UPDATED INFORMATION

From 2004 through 2011 we learned a great deal by offering free personal guidance to night terror sufferers who read our book (we became overwhelmed and had to end that service in 2011). This included monitoring and helping alleviate much of their suffering. The following updated information explains some of the understandings that we have subsequently modified, as well as some of our original points that have now been scientifically validated. This supplement will also serve as a valuable guide to help in locating those portions of the book that are most relevant to your individual situation.

1. Pages 3, 4 and 12 explain the key point that there are two distinct types of night terrors: Type A (Pure Childhood Night Terrors) and Type B (Trauma-related Night Terrors). This has become the most universally accepted concept in the entire book. Every knowledgeable professional has now imitated our classification in one form or another (some now calling them "Type 1 and Type 2").

2. Thankfully, the majority of those who have purchased this book are dealing with a child who has Type A Night Terrors. They are universally relieved to find that this type is temporary and self-resolving. Pages ix (Preface) through 58 contain just about all the information that is pertinent to this relatively common childhood sleep disorder.

There is a recent strategy, not mentioned in the book, that has been reported to help lessen the frequency and severity of childhood Type A Night Terror attacks. The parent (or caregiver) first notes the time interval between the child falling asleep and the night terror episode (typically between ten minutes and one hour). If the child usually has a Night Terror attack 30 minutes after falling asleep, then the parent mildly wakes the child about twenty minutes after he/she falls asleep. This has been found to disrupt the stage four deep sleep cycle and thus decrease the frequency of night terror attacks (stages of sleep and their connection to night terrors are explained in the book).

3. We have heard over and over, in both childhood Type A cases and the more serious Type B cases that it is absolutely essential to eliminate all caffeine.

4. Sadly, two families who bought the book fell into the gray area of a child who was probably suffering from the much more serious Type B Night Terrors. In both cases the child had been adopted after being removed from an abusive home. The guidelines on pages 49, 50 and 51 will either leave the parents almost certain that they are dealing with only Type A Night Terrors, or cause them to consider the possibility of Type B Night Terrors. Chapter Seven, "Clarifying the Diagnosis" (pages 79-85) will also be of help. But those parents who adopted children with night terrors must familiarize themselves with the entire book, and especially the sections dealing with Type B Night Terrors.

5. We have been very relieved to hear of many Type B Night Terror sufferers who had virtually none of the offshoots and secondary complications outlined in the book. Our book covers the most severe and debilitating manifestations of the condition. The worst cases are the compound cases like that of the book's author in which extreme unrelenting abuse in childhood led first to the development of Type B Night Terrors. Then the continual physical and emotional stress resulted in the secondary characteristics and health problems listed on pages 71-77. Finally the combination of night terrors, a highly dysfunctional upbringing, psychological damage, and also sleep deprivation, resulted in relationship problems later on in life. Let me stress that the actual nighttime attacks were very similar and intense in all Type B cases. But there was a great variety in how many of the negative offshoots were present among sufferers.

I also heard from people who experienced extremely traumatic events in late adulthood and then developed night terrors for the first time in their lives (very similar to doctor Marshall's three patients on page 9). These cases were much simpler to deal with because there was no long-term compounding of the problem. Also beneficial was the fact that the cause and effect were known and obvious. Even though all Type B Night Terrors are serious, the cases without the many negative offshoots and compound complications are far easier to resolve than the lifelong cases that began decades earlier with extreme childhood abuse. If yours is the more "simple" Type B Night Terror condition, then few of the negative offshoots and complications written about in the book are applicable to you. Many people who bought the book have been in this more fortunate group. In the section, "Six-Step Approach to Healing" (pages 147-159) only steps 1, 5, and 6 were applicable to them.

Of course, there have been many Type B Night Terror sufferers whose histories did parallel those of the worst case examples in the book. They have had to deal with all the negative ramifications and offshoots of their compound Type B Night Terror problem. They have been relieved to have gained an understanding of the health issues and interpersonal difficulties that have plagued their entire lives. They now had a starting point and enough information to begin the hard work of addressing and in many cases successfully resolving their multifaceted condition.

If you were one of the many sufferers who is not dealing with long-term night terror related health issues and/or interpersonal or relationship problems, then your situation is definitely far easier to resolve than a severe compound Type B Night Terror problem. Thankfully, the parts of the book that describe these progressive manifestations will not apply to you personally. We have been surprised to discover how broad the scale is concerning the varying degrees of severity in Type B Night Terror cases. Like with any disease or condition, there have been less and more severe individual cases and circumstances. However, the actual nocturnal attacks were all very similar and disruptive throughout the entire scale. A simpler case of Type B Night Terrors did not mean less severe nighttime attacks. It did mean much simpler ramifications to deal with, and in most cases, quicker resolution.

6. Recently, we have been hearing about more and more cases involving young soldiers who developed Type B Night Terrors while on their second, third, or fourth tour of duty in the bloody carnage of Iraq and Afghanistan. In these cases the offshoots are very limited or nonexistent. The time frame between the trauma and development of night terrors has been short and the connection between the two is easily understood. Although tragic and quite serious, these cases too are much easier to resolve than lifelong cases that began in childhood.

7. DRUGS: This is another area where we were quite sure that the Medical community needed to reexamine their treatment methods. At the beginning of 2004 we sent out approximately 300 FREE copies of our book to sleep clinics around the USA and another 100 books to clinics around the world. After our 2004 publication date, articles began appearing in Professional Journals that VALIDATED OUR WRITINGS. One of those post-2004 articles was written by Sue Wilson and Spilos Argyropoulos (of the University of Bristol in England), entitled "Antidepressants and Sleep." It confirmed many of our findings.

They wrote: "There is evidence that some antidepressants may be useful in the treatment of sleep disorders such as night terrors. Paroxetine (Paxil) has been reported to be effective in [treating] adult night terrors." Their findings correspond to what we wrote about Paroxetine throughout the book. See pages 34, 133-135, and pages 137-142 which began under the heading "Later Use of Paroxetine May be Better".

Wilson and Argyropoulos also wrote: "SSRI's have the advantage of low abuse potential and less impairment of performance tasks compared with the Benzodiazepines." We wrote in the book that we felt many professionals were recommending the wrong drugs for night terrors. We took issue with the widespread prescribing of Benzodiazepines (see pages 18, 121, 122, 133-137) because of their limited effectiveness and negative side effects.

Wilson and Argyropoulos also wrote about dosage: "a six week study showed that Paroxetine 15-30mg per day... showed significant improvements in ease of getting to sleep, speed of getting to sleep, restfulness of sleep, and reduced awakenings." This 15-30mg of Paroxetine per day was in line with what we wrote (we had suggested a 20mg starting dosage on page 141). Most of those we counseled began with 20mg per day and went up from there, if after 30 days that dosage was only marginally effective. When a correct dosage was found, most were instructed to stay with that dosage for at least six months. Only then did they experiment with small reductions. But almost all reported that it was necessary for them to stay on Paroxetine in order to keep the night terrors from returning. This should not have surprised us. Throughout the book we referenced some of the studies linking severe trauma with chemical changes to the brain. If these chemical changes are indeed factors in the more serious night terror cases (as the literature we quoted suggested) then one would expect the need for drug intervention to be ongoing and possibly lifelong.

But not even the experts understand exactly how Paroxetine works in helping to alleviate night terrors. Wilson and Argyropoulos also wrote that: "Paroxetine has been reported to be effective in adult night terrors and sleepwalking; of interest to the mechanism of action is that in both of these disorders the effects of the [Paroxetine] are seen early in treatment-often on the first dose. This means that the mechanism cannot be the same as for lifting mood, which takes 3-4 weeks. We suggest that the most likely explanation is a direct pharmacological action to increase serotonin in the brainstem regions suppressing ascending arousal pathways." They are saying that when Paroxetine is prescribed for mood disorders it takes weeks before it does some good. When used for night terrors the results are often instantaneous. Therefore the Paroxetine must be working by a different mechanism in each application. Otherwise the time frame would be the same.

8. Vancenase, Flonase, and similar inhaled nasal steroids (commonly prescribed for severe allergies) definitely appear to be factors in increased night terror activity among those already suffering from night terrors. These prescription medications work by suppressing HPA (hypothalamic-pituitary-adrenal) function. We quoted studies and also provided other information on the relationship between pituitary, and/or adrenal secretions, and anxiety disorders (see pages 5, 21, 26-29, 41-42). Therefore, it's not surprising that taking drugs designed to interfere with pituitary and/or adrenal secretions helps to bring on more frequent or severe night terror attacks among sufferers. Eliminate these drugs and find other allergy remedies if you are already a night terror sufferer.

9. A fairly recent study conducted at the University of Chicago Medical Center found that disrupting the deepest periods of sleep can damage the body's ability to regulate blood glucose levels, potentially raising the risk of developing type 2 Diabetes. Dr. Eve Van Cauter (co-author of the study) wrote: "These results suggest that strategies to improve sleep quality, and as well as quantity, may help to prevent or delay the onset of type 2 Diabetes."

This Diabetes study was especially interesting to me. For 2 decades now, I've had my professional Blood Glucose Test done after a day fast rather than first thing in the morning. My at-home testing records revealed unusually high morning Blood Glucose readings after a nighttime fast, and normal readings after a daytime fast. The nighttime fast readings suggest Diabetes or Pre- Diabetes, while the daytime fast shows NORMAL blood glucose levels. I believe that even without serious Night Terror attacks, "ADRENAL DUMPING" (covered in book), occurs throughout the night, and with it the accompanying "Glucose Dumps"into the bloodstream as part of the body's fight or flight mechanism. The result is that my morning Blood Glucose level is artificially high. One either has Diabetes or they don't. The time of the 8 hour fast makes no difference in people who never had Night Terrors. There is no reason for my Daytime Fast Glucose Level to be around 93 mg/dL, and my Nighttime Fast Glucose Level to be some 20 mg/dL higher (except for Night Terror related "Adrenal Dumping). I'm sure it's NOT indicative of Diabetes because my A1C tests are always NORMAL (the AlC test measures the average blood sugar levels for the prior 3 months). One clinic I get my tests done at, does not do bloodwork after 12 noon. When I go there I begin my day at 4AM, have breakfast, and then fast for 8 hours before the test. The reading then comes in normal (around 93 mg/dL). All adult Night Terror sufferers should carefully consider the above (as well as the sleep disruption complications we noted on p. 71-77).

[The late Dr. Jane Dill (co-author) had enjoyed archiving the many validations of our findings in the professional literature. Until her death in 2015, she had been noting confirmation after confirmation of the information we had written in our book.]