A 7-year-old boy suddenly sits up in bed during the first two hours of sleep, screaming and appearing terrified, with sweating and tachycardia. He is unresponsive to his parents' attempts to console him and has complete amnesia for the event the next morning. During which sleep stage do these episodes typically arise?

• A Stage N2 sleep
• B Stage N1 light sleep
• C REM sleep
• D Stage N3 slow wave sleep ✓

Explanation

Sleep terrors are disorders of arousal arising from stage N3 slow wave sleep, typically in the first third of the night, with intense autonomic activation and amnesia. The key discriminator from nightmares is timing and recall: nightmares occur in REM sleep in the latter part of the night and are vividly remembered.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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