequent, it is recommended to talk to a healthcare provider, who can help identify triggers, rule out underlying conditions, and manage any sleep disorders or other conditions that may be contributing.

There is no standard treatment for night terrors, but they can be managed through reassurance, scheduled awakenings, and, in extreme cases, medication such as diazepam (Valium). Psychotherapy, talk therapy, or counselling may also help reduce the frequency of night terrors. Additionally, reducing stress or using coping mechanisms can be beneficial. If night terrors are causing embarrassment or disrupting others in the household, it may be helpful to seek professional help to address any underlying conditions or triggers.

Underlying conditions

Night terrors, or sleep terrors, are a common cause of waking up screaming. They are a type of parasomnia, or sleep disorder, that involves abnormal physical movements, behaviours, emotions, perceptions, and dreams. They are characterised by feelings of fear and panic, and those experiencing night terrors may scream, cry, or move around violently. Night terrors usually occur during the first third of the night, often between midnight and 2 am, but they can also occur during naps.

While the exact causes of night terrors are unknown, they are associated with several factors, including age, environment, and triggers. They are most common in children, with 30% experiencing them, but they are rare in adults. However, adults who experience night terrors are more likely to have underlying conditions such as depression, bipolar disorder, or anxiety. Night terrors can also be triggered by lifestyle factors such as an irregular sleep schedule, stimulants like caffeine, stress, and alcohol consumption.

In some cases, night terrors may be symptoms of underlying conditions. These conditions can include neurological disorders such as Parkinson's disease, Lewy body dementia, multiple sclerosis, or migraines. They can also be associated with psychiatric disorders, especially in children and young adults. If night terrors are frequent and interfering with your sleep or daily life, it is important to seek professional help to address any underlying conditions and manage your symptoms.

Treatment options for night terrors depend on the underlying cause and may include psychotherapy, medication, or lifestyle changes. In some cases, scheduled awakenings, where individuals are woken up just before the onset of night terrors, can be effective. However, it is important to note that this should be done cautiously, as intervening during a night terror can potentially lead to injury. Reducing stress through coping mechanisms or talk therapy may also help lessen the frequency of night terrors.

Parasomnias

Waking up screaming during your sleep could be a symptom of parasomnias, a category of sleep disorders characterised by disruptive behaviours or events that affect sleep. Parasomnias can occur while falling asleep, during sleep, or upon waking up. They can manifest as undesirable experiences, such as sleepwalking, sleep talking, nightmares, and sleep paralysis.

One type of parasomnia that may involve screaming is sleep terrors or night terrors. These are sudden episodes of fear and panic during sleep, characterised by screaming, crying, fast heart rate, dilated pupils, rapid breathing, and violent movements. Sleep terrors usually last for 30 seconds but can extend up to a few minutes. They are believed to occur when the brain is partially asleep and partially awake, resulting in a state of panic and fear.

Another possible parasomnia is REM sleep behaviour disorder (RBD), where individuals act out their dreams through physical actions like punching, kicking, or vocalisations such as talking, screaming, or moaning. Unlike sleep terrors, individuals with RBD typically recall their dreams in detail.

Frequently asked questions