Have you ever woken up in the middle of the night drenched in sweat with your heart pounding? This baffling phenomenon is known as night terrors, or sleep terrors, a type of parasomnia that typically occurs during the deepest stage of the non-rapid eye movement sleep (NREM). Night terrors are characterized by sudden awakenings at night and are accompanied by intense fear and confusion.

Keep in mind that sleep terrors are not the same as nightmares. People would wake up from nightmares. For sleep terror, people would appear frightened with wide-eyed stares, some episodes even start with a scream or shout, all of this happens while the person stays asleep. Sleep terrors are the same as night terrors, and those two terms are used interchangeably.

In some cases, sleep terrors can result in sleepwalking, another type of parasomnia.

Various factors can trigger the occurrence of night terrors, including certain medications. Night terrors are common in children but can also affect adults.

In this article, we’ll explore the medications that can cause sleep terror in adults. We will also learn the mechanisms and factors associated with causing nightmares.

Medications that can cause night terrors

Various medications can cause night terrors in adults, including:

Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs) are prescription medicines used in combination with talking therapy (cognitive behavioral therapy) to treat depression and anxiety disorders. However, potential side effects include sleep disturbance, including sleep terrors. The antidepressants that can cause vivid dreams may include:

Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Citalopram (Celexa)
Paroxetine (Paxil)

It is important to note that not everyone who takes these medications will experience sleep disturbance. Sleep terrors and other side effects caused by SSRIs may vary from person to person. Studies show that SSRIs suppress REM (rapid eye movement) sleep cycle leading to increased number of awakenings while reducing the overall sleep quality.

Even though paroxetine (Paxil) and fluoxetine (Prozac) have the most data reported for sleep disturbance, virtually all SSRIs seem to be associated with this sleep-related side effect.

It is essential to know that serotonin plays a significant role here. However, the mechanism by which SSRIs cause sleep terrors and nightmares is incredibly complex and has yet to be fully understood. More research is essential to learn about the relationship between SSRIs and sleep side effects.

If you’re wondering whether SNRIs (serotonin-norepinephrine reuptake inhibitors) can cause bad dreams, indeed, not only certain SNRIs, but some other medicine for mental disorders also can cause sleep disturbance. Below are some examples:

Bupropion (Wellbutrin SR), Mirtazapine (Remeron) — atypical antidepressant
Duloxetine (Cymbalta), venlafaxine (Effexor) — SNRIs (serotonin-norepinephrine reuptake inhibitors)

Tricyclic Antidepressants (TCAs)

TCAs are also antidepressant medications. Sleep terrors or vivid dreams are also associated with these medications. The mechanism behind this is that they can affect neurotransmitter levels in the brain, such as serotonin and norepinephrine.

TCAs’ effect on serotonin is similar to SSRI’s. In addition to serotonin, it is believed that TCAs’ sleep side effects can be a result of their anticholinergic and antihistamine properties. Acetylcholine and histamine are natural body chemicals that hold an important role in regulating REM sleep.

Examples of tricyclic antidepressants (TCAs) include:

Beta Blockers (Blood pressure medicines)

Beta-blockers are the blood pressure medicines prescribed to treat high blood pressure, irregular heartbeat, and other heart-related diseases. In addition, beta blockers are also used to prevent migraine headaches, and relieve the symptoms of anxiety. Studies have found that beta blockers reduce the production of melatonin, leading to sleep pattern disruptions and causing nightmares.

The beta blockers that can cause nightmares are:

While they are commonly prescribed without issue, some people may experience drug-induced nightmares or sleep terrors as a side effect. If you notice sleep problems while taking beta blockers, inform your healthcare provider so that he can prescribe an alternative medication.

The good news is that certain beta blockers carry a higher risk of sleep disturbance. If you experience nightmares or sleep terrors while on a beta blocker, you should talk to your doctor to try a different beta blocker.

Dopamine Agonists

Dopamine agonists are used to treat Parkinson's disease or restless legs syndrome (RLS). These medications increase the levels of dopamine in the central nervous system, a neurotransmitter regulating movement and emotions. They can cause parasomnias, including sleep terrors.

If you are taking dopamine agonists such as ropinirole, pramipexole, rotigotine (Neupro), or apomorphine and experiencing sleep disturbances, consult a healthcare provider about alternatives.

Anti-Allergics or Antihistamines

Antihistamines are commonly used to treat allergy symptoms, such as runny nose, sneezing, and itchy eyes. However, there have been case reports, particularly with the older generation of antihistamines, that associate these drugs with the risk of adult night terrors.

The mechanism behind it is not yet fully understood, but it is thought that the nightmares are related to the sedative properties of antihistamines. These medications can affect the central nervous system, disturbing the normal sleep-wake cycle.

Newer-generation antihistamines, such as cetirizine and loratadine, present a lower risk of causing drug-induced nightmares than diphenhydramine, older-generation antihistamines.

It is important that you consult with a healthcare professional if you experience any unusual side effects while taking these medicines.

Sleep Medications

Some medications prescribed to address sleep disorders may inadvertently cause night terrors. Sleep medicine affecting sleep architecture, or those that promote deep sleep or rapid eye movement (REM) sleep, can increase the chances of experiencing vivid dreams.

It is important to treat the side effects of sleep medicine. Consult with your physician to ensure an appropriate treatment plan.

What are the factors contributing to night terrors in adults?

Various lifestyle factors can contribute to adverse effects like night terrors in adults, other than medications. Some of these common factors include:

Stress and Anxiety

Excessive stress or anxiety can lead to sleep disruption. A stressful event or home environment, relationship problems, mental disorders, poor mental health, work pressure, or financial worries can increase the likelihood of experiencing scary dreams at night.

Sleep Deprivation

Insufficient or irregular sleep schedules, insomnia, or sleep disturbance are some factors involved in sleep deprivation. They can alter your normal sleep cycles, making you more prone to a sleep terror episode.

Fatigue and Exhaustion

Mental and physical exhaustion can increase the chances of causing nightmares more frequently.

An overly tired mind and body may interrupt the normal sleeping cycle, ultimately triggering episodes of intense fear and confusional arousals.

Excessive Daytime Sleepiness

The connection between excessive daytime sleepiness (EDS) and sleep terrors is multifaceted. It can change the natural sleep-wake cycle, leading to sleep problems and a sleep disorder. This can contribute to the occurrence of sleep terrors.

Certain sleep disorders, such as obstructive sleep apnea or narcolepsy, associated with EDS, can also increase the risk of experiencing sleep terrors.

Sleep Disorder

The following sleep problems are commonly reported to contribute to nightmares:

Sleep-related breathing disorders (obstructive sleep apnea)
Restless legs syndrome (RLS): an irresistible urge to move the legs
Narcolepsy: a neurological disorder that affects the regulation of sleep-wake cycles)
Sleep epilepsy or nocturnal seizures
Sleep dissociative disorders: a dissociative identity disorder (DID)

Family History

Genetics or family history can be a potential cause of sleep terrors. The chances of someone struggling with sleep terrors increase when a family member already suffers from them.

Certain Medications

Antidepressants, sleep medicine, blood pressure medicines, and mental disorders medicines can affect the balance of natural brain chemicals, causing nightmares as a side effect. These medications may disturb sleep balance, leading to sleep disturbances like night terrors or bad dreams.

What is the connection between medications and sleep disorders in adults?

There is a complex connection between medications and night terrors in adults. The exact reason or criteria is not well-established or extensively researched.

While some medications alleviate health conditions, they can also cause sleep disorders that lead to vivid dreams or sleep terrors as side effects. Not all medications cause these issues. The intensity and frequency may vary from person to person.

How do medications cause sleep terrors?

It is important to understand why and how medications can trigger night terrors. Some of the reasons are:

Medications’ adverse effects

All medications come with adverse effects. Certain medications are designed to target neurotransmitter levels in the brain to treat certain health conditions. However, due to the complexity of these brain chemicals, imbalance of certain brain chemicals and hormones can lead to nightmares or sleep terrors.

Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) work by changing the levels of neurotransmitters or brain chemicals in the nervous system.

An imbalance of serotonin and norepinephrine levels can disrupt sleep patterns and may lead to sleep disturbances, including sleep terrors.

Other natural body substances, such as histamine and acetylcholine, also play a part in regulating sleep. Therefore, allergy medications and certain antidepressants can cause sleep terrors as side effects.

Alterations in Sleep Architecture

Sleep aids that help with falling asleep and drugs used to treat sleep disorders can disrupt the structure and stages of sleep. For example, medications promoting rapid eye movement sleep (REM) can increase the chances of adult night terrors.

Heightened Sensitivity

If someone shows a heightened sensitivity to specific drugs, it can increase the risk of experiencing nightmares. Not everyone shows the same severity of the effects of the medication interaction.

If you suspect that your medications are causing nightmares, contributing to your night terrors or sleep disturbances, consult with your healthcare provider to discuss treatment options.

When to see a doctor for vivid dreams caused by medications?

If you are experiencing vivid dreams as a side effect of medication, it is advisable to consult your doctor. You should consider reaching out to your healthcare provider if your sleep problems are causing any of the following:

Distressing or disruptive dreams
Increased anxiety or worsening mental health
Worsening or persistent symptoms

If you are experiencing sleep terrors or other sleep disturbances while taking medication, immediately communicate this to your doctor. It is always recommended to consult with your healthcare provider or pharmacist for possible alternatives.

A sleep specialist may recommend you keep a sleep diary to track each sleep terror episode and allow them to prescribe alternative medications to minimize these episodes for a restful night's sleep. As always, practicing sleep hygiene is highly recommended. Even though sleep hygiene may not alleviate sleep terrors, you may benefit from having a restful sleep in the long run.

References:

https://www.nhs.uk/conditions/night-terrors/
https://www.ncbi.nlm.nih.gov/books/NBK19961/
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235766/
https://pubmed.ncbi.nlm.nih.gov/15892588/
https://jpc.tums.ac.ir/index.php/jpc/article/view/98/86
https://www.healthcentral.com/condition/night-terrors#:~:text=Particularly%20among%20adults%2C%20prescription%20drugs,all%20can%20provoke%20sleep%20disturbance.
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