An Overview of Night Terrors

Night terrors, or sleep terrors, are a type of sleep disturbance that mostly affects children ages 3 to 7, although some older children and adults experience them. Signs someone is experiencing a night terror include screaming, crying, moaning, elevated heart rate, panting, and other indications of fear. Though children may open their eyes, talk, and even walk around during a night terror, they do not awaken fully. It can be distressing to witness a child having a night terror but it's important to know most children fall back fully to sleep afterward and typically do not remember it the next day. Because few longterm consequences are observed in children who experience night terrors, the condition usually is considered harmless and manageable with measures such as regulated sleep scheduling. In rare cases, medication may be prescribed.

Symptoms

Despite some similarities, night terrors are not the same as nightmares. Children experiencing nightmares are easy to wake up and able to respond to caregivers, while children experiencing night terrors may seem unresponsive or even combative. Because they do not awaken fully, they usually aren't able to interact with others. Night terrors frequently occur in the first part of the night, or about one to four hours after the onset of sleep, and coincide with deep, non-REM sleep. Most last for only a few minutes, though some are more prolonged.

Symptoms of night terrors may include:

• Bolting upright in bed
• Crying, often inconsolably
• Screaming
• Elevated heart rate
• Panting or rapid breathing
• Glassy eyes
• Sweating
• Gasping
• Moaning
• Other symptoms of anxiety or panic
• Confusion if awakened fully
• Lack of dream recall

Sleepwalking, though not a direct symptom, can also be associated with night terrors.

Causes

Sleep terrors seem to occur when deep sleep becomes fragmented. This may be more likely in periods of stress characterized by sleep deprivation or irregular sleep patterns, or it may be secondary to other sleep disorders like sleep apnea.

It is important to differentiate these episodes from seizures that occur in sleep, as seizures can also cause unusual behaviors and are often triggered by sleep transitions.

There may be a genetic component of both night terrors and sleepwalking. Fever, certain medications, head trauma, and stress may also be implicated.

Diagnosis

The characteristics of a night terror are relatively obvious and unique. If you seek guidance from your child's pediatrician, they will likely review your child's medical history, perform a physical exam, and ask you to describe the frequency and intensity of symptoms. To provide accurate information, it may be helpful to keep a journal to document your child's episodes. Your child's pediatrician can also perform an EEG to determine any unusual brain activity associated with seizures, or a sleep study to check for apnea or a related sleep disorder.

Treatment

Most children do not experience severe or prolonged symptoms that necessitate treatment, and the condition tends to resolve itself as the child ages. Helpful practices include sticking to a regular bedtime and avoiding overtiredness. However, when symptoms regularly interfere with sleep, there are a few treatment options available.

Scheduled Awakenings

This involves waking the child approximately 15 minutes before they tend to experience sleep terrors—typically during the first one to four hours of sleep.

Keeping a Sleep Journal

Maintaining a record of factors that seem to coincide with or contribute to a child's night terrors can provide helpful information that can be used to develop a plan for manageing them. Helpful things to note in a sleep journal for your child include their bedtime, napping routine, and everyday stressors.

Technology

The Lully Sleep Guardian is a Bluetooth-enabled device about the size of a hockey puck that's placed under a child's pillow. It vibrates to gently draw the child out of the deep, non-REM sleep associated with night terrors. Ask your child's doctor about the possible benefits and risks of using such a device.

Medications

Night terrors generally are considered non-traumatizing because most children don't remember them in the short term, and tend to outgrow them. For this reason, medication is rarely necessary to manage them. In cases in which a medication may be helpful, the types of drugs most often prescribed are benzodiazepines (sleep medication) or antidepressants.

Coping

When a child is experiencing a sleep terror, remain calm. Since it's unlikely you'll be able to wake them, focus on making sure they're safe, be comforting and reassuring even if the child seems unresponsive, and do what you can to help soothe them back to sleep. Let babysitters and other caregivers know your child is prone to night terrors, describe what an episode looks like, and offer instructions for what to do.

A Word from VeryWell

If your child has recurring night terrors, it can be frightening to observe and exhausting to live through. Have your child evaluated to make sure something else is not to blame for these episodes and then come up with strategies to manage them until your child grows out of them, which in all likelihood will happen. Most of all, be assured your child is not being harmed or traumatized by their night terrors and eventually they will be a thing of the past.