Why am I afraid of sleep?

Night terrors (Pavor Nocturnus)

Sleep disorders (page 6/9)

Violently excited startling in the deep sleep phase without real and conscious waking up (parasomnias)

In the Pavor Nocturnus there are repeated episodes in which the person concerned is startled from sleep and is very aroused. The episodes usually occur in the first third of the night during deep sleep. There is a partial awakening from deep sleep.

An episode often begins with the person sitting up in bed, screaming, opening their eyes wide, and looking extremely frightened. During the phases, which usually only last a few minutes, the sleeper moves vigorously, appears frightened and shows clear signs of physical excitement such as rapid breathing, sweating and a rapid heartbeat. He does not react to external stimuli, including attempts by other people to calm him down. After waking up, there is no memory of the events, nor of dreams or impressions that might have caused the strong fear. Many children affected by Pavor Nocturnus also tend to sleepwalk at times.

Frequency and course

About one to six percent of children are affected by Pavor Nocturnus. In adults, the incidence is about one percent. The disorder occurs more frequently in boys than in girls; in adults, both sexes are affected about equally often. In children, the disorder usually begins between the ages of four and twelve and usually stops on its own in adolescence. It is not associated with any other psychological abnormalities here.

In some of those affected, the disorder only begins in adulthood. Here it occurs most frequently between the ages of 20 and 30 years. In adults, the pavor nocturnus usually lasts for a longer period of time and is often associated with other mental disorders. Pavor nocturnus can be observed more frequently in post-traumatic stress disorder (PTSD), generalized anxiety disorder and certain personality disorders than in people without these disorders.

A couple wakes up at night because their three-year-old son is screaming in panic. When they run to his room, he is sitting in bed with wide eyes, whimpering and moving restlessly to and fro. When the mother tries to hug him and calm him down, he begins to thrash and appears to be terrified. The mother observes that his heart is beating fast and that his pajamas are soaked in sweat. She continues to talk to her child soothingly without this having any effect. After about ten minutes the boy calms down again and lets himself lie back on his pillow, where he is soon slumbering deeply. There were no further incidents until the next morning.

Causes and explanatory models

Similar to sleepwalking, Pavor Nocturnus occurs more frequently in some families, so that genetic factors presumably play a role in the disease. Similar to sleepwalking, Pavor Nocturnus can be triggered by lack of sleep, febrile illnesses and stress. Maturation processes in the brain could also play a role in the disorder.

Treatment approaches and self-help options

In most cases, no special therapy is necessary for Pavor Nocturnus. Similar to sleepwalking, it makes sense for those affected to adhere to good sleep hygiene (see above) so that there is no sleep deficit.

Most importantly, when children have Pavor Nocturnus, it is important that parents are aware of the disorder and how to deal with it. For example, you shouldn't wake your child during the episodes because they will be confused and disoriented. It can be useful to have a calming effect on the child - at the same time, it is important to know that the children are unlikely to react to this. Some children with Pavor Nocturnus are also afraid of falling asleep - then the parents can have a calming effect on them during the day or before going to sleep.

If the disorder persists, some experts advise waking the person up shortly before the pavor nocturnus normally occurs. This can interrupt the sleep pattern that led to the occurrence of the episodes.

If the Pavor Nocturnus is associated with strong fears or other psychological problems during the day, psychotherapeutic treatment is often useful.

Exclusion of other diseases

Similar to sleepwalking, the abnormal behavior at night can also be caused by short epileptic seizures (so-called petit mal seizures). Therefore, you should discuss the incidents with a doctor, who may then advise further clarification. During an examination in the sleep laboratory, in addition to epileptic seizures, other possible diseases during sleep can also be detected or excluded. Similar to sleepwalking, Pavor Nocturnus can occur in connection with restless legs syndrome (see below) or breathing disorders during sleep (see below).

Medical therapy

Drug treatment is only useful in very rare cases with Pavor Nocturnus. Then benzodiazepines are usually used in low doses. Since there is a risk of addiction here, they should only be used for a short period of time (maximum four weeks).