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Is It Sleep Paralysis or a Night Terror?

Conditions Can Be Distinguished by Differences

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Updated June 04, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

There are two distinct sleep conditions that might seem similar in their descriptions: sleep paralysis and night terrors. Each can have elements that terrify, either experienced by the person who has it or alternatively by those who witness it. Sometimes the terms may incorrectly be used interchangeably, but there are clear differences. What is the difference between sleep paralysis and night terrors? How can these conditions be distinguished from one another?

First, it is key to understand the basics of each condition. (To add another layer of confusion, night terrors are sometimes referred to as sleep terrors.) You can get a nice introduction to each by reviewing these articles:

As you consider these detailed descriptions of each occurrence, hopefully you begin to recognize some of the key differences between sleep paralysis and night terrors. In order to better understand these distinctions, let’s review some of the highlights.

Night terrors may uncommonly affect adults, but they typically affect children. On the other hand, sleep paralysis often begins in adolescence and persists well into adulthood.

A key element to consider is how the condition affects the person who experiences it. In the case of night terrors, the event is not remembered by the child. Quite to the contrary, sleep paralysis is vividly recalled in horrible detail by the person who endures it. This suggests distinct levels of consciousness in the conditions.

When a parent observes a night terror, the child may seem anxious and upset, perhaps moaning or screaming. In contrast, someone who is witnessed having sleep paralysis may seem still and silent, with quiet breathing and open eyes. The self-reported experiences of sleep paralysis may be as vivid and varied as that which occurs in our dreams, which fits nicely with the underlying cause.

Night terrors come out of slow-wave sleep that occurs in the early part of the night. This deep sleep makes the affected child difficult to arouse. In sleep paralysis, which may often occur toward the morning, the persistence of REM sleep into wakefulness results in the characteristic symptoms. There may be vivid hallucinations, an inability to move or speak, and emotions such as fear. When this occurs as part of dreaming sleep, it is unremarkable, but when we have regained consciousness, it becomes upsetting. The unique sleep stages that result in these conditions is a clear difference.

It is difficult to wake children from a night terror. Instead, it is best that they fall back asleep, which they often do. Most people with sleep paralysis also fall back asleep within a few minutes, but it is also possible to awaken fully. Some people report being able to gradually regain control of their extremities as the paralysis slowly leaves. Alternatively, someone else can also stimulate you enough to awaken you from sleep paralysis.

Isolated sleep paralysis occurs frequently and has no major adverse consequences or association with any particular disorder. However, it may also occur with three other characteristic symptoms as part of a more serious sleep disorder called narcolepsy. Conversely, night terrors that occur in childhood may simply suggest a brain that has not fully developed. Night terrors are not associated with other sleep disorders.

Finally, the treatment options for sleep paralysis and night terrors differ. It is often unnecessary to treat night terrors as most children outgrow them. There is little risk of harm and since the child does not remember the event, there are few consequences. Once parents understand what is happening and how best to ease the child back to sleep, this is usually sufficient. In rare circumstances, if the night terrors are severe and disruptive, medications such as benzodiazepines and tricyclic antidepressants may be used. The treatment of sleep paralysis often includes avoiding triggers that disrupt sleep, but it also may not need to be treated.

In conclusion, sleep paralysis and night terrors are distinctive conditions that can be distinguished in multiple ways. They are experienced differently by the affected person and can be uniquely characterized by what is observed. Each event occurs at a different time of night, from a different sleep stage, and even at a different time in life. The treatments are unique, and understanding whether it is sleep paralysis or a night terror is an important first step.

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