I‘ve been startled awake countless times in my life. Rowdy neighbors? Check. Teething babies? Check. Wandering fox in the neighborhood? Double check. Well, waking up to the sound of my 3 year old daughter having a night terror makes all those other noises seem quaint in comparison.
I had never even heard of night terrors before then, but you better believe I started researching them quickly. You know, because I had a few hours of wide eyed shock to work through before dawn.
What I learned surprised me, and hopefully some of the following information will help other parents (such as yourself) struggling with this difficult issue.
What Exactly Are Night Terrors?
Night terrors, sometimes referred to as sleep terrors, live up to their name. They are a sleep disorder which cause children, and adults in rare cases, to experience extreme fear and dread while still seeming to be asleep.
When in the grips of an episode, the child will not be responsive to parents or anyone else. Their eyes will likely be open, which is confusing for those trying to calm them down.
Some other frequently seen symptoms include:
- Glazed over stare
- Appearing unaware of one’s surroundings
- Confusion and paranoia
- Unresponsiveness to loved ones and/or inability to be soothed
- Hysterical crying, shaking, and/or screaming
- Terrified facial expression
- Flailing of arms, legs, and other violent movements of the body
- Heavy sweating and labored breathing
As horrible as this experience is, it usually ends in a few minutes and the child has no memory of it ever happening once they wake up in the morning.
For the parents however, it can seem like an eternity while they and their child are going through it.
Note from Dr. Leah Alexander, M.D., F.A.A.P.: “Here is an additional useful link from Nemours Hospital.
This link explains why night terrors occur and how they are associated with REM sleep.
In discussions of night terrors with parents who come to me for help, they seem to occur at the same time each night.
As for age of onset, the earliest I have seen night terrors is at age 3, but research shows they can occur as young as 18 months old.”
How Many Children Do Night Terrors Affect?
Night terrors are a fairly common childhood disorder, with an estimated up to 40% of kids experiencing them at some point in their lives.
There is little you can do to prepare for such an unsettling event, but arming yourself with the facts will help you and your little one cope.
Children from as young as 2 years to as old as 12 years are the most commonly affected.
Both boys and girls are equally afflicted with night terrors, as are all different nationalities as well.
While no gender or race seems to be at a higher risk than others, there does appear to be an hereditary factor involved.
A reported 80% of children who experience night terrors have at least one family member who either sleepwalks or has another sleep disorder of some kind.
Nightmares Vs. Night Terrors: Not The Same Thing
This is a good time to quickly shed light on a common misconception.
Though they are frequently discussed interchangeably, nightmares and night terrors are two entirely distinct conditions.
The main difference between the two has to do with when they occur.
To better understand, let’s look at a brief description of what happens to our bodies while we sleep.
CHOP has a nice article that distinguishes nightmares and night terrors in a parent-friendly way as well, while also giving information about how seizures are different.
What Is A Sleep Cycle?
Our knowledge of what happens to our brains while we sleep is still very limited.
However by combining close observational studies and EEG (ElectroEncephaloGraphy) scans, scientists have developed a rough outline of the human sleep cycle.
Each 5 stage cycle takes approximately 90 to 120 minutes to complete, and the average person completes 4 to 6 cycles per night.
1) Stage 1 – This is the brief onset of sleep, meaning it is very light in comparison to the other stages. The muscles are just beginning to relax, and the body of someone in this stage can be easily awakened.
2) Stage 2 – Consisting of over half the total sleep cycle, this stage involves a slowing down of all the major bodily systems. The breathing and heart rates slow as the brain prepares for deep sleep.
3) Stage 3 – This is a transitional phase where the body slips into very deep sleep. Scientists mark this stage by the onset of delta brain waves.
4) Stage 4 – The last non-REM stage is characterized by slow, steady breathing and pervasive delta wave patterns in the brain. The muscles of the body are mostly shut down at this point.
5) Stage 5 – This stage is distinct from all the rest because it is the only one where REM (Rapid Eye Movement) occurs. It is still uncertain whether or not the eye twitches signal that the brain is accessing images for dreams.
So When Do Night Terrors And Nightmares Happen?
Night terrors have been demonstrated to occur during Stage 4, the last stage of non-REM sleep, whereas nightmares happen almost exclusively during the REM sleep of Stage 5.
Although a small percentage of dreams seems capable of happening at other stages of the sleep cycle, REM sleep is strongly associated with when humans dream.
This helps explain why kids may remember nightmares in great detail, but have zero recollection of an episode of night terrors.
By further studying the effects and length of each part of the sleep cycle, we can also know with some certainty when a child will most likely experience an episode.
Every kid will have slight variations, but typically the first REM sleep stage of the night begins about 2 hours after falling asleep.
This in turn means night terrors occur fairly predictably between 1.5 to 2 hours after the person goes to bed.
Why Do Night Terrors Happen In Babies?
No direct cause has yet been found, but there are a number of risk factors associated with night terrors in babies.
Some of the following may help trigger an a episode in those who are already predisposed to get them.
Children have higher instances of night terrors when they are going through a very stressful experience such as moving to a new home, the birth of a sibling, having a family member in the hospital, or the death of a loved one.
When children maintain a temperature above 101.5°F, it can increase the likelihood and severity of night terrors.
It is not yet known why, but the body fatigue associated with a fever seems like a reasonable cause.
Note from Dr. Leah Alexander, M.D., F.A.A.P.: “I should make a point of distinguishing fever with a night terror from a febrile seizure.
Febrile seizures can occur during awake or sleep periods and are due to rapid increases in temperature, typically under the age of 3.
To further explain the difference between night terrors and febrile seizures, here is a link from Mayo Clinic.”
3) Sleep Apnea
Sleep disorders such as this one can be a huge factor in bringing on an episode.
Sleep apnea in particular causes the brain to receive too little oxygen, which can startle it out of sleep quickly during any stage of the sleep cycle.
4) Disrupted Bedtime Routine
Every parent learns how important it is to establish a regular bedtime routine.
By doing the same calming activities each night before sleeping, a child’s body and mind get into a relaxed state much more conducive to rest.
Not surprisingly, a lack of night time routine makes for a less restful sleep.
5) Awakenings During Stage 4 Sleep
Loud environments may disrupt the brain as it attempts to go through the sleep cycle.
Whether it involves partying in the house, city noise and traffic, or simply inconsiderate older siblings, excessive noises can startle a child out of stage 4 and trigger a night terror.
When To Consult A Doctor
We’ve discussed how horrible, yet brief and immediately forgotten, night terrors can be – but is it a serious health concern, and when should you reach out to a doctor for help?
If you feel something is not right with your child, please do not hesitate to ask your pediatrician. Most parents have no problem dialing up the doctor’s office at the slightest concern.
Night terrors are usually infrequent, and will require no special treatment. They rarely go on for more than a few weeks to a month, and then may never happen again. Even the worst and most recurring cases go away by puberty as the child’s brain develops further.
Note from Dr. Leah Alexander, M.D., F.A.A.P.: “Most of the patients who get night terrors have them several times/week, usually in nightly clusters. Or, perhaps these are primarily the cases that I’m hearing about.
For these situations, I recommend that the parent lightly wake the child 30 minutes prior to when the night terror usually starts.
After about 3 or 4 nights of doing this, the night terrors stop or become very infrequent.”
Certain children have more severe terrors, and because of the effect on themselves or their family, their parents seek ways to treat the problem.
Some reasons prompting parents to call the doctor include:
1) Injury To The Child Or Others
The flailing movements and sleepwalking can be a serious danger.
Children have been known to trip down stairs, punch and kick wildly, or even throw nearby objects.
2) Chronic Sleep Deprivation
This usually means the parents or siblings of the affected child, since the child themself usually falls right back asleep.
But occasionally a kid will have multiple episodes a night, causing them to be overtired constantly.
Perhaps not as serious sounding as the previous two reasons, the feelings of the parents are an equally valid reason for seeking treatment.
While children may not be awake during a night terror, the disturbance felt by everyone who hears the screaming can be a compelling reason to hide it at home.
Many families choose to cancel vacations, camp outs, and hotel room stays because of the potentially very embarrassing explanations to strangers.
How Will The Doctor Help?
Before any treatment will even be discussed, your doctor will first ask you some questions and perhaps run some tests.
They will ask about the risk factors which are talked about above such as family history, stressors, other sleep disorders, and sleep environment.
If further more detailed observation is needed, a sleep study (polysomnography) may be recommended.
Your child might be asked to sleep in a controlled environment with various monitoring devices such as cameras or EEG caps helping to provide data of what’s going on while they sleep.
What Are The Treatments?
There is usually no need for medications, although in the most extreme cases your doctor may prescribe a mild sedative or sleeping pill.
The pediatrician is much more likely to offer a number of suggestions on how to either prevent or lessen the intensity of future night terrors.
1) Minimize Stress
We all have stress, adults and kids alike, but you should do everything you can to cut out the major stressors.
This will mean something different for each family.
You know your child best. Comfort them as best you can in order to help reduce their stress, and their sleep will greatly benefit.
1) Establish Bedtime Routine
Get on a schedule, refine the schedule, and stick to the schedule.
I think it’s safe to say most of us, if not all of us, admit to being guilty of changing our children’s routines when either of us is especially tired.
This may not affect much under normal circumstances, but a child prone to night terrors could see improvement with a stable routine.
2) Interrupt Sleep Cycle
It might seem counter-intuitive at first to wake your child on purpose, since being startled awake is known to be a risk factor.
After keeping a sleep diary, parents are able to pinpoint exactly how long after falling asleep an episode will occur.
Gently waking the child up 10-15 minutes before an anticipated event has been an effective preventative for some.
3) Eliminate Hazards
As was noted above, the entranced state of sleepwalking and night terrors can be quite dangerous for everyone involved.
Preparing for the possibility can go a long way towards preventing injury.
Try installing extra baby gates near stairs, locking nearby windows, and removing any sharp or heavy objects from near their beds.
Note from Dr. Leah Alexander, M.D., F.A.A.P.: “I want to add one more safety precaution to this section.
For patients who sleep walk, I recommend putting a door alarm, bell, or out-of-reach sliding lock on doors of the home.
Although the screaming from the night terror should alert the parent, a more quiet sleepwalker may go unnoticed.
I’ve had two patients who sleepwalked themselves outside; one was a 2 year old who managed to walk into the street! Fortunately, there were no cars and the parents woke up and found her.”
Effects On The Parents
Despite the screaming and hysterics by the child, night terrors are usually the toughest on parents and other family members.
Children are at least lucky enough not to remember the experiences.
For parents and others in the vicinity, though, every night is a nerve wracking wait to be startled by terrible screams.
As a parent who went through this I can tell you, the worst part is not being able to soothe your child.
Scrapes, cuts, broken bones? These can be solved with a first aid kit or a trip to the hospital.
Hearing your little boy or girl screaming in terror and not being able to calm them or stop the fear? That is a gut punch to any parent.
Wrapping It Up
Hopefully science will provide more answers soon as to what causes night terrors and how to eliminate them.
In the meantime, know that you are not alone.
Arming yourself with knowledge will help you through the hardest times.
If you follow the steps laid out in this article, you stand a good chance of lessening or even preventing some of your child’s night terrors.
Also remember that most cases resolve themselves quickly on their own.
Soon this horrible experience will be just another parenting war story to add to your collection.