Night terrors are a type of sleep disturbance. Your sleep is suddenly disrupted by intense fear, screaming and sometimes movement. Heart rate is elevated, and breathing can be fast. What makes them different from nightmares is that they occur during non-REM sleep (we dream in REM phase), usually in the first third of the night. There is usually no recollection of the events after waking, and no specific “bad dream” triggered the reaction.
Neurologically, night terrors occur because, for some reason, the autonomic nervous system gets activated during deep sleep, when it shouldn’t have been. Fear circuits get activated, while the cognitive regions of the brain remain in a sleep state. 1
Night terrors happen to neurodivergent folks significantly more than the general population.3 The episodes might be triggered or made worse by any kind of sleep disruption, stress, anxiety, even hormonal changes, and some medications. There are some research indications about genetic components, as with many other neurodivergent traits, so the factors are not purely environmental, but also neurological.
Night terrors can affect both adults and children, and can be really scary or upsetting for both the people experiencing and witnessing them.
Let’s look at night terrors more closely to understand what is actually happening.
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What do night terrors look like?
Night terrors are aptly named, as the reaction is truly one of terror. Screaming is often part of it, and they can be long, deafening, and sound like a genuine scream of fear – because they are.
From the brain’s perspective, if the fear centre is turned on, it is turned on. It will not evaluate on the source, whether it was a sabretooth tiger entering the room, or there was an abnormal arousal from deep sleep because the autonomic nervous system was activated.
All other physical symptoms – heart pounding, heavy breathing, dilated pupils and excessive sweating – are also signs of fear, and happen during night terror episodes. Movement can also be part of a night terror episode: jolting upright, kicking in bed, or even getting out of bed. All while screaming and panicking. The person is inconsolable, and it is impossible to wake them up; they are non-responsive, even though they might appear awake.
From the outside, the person is in deep distress and fear, and anyone witnessing the episode could be worried that something terrible has happened.
Except… when the episode stops, the sleeping person is unable to communicate (unlike when woken from a bad dream), they are not truly awake, and often fall back asleep immediately.
What does it feel like to have a night terror episode?
As night terrors are not bad dreams, and happen in the non-REM phase of sleep, generally, people have no memory of the episode after waking (retrograde amnesia).
Often, the only way to tell you have had a night terror episode is the feeling of rawness in your throat from all the screaming, or, if you also get up, items moved around, or new bruises from you bumping into things while having the episode.
People who have witnessed the episode might be able to give a clue on what they saw, and then, putting the pieces together, you can deduce that you had a night terror episode.
Because it was not caused by bad dreams, there is nothing specific to recall that triggered the screaming — no axe murderers or having to hand in the maths homework you didn’t know about. It is a neurological occurrence.
Why do night terrors happen more often to neurodivergent people?
Neurodivergent conditions are differences in our neurological make-up and how our brains work.
Since sleep happens in the brain, sleep architecture is often affected. Dysregulated sleep-wake transitions can be present in both ADHD 2 and autism.3 Delayed sleep (not being able to fall asleep), secondary insomnia (falling asleep easily but then waking up after a while and not being able to fall asleep after that), snoring, restless leg, are all more prevalent in the neurodivergent population.45
Arousal regulation is one of the key traits of ADHD. (Please note that arousal in medical terms means any kind of activation, not only sexual, but also emotional, focus-related, or anything to do with executive function.) Regulating arousal means that there is a stable system that oversees when to crank alertness, focus, and excitement up, and how to wind it down when needed. Regulation also means that the transitions from one state to another are smooth and not abrupt.
So, no wonder that if a neurodivergent person already has disruptions when it comes to getting back to baseline, regulating sleepiness, energy levels, etc., it can happen during their sleep, too.
Management and Support for Night Terrors
While night terrors are neurological, there are some environmental changes that can help.
These include focusing on sleep hygiene and supporting falling – and staying – asleep in a way that works for the person in question.
- For some, it might be helpful to leave phones out of the bedroom; others might benefit from listening to familiar books in audio format to help calm their thoughts and drift to sleep. As always, there is no one-size-fits-all solution.
- Make sure to also look into sensory factors in the bedroom: light sources, noises, and smells that could disturb sleep. Visual stimuli can also be too much, so keeping the bedroom clutter-free and minimalistic could work for some.
- Studies have found that ADHD stimulant medication can have a supporting effect on some people by helping regulate their sleep, even taking small, short-acting top-up doses before bed, but for others, stimulants disrupt their sleep patterns. Taking supplements like magnesium or melatonin also works for some.
- As sleep is connected to dopamine production, and dopamine and estrogen like to go everywhere together (i.e. when one is elevating, it takes the other with them, and when they drop, the other drops as well), people with periods can find that their sleep is different before the week their period starts, as this is the phase when dopamine and estrogen drops. Sleep disruptions are one of the symptoms of PMDD6, so if you are having periods and experience night terrors, start tracking when they happen compared to your menstrual phases to figure out a pattern.
- Unfortunately, sleep deprivation symptoms (lack of focus, zoning out, executive dysfunction) are things ADHD folk already have to deal with, and if their ADHD causes sleep disturbances. Therefore, sleep deprivation just exacerbates ADHD struggles, so it is helpful to support both the ADHD part and the sleep part of the equation.
How to figure out what works for you
Tracking night terrors and the circumstances when they happen can help you figure out some patterns. It can be an overstimulating day, social events before the night, watching something too exciting before bed, a late dinner, roadworks on your street, the day of your cycle…
Even if you cannot fully eliminate them, if you discover some correlations, you can prepare for night terrors coming, and maybe do extra self-care or regulation time before sleeping.
For example, if you know they happen more often between days 23-28 of your cycle if you had a busy day full of meetings and talking to other people, you can prepare by not putting extra events in your calendar for that day, having a quiet night, and do things that help you regulate (kickbox, yoga, karaoke, meditation, nature walk, true crime podcasts – whatever works for you!)
If you share spaces with other people when you sleep, it helps if you can talk to them about what and how it happens, what they can do to support you, or reassure them that you are not being axe-murdered if it happens. Using white-noise machines, earplugs or noise-cancelling headphones, both for you or the person near you, can also help, so it is less of an upsetting experience for them to be woken up by poor you in a complete panic.
Night terrors are terrifying, but it is okay if you have them
Night terrors can also bring a lot of shame, as they are traditionally associated with children, not adults. Having night terrors is not a personal failing, but a neurological experience, and they happen because you have a nervous system. We like that you have one, so please keep it. 🙂 But also, support yourself in any way you can.
