A recent case report that closely examined the “idiopathic” sleep terrors of an adult man, found that thorough assessment and early intervention can help deal with the condition. The case focused on a man in his 40s who lived with sleep terrors for two years with seemingly no underline causes. His terrors would manifest as violent behaviour at night, including a concerning episode where he tried to strangle the person he was sleeping next to. The research defines sleep terrors as “non-rapid eye movement (NREM) parasomnias involving sudden arousals from slow-wave sleep with intense fear, autonomic symptoms and amnesia.” While between one and 6.5 per cent of children experience the condition, it’s relatively uncommon in adults, with only about 2.2 per cent affected. The study also notes that sleep terrors are often closely linked to triggers like stress, alcohol use or sleep deprivation. However, the psychiatric evaluation of the man who was the focus of the case report did not find any “neurodevelopmental disorders, anxiety spectrum disorders, depression, post-traumatic stress disorder, substance use and recent psychosocial stress.” His sleep routine was described as “regular,” with no excessive daytime sleepiness, though he did snore on occasion. Researchers study male subject The man’s sleep habits were studied in lab for two nights. During the first night, he didn’t have an episode, while on the second night, he was observed having increased heart and respiratory rates, briefly screaming, sitting up, and attempting to leave bed, though there were no changes to his brain waves or breathing beforehand. After being diagnosed with idiopathic sleep terror, the patient was given 0.5 mg of clonazepam at night, along with management strategies like “optimizing sleep hygiene, ensuring a safe sleep environment, stress management and avoidance of potential sleep disruptors.” After a four-week follow-up, he reported a dip in the frequency of his episodes from nearly every night to once a week. Since he was experiencing drowsiness from the medication, it was reduced to 0.25 mg. During follow-ups four and eight weeks later, the patient noted that he had not experienced any sleep terrors, and was no longer feeling sleepy during the day. After 12 weeks, he stopped taking the medication, and remained asymptomatic. Study emphasizes diagnosis, treatment In the study’s learning point, it notes that “adult sleep terrors, particularly those involving violent behaviours, require careful diagnostic evaluation to exclude other parasomnias or epileptic events.” It added that overnight sleep studies, known as polysomnography, are essential. In order to safely manage precautions, it suggests treating comorbidities – multiple medical conditions at the same time – as well as pharmacologic therapy when needed. “This case highlights the need for prompt recognition and intervention to prevent harm,” it read.
