A 38-Year-Old Woman’s Screaming, Thrashing Alarms Her Husband

Heidi Moawad, MD


January 24, 2023


The patient in this case had sleep terrors, which are events characterized by abnormal movements, sounds, autonomic symptoms, and a sense of fear during sleep. Routine nightmares or bad dreams are not typically associated with a specific pattern of movement or the production of sounds during sleep. Sleep paralysis is an experience during sleep that patients describe as a terrifying feeling, with an inability to move their body during the episode. This patient does not have any history to suggest that she has experienced a severely traumatic event that could lead to posttraumatic stress disorder (PTSD). Although the type of nighttime parasomnia this patient describes could be associated with PTSD, it does not appear to be the case in her situation.

This patient probably had sleep terrors as an adverse effect of her allergy medication. Her pills were taken to a pharmacy and identified as generic cetirizine, which can cause sleep terrors. After she was advised to stop taking the medication, she no longer experienced any similar symptoms. She was also tested for allergy triggers. When no specific allergy trigger was identified, she started using an air purifier and did not have allergy symptoms for several months. However, as of the time of follow-up, a year had not yet passed; thus, she did not know whether a seasonal trigger would cause her allergic rhinitis to return.

Sleep terrors, also described as night terrors, are a type of parasomnia. Parasomnias are episodes of abnormal movements during sleep, and they can become distressing, especially when they are recurrent and when they occur during adulthood. The most common parasomnias are nightmares, sleep terrors, sleepwalking, rapid eye movement (REM) sleep behavior disorder, and sleep paralysis.

Sleep terrors are episodes of abrupt arousal from sleep. Patients exhibit behaviors such as sitting up, screaming, flailing, or fighting. During the episodes, patients have autonomic hyperactivity. In the morning after the episode, patients may recall that they felt terrified or had a feeling of doom. However, some patients, especially children, do not recall the episodes.


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