Owens et al1 found that night terrors in a 5-year-old girl characterized by agitation, unresponsiveness, violent shaking, flailing, screaming, crying, a "choking" sensation at sleep onset, and extreme autonomic arousal were exacerbated by sleep deprivation and environmental noise. They also noted that the periods of exacerbation immediately preceded or coincided with linear growth spurts, and a recent move and the father's frequent absences on business travel were identified as potential stressors. She had had a recent onset of severe, unilateral headaches accompanied by photophobia, which were subsequently diagnosed as migraine headaches by a pediatric neurologist. Neurobiological features are suggested by reports linking noise stress, wakefulness, subclinical impairment of lung airways, disruption of brainstem cardiovascular control, and dysregulation of cortical silent periods, growth hormone, the microvasculature, and mood with dopamine abnormalities lateralized to the right hemisphere for which the metabolic rate is higher in females. This hypothesis is supported by optimal response organization and working memory at intermediate dopamine tone in a mediofrontostriatal activation system and deactivation of the right hemisphere, a state marker of depression, that promotes dominance of the left hemisphere associated with cardiac dysrhythmia, vasoconstriction, and aggressive response.2-5 It is also supported by the correlation of periodic leg movements in sleep with microarousals lasting more than 3 seconds and a more marked shortening of the R-R interval in the electrocardiographic signal.6 Therefore, the reemergence of an abnormally increased percentage of slow-wave sleep after of discontinuation of treatment with benzodiazepines in this patient prompts cognitive-behavioral and/or pharmacological strategies that balance asymmetrical brain functions and promote a primary rhythm in the central nervous system that entrains heart rate, blood pressure, and respiratory rate,5 to prevent the arousal response going from autonomic activation to bursts of δ activity to α activity to a full awakening.6
Friedman EH. Sleep Terrors. Arch Pediatr Adolesc Med. 1999;153(8):893. doi:https://doi.org/
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: