Sleep terrors and confusional arousals in adults

Abstract

Sleep terrors (STs) and confusional arousals (CAs) are types of nonrapid eye movement (NREM) parasomnias that can be associated with agitation or violence which may lead to injury. Most frequently, they occur in the first third of the night. Typically, STs arise from NREM sleep (usually slow-wave sleep), while CAs, as the name suggests, are abnormal arousals from sleep (typically NREM sleep). STs are characterized by an initial sudden scream or loud cry that arises from sleep typically accompanied by sitting in bed with intense autonomic nervous system activation. CAs are characterized by an awakening in a disoriented state, vocalization, and apparent confusion. In both disorders, the patient gradually transitions to full wakefulness. Frequently, there is amnesia. Both disorders need to be differentiated from other parasomnias, especially rapid eye movement (REM) behavior disorder (because it carries a different prognosis), from seizures, and from medical and psychiatric conditions. Patients should be evaluated for sleep-fragmenting disorders as these can provoke the events.