Night terrors: When your dreams could kill you

Imagine waking up covered in blood with a paramedic at your side. Or convinced every night you will choke in your sleep. Eimear O’Hagan explores the all-too-real realm of night terrors. 

Opening her eyes, Emelie Hryhoruk stared in confusion at the two paramedics crouched by her bedside. Sitting bolt upright in bed in her home near Bath, her confusion turned to horror as she took in the splatters of blood on her carpet.

Nick Hayes

‘I had absolutely no idea what had happened, or why paramedics were in my house in the middle of the night,’ says Emelie, 37, an artist and mother of two. ‘I was aware of my husband stroking my back trying to calm me down, but my heart was racing and I felt utterly terrified.’

Emelie hadn’t been the victim of a vicious attack nor even had an accident. She had harmed herself while in the throes of a night terror. Believing she was choking to death, she’d coughed so violently and clawed inside her mouth and throat that she had burst a blood vessel.

‘My husband Nick had called 999 because he knew from past experience not to try to wake me from a night terror. He realised that I needed help because that one was so severe,’ says Emelie. ‘When I was calm enough to take in what had happened, and the paramedics had left after checking my blood pressure and vitals and examining my throat – which was scratched and sore – I felt shaken, unable to stop crying or go back to sleep.’

It’s estimated that around two per cent of adults suffer from night terrors – but what exactly are they?

Sleep expert Dr Neil Stanley is keen to make the distinction between night terrors and nightmares. ‘The two are often confused,’ he says, but they are very different experiences, caused by entirely separate processes: ‘A nightmare is a bad dream with imagery you find distressing, which occurs during the dream period – known as REM [rapid eye movement] sleep.

‘A night terror happens in the deepest phase of sleep and is known as a partial arousal parasomnia,’ he explains. ‘While the conscious brain can be deeply asleep, unaware of what’s going on, other parts of the brain can awaken – and if that happens, that part will do what it’s designed to do. For example, with sleepwalking the part of the brain that controls locomotion has woken, whereas with sleep talking it’s the part that controls speech.

‘With night terrors, it is the area of the brain that controls fear which is awake, hence why sufferers experience distressing feelings of panic and terror and can have frightening hallucinations. They respond accordingly, whether that’s screaming, thrashing limbs, sweating or even fleeing their bed. They may have their eyes open, and appear awake, but often they will have little or no memory of the episode.’

According to Dr Stanley, author of How to Sleep Well: The Science of Sleeping Smarter, Living Better and Being Productive, night terrors can be triggered by a range of factors.

‘More research needs to be done but we do know that sleepwalking has a genetic component, so it’s possible that night terrors may run in families and some people are simply more predisposed to them. ‘Other triggers can include stress and anxiety, alcohol, drugs and medications, sleep apnoea – which impacts breathing – and hormonal fluctuations. Essentially, anything that disturbs sleep can cause a night terror. And in the current climate of fear and anxiety, when we’re all in a heightened emotional state, it’s highly likely that more people will be suffering from night terrors as a result.’

Emelie suffered such a severe night terror that her husband called 999

Emelie’s began during the third trimester of her second pregnancy in 2013. ‘As a teenager I was prone to sleepwalking and talking, but that stopped when puberty ended. Until I was expecting my second son, I was a “good” sleeper.

‘From the outset my terrors centred on choking, even though I’d never choked in my life. To an onlooker it would appear I was just coughing repeatedly in my sleep, but I believed I was choking to death and would wake up gripped with panic, sometimes sitting up in bed, my heart pounding and my body drenched in sweat.

‘My husband was so concerned when I explained what I was experiencing while asleep – he had no idea what to do to help me and nor did I.

‘At first, I put it down to pregnancy hormones and anxiety about having a new baby, and my GP agreed. I tried not to worry about it as the more anxious I felt about having them, the more frequent they were.’

After her son was born in August 2013, Emelie hoped her sleep would return to normal – albeit broken by the demands of a newborn – but instead the night terrors became progressively worse.

‘I dreaded going to sleep – I was so afraid of what lay ahead of me. I was having two to three terrors every night, starting around 40 minutes after I first went to sleep, and was exhausted as a result. I offered to sleep in a separate room, feeling guilty that Nick’s sleep was being disrupted, but he didn’t want that.

‘My son was around six months old on the night Nick made that 999 call, but they carried on. On one occasion I scratched my husband’s back, leaving deep marks. Another time I typed a goodbye note on my phone to my sons in my sleep, which read:

“Charlie and Isaac, I love you so much. I’m so sorry I wasn’t there for you in the morning” because I believed I would be dead by the time they woke up.’

Emelie was referred for cognitive behavioural therapy and then to a general counsellor, but neither had experience of treating adult night terror sufferers, and she felt the sessions did little to help. ‘I was doing a lot of research, desperate to regain some control over my sleep. I began to practise mindfulness and meditation at bedtime, as well as investing in new bedding. These helped me at least get to sleep – which had become another big problem – although they didn’t stop the terrors.

‘My day-to-day life was affected. Not only did my sleep deprivation leave me mentally very low, I also began cutting up our food into tiny pieces as the night fear of choking seeped into my waking hours.’

In early 2019, after suffering for six years, Emelie agreed with her GP that it was time to try medication. ‘I’d resisted going down that road for a long time, but I was so physically and mentally broken, I agreed. My GP put me on a low dose of Sertraline, an antidepressant, and within five weeks my night terrors had reduced from three a night to three a week. ‘Two years on, I still take medication. I have one or two terrors every few weeks. It’s been life-changing to feel I have more control over my sleep again.’

‘Unless you’ve experienced them, it’s impossible to fully explain the deep fear,’ says Georgina

Georgina Probert has suffered from night terrors since she was a child. And 25 years later says they – and the terrifying hallucinations they cause – are a constant presence in her life.

‘I was diagnosed as suffering from them when I was ten. I would run into my parents’ bedroom in my sleep, screaming hysterically after seeing spiders in my room – I’d see them on the walls and falling from the ceiling on to me,’ says Georgina, 35, a writer.

‘As I got older, I’d have periods of respite from them but then they’d return, usually during times of stress. Currently, against the backdrop of the pandemic and all its anxiety and isolation – plus a six-month-old baby who has just moved into her own room – I’m experiencing them almost every night. But now they are about people.

‘I hallucinate figures and shadowy shapes in my bedroom and believe they are going to harm me and my family, or take my children. It’s so frightening – unless someone has experienced how real they feel it’s impossible to fully explain the deep fear.

‘My husband Tom will put his hand on my shoulder and tell me I’m OK, but not try to wake me. He says I will often just look at him with a glazed expression and then go back to sleep, or speak to him in what sounds like a foreign language and appear very agitated.’

Dr Stanley says both Georgina and Emelie’s husbands’ approach of not waking them during a night terror is the correct one. ‘As distressing as it may be for an onlooker, it’s advised to observe someone having a night terror, ensuring they don’t come to harm, but try to leave them alone. Being woken up can add to their sense of fear, so it’s best to remain calm and let it take its course.’

Carrie has been known to kick and punch in the throes of a night terror.

By day Carrie Wilson, 41, is a mother of one and CEO of a translation services company. By night, she’s been known to kick and punch while in the grips of a night terror.

‘After I started having them aged 12, on several occasions I kicked out at and hit my mother when she came into my bedroom to try to calm me. And a few years ago, I woke to find myself sitting on top of my husband having punched him in the stomach and winded him. We can laugh about it now but at the time I was horrified at how I’d behaved, even though I wasn’t aware I was doing it.’

Carrie believes her night terrors were triggered by both stress and hormones. ‘Looking back, they often coincided with challenging times in my personal or professional life, and they also aligned with symptoms of endometriosis and polycystic ovary syndrome, both of which I suffered from,’ she says.

‘During a night terror I cry aloud, scream, lash out and see someone in the room with me. They are very traumatic, with layers of terror and a feeling of being trapped, unable to get away from the source of the fear.’

Carrie says she is usually very private about her sleep disorder. ‘I find it hard to speak about in case people think I’m “crazy”. It’s embarrassing not being in control of my behaviour and emotions. When my daughter, now 11, was younger I was concerned I’d be seen as not a good mother because of them.’ This embarrassment prevented Carrie seeking help for her night terrors, but beginning HRT has brought some respite. ‘I had a hysterectomy in November 2017 and since my HRT dosage has reached a level where it needs to be, the terrors have become less frequent. It’s now three months since I had one. I used to think they were just something I had to live with, but not having them is such a relief.’

For Emelie, while night terrors remain part of her sleep, they are less frequent and she feels better equipped to live with them.

‘Now I’m not so sleep-deprived, and have tools in the form of both medication and the techniques I practise myself, I’m not as scared of them and cope better when they do strike. They don’t leave me as upset and fatigued, because I know I don’t have to suffer them every night. And meditation helps me remain calm where once I was
so shaken by them. My bedroom is once again a place of rest and sanctuary,
no longer one of terror.’

How to tackle night terrors

Geraldine Joaquim is a clinical hypnotherapist, psychotherapist and founder of mind-yourbusiness.co.uk

Talk about them

Confiding in friends, family or a partner normalises what’s happening and can help them understand what you’re experiencing.

Prepare for sleep

Ensure your bedroom is a calming place where you feel relaxed and secure. Dim the lights half an hour before you plan to go to sleep. Practise relaxation techniques.

Keep a diary

By recording when you have terrors, it may be possible to identify what triggers them – you may then be able to reduce or eliminate the triggers.

Get professional help

The right treatment can lessen frequency and severity of night terrors. With clients I combine hypnosis with talking therapies.