Night terrors

Night terrors are a form of sleep disorder that can be very distressing for young children, as well as upsetting for their parents. Night terrors are distinctly different from common nightmares and are characterised by frequent and recurrent episodes of fear and crying and during sleep, with difficulty rousing the child to wakefulness. Night terrors typically occur in children aged 3-12 years, with boys slightly more affected than girls. In children younger than 3½ years, the peak frequency of night terrors is at least one episode per week. Among older children, the peak frequency is one to two episodes per month. The disorder usually resolves during adolescence.

Night terrors or nightmare?

Sleep is divided into two categories; rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. Non-REM sleep is further divided into four stages and night terrors occur during the transition from stage 3 to stage 4 non-REM sleep, starting around one hour and 30 minutes after the child falls asleep. Nightmares which occur during REM sleep and are dreams that contain images. These images can be recalled once the child has awoken. Night terrors are not technically dreams, but rather a fear reaction that occurs during the transition from one sleep phase to another. Unlike many incidences of nightmares, a child won’t have any memory of a night terror the next day because they were in a deep phase of sleep when it happened and there are no dream images to recall.

Symptoms of night terrors

The most common symptoms of night terrors are the frequent and recurrent episodes of intense crying and fear during sleep combined with difficulty in awakening the child. Other typically seen symptoms include:

  • Sweating during episodes
  • Agitation and thrashing around in bed
  • Screaming out
  • An increased heart rate
  • An increased breathing rate
  • Inability to be comforted
  • Lack of awareness of parents’ presence

Most night terror episodes last 1-2 minutes, but they can last up to 30 minutes before the child relaxes, calms down and then simply returns to normal sleep. If the child does awake during a night terror, they usually cannot recall much of the episode. Similarly, the child generally won’t be able to remember the episode after waking in the morning.

What causes night terrors?

Night terrors are caused by an over-stimulation of the child’s central nervous system (CNS) while they are asleep. The CNS regulates sleep and waking brain activity and takes time to mature – it is thought that night terrors may result from having a not yet fully matured CNS. There may be an inherited component as well, as about eight out of every ten night terror sufferers has a family member who has also experienced them, or has had another sleep disorder such as sleepwalking. Specific triggers for night terrors have been identified as including the following:

  • Stressful life events
  • Fever
  • Sleep deprivation
  • Sleeping away from home
  • Medications that affect the central nervous system (the brain)
  • Recent anesthesia given for surgery

Coping With Night Terrors

Night terrors can be very upsetting for parents, as it is distressing when a child is unable to be comforted during an episode. Frequent and recurrent night terrors can be disruptive to family life and lead to a lack of sleep for parents and siblings, especially those who share the same room as the child experiencing them.  The best way for you as a parent to deal with a night terror is to stay with your child and wait for it to pass without trying to wake them. Many attempts at arousal don’t work anyway, with those who are awoken likely to be disoriented and confused, taking longer to settle and go back to sleep. What you can do is make sure that your child’s environment is safe during an episode and ensure that they don’t get hurt if they thrash around. Children will usually settle down and return to sleep on their own after a few minutes.

Should I seek medical treatment for my child?

Although night terrors are not in themselves dangerous, the sleep deprivation that often ensues during frequent and repetitive episodes can be a cause for concern, as it can lead to delays in their development. Half of all children with night terrors develop a disrupted sleep pattern serious enough to warrant assistance from medical professionals. If your child seems to be experiencing night terrors, you should first contact your doctor, who may refer your child to a paediatrician who will make an evaluation and exclude other possible disorders that might be causing them. In severe cases, a referral to a specialist sleep disorders clinic.

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