An Overview of Night Terrors

Night terrors, a common sleep disturbance found mostly in children, can include signs such as screaming, crying, moaning, elevated heart rate, panting and other fear signals. Though children may open their eyes, talk, and even get up and walk around, they do not awaken fully during an episode of night terrors. While this sleep disturbance can be distressing for parents and caregivers, children are usually able to fall back asleep once the episode has finished and do not typically remember it the next day. Because few longterm consequences are observed in children who experience night terrors, the condition is usually considered a harmless one. Night terrors most often occur in children aged 3 to 7, however, it is also possible for older children and adults to experience them. Estimates on the prevalence of night terrors vary widely; some studies show that 56% of children experience at least one episode of night terrors.

While there are certain similarities, night terrors—also known as sleep terrors—are not the same as nightmares. Children experiencing nightmares are easily awoken and able to respond to caregivers, while children experiencing night terrors may seem unresponsive or even combative. Because they do not awaken fully, they are usually unable to interact with parents or caregivers in their normal fashion. Night terrors frequently occur in the first part of the night, or about 1-4 hours after sleep onset, and coincide with deep, non-REM sleep. Though they can last between one and several minutes, occasionally they 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.

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 contributing to both night terrors and sleepwalking. Fever, certain medications, head trauma, and stress may also be implicated.

If your child's behaviors fit the description of a night terror, then that is the most likely cause of symptoms. Conversely, if your child is easily awakened, can interact with you normally, and has dream recall, they are likely experiencing a nightmare instead of a night terror. 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.

Most children do not experience the kind of 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 to prevent episodes. However, when symptoms regularly interfere with sleep, there are a few treatment options available.

This involves a parent or caregiver waking the child approximately 15 minutes before sleep terrors are usually experienced (which tends to be during the first 1-4 hours of sleep).

It may be helpful to keep a sleep journal for your child and note the factors such as their bedtime, napping routine, and everyday stressors that may be contributing to night terrors.

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

Night terrors are generally considered non-traumatizing because most children outgrow them and because episodes are not usually recalled the next day. As such, medications are used only rarely in children. Benzodiazepines or antidepressants are two options your child's pediatrician might recommend if night terrors remain a persistent problem and do not respond to other interventions.

Remain calm. Because you may not be able to fully awaken a child experiencing a night terror, it's best to ensure that the child is safe, provide comfort and reassurance, and help him or her fall back asleep. In many cases, it's actually better not to attempt an abrupt awakening of the child and instead to wait out the night terror. Because night terrors can be associated with sleepwalking and abnormal movements, be sure that your child's sleeping environment is safe, i.e. that windows are closed and doors to the outside are locked. Also, be sure to alert babysitters or other caregivers if your child experiences night terrors and coach them on how to respond appropriately.

Night terrors are one fairly common type of parasomnia, or sleep disturbance, that usually resolves as a child's nervous system matures. If you find that night terrors occur according to a pattern, or if they regularly disturb your child's sleep, you can consult with a pediatrician for possible solutions. Most of the time, however frightening they may seem in the moment, night terrors do not warrant medical intervention.