Night Terrors

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With their eyes shut and heads resting on a fluffy white pillow, young children often look like peaceful angels snoozing on a cloud of cozy blankets. But for children who suffer from night terrors, tranquil slumbers can quickly turn to blood-curdling screams, sweating and flailing limbs.

Watching a young child in the midst of a night terror can feel terrifying. That’s why I explain to my patients’ parents what’s happening and why – the knowledge provides a bit of peace amidst the chaos.

A classic question I’m asked is: what’s the difference between night terrors and nightmares? Parents can distinguish between the two based on how easily it is to wake the child and when the bad dream occurs.

With a typical nightmare, children awaken easily and they often recount details from their scary dream, which usually involves a story line. On the other hand, it’s extremely difficult to wake a child from a night terror. Typically the child will fall back to sleep quickly, and in the morning, he won’t remember a wink of it. The differences are linked to separate sleep stages. Nightmares occur during rapid eye movement (REM) sleep in the second half of the night, while night terrors happen in the deepest stage of non-REM sleep, which occur in the first few hours of the night.

During the deepest stage of non-REM sleep, the brain’s cortex (the largest part of the brain that controls thought and other higher brain functions) turns off – leaving only reflexes and primitive emotions at work. That’s why the brain continues to sleep during a night terror, even though the body awakens. It’s sleep limbo, and that’s why sleep experts label night terrors as a partial arousal disorder.

While 50 percent of children experience nightmares at some point, only 3 to 5 percent experience night terrors. The terrors usually begin in preschool-aged children. The good news is that most children outgrow night terrors. In fact, among youngsters with night terrors, roughly half experienced their last one by age 8.

What should parents do if they think their child is having a night terror? Many night terrors look like this: A child jolts up in bed, crying, screaming, panicking and pushing. The child’s eyes may be open and dilated, but she seems unaware of basic surroundings. Though parental instincts say to hug the child tightly and calm her down, the child will likely become aggravated by physical touch and will not respond to soothing voices.

The best thing a parent can do is remain calm and remember it’s harder to watch than to experience. Night terrors torture parents more than the child because the child won’t remember any of it, but the parent often feels traumatized by seeing their little one so petrified. Night terrors usually last only a few minutes, but they can continue for up to an hour; and many follow a pattern of occurrence.

If parents note that the child’s terrors begin approximately 90 minutes after falling asleep, I suggest parents stir the child 30 minutes prior to the upcoming terror. By simply changing sleep positions, the brain resets into a non-REM stage, skipping the menacing sleep limbo.

Another treatment option is a temporary nightly dose of clomazepam, a medication prescribed to make sleep more restful. Talk with your pediatrician or pediatric sleep specialist to find out if a prescription would be right for your child.

Parents should also talk with medical professionals if they notice:

Repetitive movements during scary sleep. Repetition, such as a child always shaking or turning to the same side during the episode, may be a sign of sleep seizures.

Night terrors occurring every night for multiple nights. Most terrors show up once a month; or if the child is sick, has a fever or feels overly tired. Sometimes terrors are a result of a different problem that continuously awakens the child, like too big of tonsils or sleep apnea. If night terrors happen every night, the brain can get in a rut.

Sleep studies are recommended for teens and adults with night terrors to see if something is waking them during deep sleep, such as sleep apnea.

Many parents worry that night terrors indicate the child has experienced a traumatic event, but it’s not true. On the same note, researchers have found no common links between night terrors in childhood and future psychiatric problems.

Though night terrors look terrifying, remember that the condition is not dangerous and the child doesn’t know what’s going on — it’s just a combination of the unplugged brain and primitive emotions — so remain calm and try to get some rest.

For more information, visit www.presbyterian.org/sleep.

Dr. Carolyn Hart is a pediatric sleep specialist at Presbyterian Family Sleep Center.