Question:
What causes night terrors for people with DS? My daughter does not have a definitive diagnosis of Regression or Alzheimer’s but we continue to see a memory neurologist. We have been without a diagnosis for over three years but in the last three to four months she has been having night terrors five nights out of seven and lasting anywhere from 1-3 hours. She is on a lot of psychotropic meds so wondering if that has anything to do with it but has been on these same ones for over a year. Her caregivers are getting worn out.
Answer:
Night terrors (or sleep terrors) are described as a sudden arousal from sleep associated with sitting up in bed, intense fear, and a piercing scream. Symptoms include increased heart rate, increased respiratory rate, sweating, and/or facial flushing. The Mayo Clinic Patient and Health Information website has more information at this link. Night terrors are part of a variety of conditions that are classified as “disorders of arousal from non-rapid eye movement sleep.”
We have not had many people report night terrors at the Adult Down Syndrome Center. In our limited experience with night terrors, medications seem to be the most common cause in those that develop them in adolescence or adulthood. We have also infrequently had people note increased nightmares as a side effect of a medication, usually one of the selective serotonin reuptake inhibitor anti-depressants.
For changes in arousal including night terrors, some of the contributing factors or causes include:
- Sleep deprivationStressBladder distension. The inability to completely empty one’s bladder that results in bladder distension seems to be more common in people with Down syndrome. Medications with anti-cholinergic side effects, which include some psychotropic medications, may reduce the ability to empty one’s bladder and cause more bladder distension.
- Obstructive sleep apnea, which is significantly more common in people with Down syndrome.
- Restless legs syndromeMood disorders, such as depression and anxiety. (Your question did not indicate whether mood changes were part of her symptoms. However, many people with Down syndrome who have a regression or Alzheimer’s disease will have a co-occurring mood disorder, especially depression).
- Alcohol use
- Some medications used to treat psychological or psychiatric conditions may also contribute to night terrors. Examples include:
- Lithium
- Clonidine
- Risperidone and other anti-psychotic medications
- Medications with anticholinergic properties or side effects (medications affecting the nerves in the nervous system that use acetylcholine to transmit messages from nerve cell to nerve cell). A variety of medications have these side effects including some over the counter medications including some allergy medications.
- Some stimulants (usually prescribed for attention deficit hyperactivity disorder)
- Nonbenzodiazepine benzodiazepine receptor agonists (sedatives used for sleep including zolpidem, zaleplon, eszopiclone)
Treatment includes:
- Avoiding sleep deprivation.
- Maintenance of consistent and regular sleep-wake cycles (information on sleep hygiene can be found at this link).
- Making the environment safe which may include padding furniture, lowering the mattress to the floor, securing doors and windows (some individuals sleepwalk during sleep terrors), and removing dangerous objects.
- Treating underlying conditions (such as sleep apnea).
- Avoiding alcohol.
- Reviewing medications being used and considering switching to alternative choices if sleep terrors can be caused by the medication. Changing medications may particularly be indicated if the sleep terrors cause safety issues or sleep deprivation for the person with the sleep terrors or the family (as your question indicates).
- Infrequently supplements or medications may be needed to treat night terrors which include:
- Melatonin (although some people note more vivid dreams when taking melatonin).
- Clonazepam