An evolutionary perspective on night terrors

Abstract

Night terrors, also known as sleep terrors, are an early childhood parasomnia characterized by screams or cries, behavioral manifestations of extreme fear, difficulty waking and inconsolability upon awakening. The mechanism causing night terrors is unknown, and a consistently successful treatment has yet to be documented. Here, we argue that cultural practices have moved us away from an ultimate solution: cosleeping. Cosleeping is the norm for closely related primates and for humans in non-Western cultures. In recent years, however, cosleeping has been discouraged by the Western medical community. From an evolutionary perspective, cosleeping provides health and safety benefits for developing children. We discuss night terrors, and immediate and long-term health features, with respect to cosleeping, room-sharing and solitary sleeping. We suggest that cosleeping with children (≥1-year-old) may prevent night terrors and that, under certain circumstances, cosleeping with infants (≤11-months-old) is preferable to room-sharing, and both are preferable to solitary sleeping.

The Parasomnias and Sleep Related Movement Disorders—A Look Back at Six Decades of Scientific Studies

“…Hartmann has provided two publications on nightmares [46,47] one of which is on schizophrenia and creativity. A very interesting recent evolutionary explanation of sleep terrors has been published by Boydon et al [48]. The treatment of sleep terrors has been pharmaceutical using diazepam and, more recently, clonazepam.…”

Sleep terrors—A parental nightmare

“…11,39,40 Moreover, it has recently been proposed a revised version of the environmental mismatch hypothesis, applied to STs. 41 This hypothesis is based on the idea that specific traits developed to improve their evolutionary fitness in an environment significantly different from the one in which they are expressed today, thus becoming a potential evolutionary basis for several diseases. 42 Therefore, Boyden et al 41 proposed that STs might be an extreme response to the evolutionary-environmental mismatch that has resulted from changes in sleeping behavior from cosleeping-with decreased risk of predation of children having parents nearby-to sleeping separately.…”

Sleep Terrors: An Updated Review

“…Otherwise, no medical intervention is required [ 76 ]. Attempts to interrupt a sleep terror episode should be avoided as such intervention may confuse and frighten the child even more and can lead to paradoxical increase in aggression [ 33 , 61 , 76 ]. Underlying conditions should be treated if possible and precipitating factors should be avoided.…”

“…With improvement or resolution of the sleep terrors, clonazepam should be slowly tapered because abrupt discontinuation may result in slow-wave sleep rebound and recurrence of sleep terrors [ 22 ]. Melatonin (N-acetyl-5-methoxytryptamine) has also been found to be useful [ 17 , 76 , 80 - 82 ]. Tricyclic antidepressants (such as imipramine, amitriptyline), selective serotonin reuptake inhibitors (such as paroxetine, fluoxetine), mirtazapine, and ramelteon have also been used for the treatment of sleep terrors with varying success [ 25 , 57 , 65 , 83 - 88 ].…”

“…Tricyclic antidepressants (such as imipramine, amitriptyline), selective serotonin reuptake inhibitors (such as paroxetine, fluoxetine), mirtazapine, and ramelteon have also been used for the treatment of sleep terrors with varying success [ 25 , 57 , 65 , 83 - 88 ]. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors [ 9 , 22 , 42 , 57 , 65 , 76 ]. Psychotherapeutic intervention is indicated if an underlying psychopathology is suspected.…”