Night Terrors: What are they, Symptoms, Causes, and Prevention

 

Trouble sleeping is common. Whether due to a busy schedule, stress, or other factors, many people struggle to get a healthy amount of sleep. In fact, over 75 percent of adult Americans from ages 20 to 59 report being unable to get the sleep they desire. Moreover, up to half of the children will experience sleeping problems. When an individual is chronically unable to get healthy sleep, they may have a sleep disorder. Sleep disorders are medical conditions that interfere with an individual’s sleep patterns. Night terrors are a common sleep disorder that effects both children and adults.

Night terrors

Night terrors are not uncommon in children

What are Night Terrors?

To understand night terrors we need to understand the stages of sleep that we go through at night.

There are two principal stages of sleep that alternate at night:

  • Non-REM, where there is hardly any eye movement
  • REM, characterized by rapid eye movement. This is the stage of deep sleep, where it’s difficult for us to wake up. It’s also when dreams and nightmares occur.

The Non-REM stage has various stages that start as soon as we fall asleep. The first is the transition from wakefulness to sleep, then light sleep, and the last two stages are a deep sleep. It’s in these stages of Non-REM deep sleep where night terrors happen, which is usually around 90 minutes after falling asleep.

Night terrors, or sleep terrors, are a type of sleep disorder involving feelings of terror or dread. Among sleep disorders, night terrors are classified as a “parasomnia”. Parasomnias involve abnormal movements, behaviors, perceptions and emotions that occur during sleep. An individual experiencing a night terror may awake suddenly in fear, scream, cry, thrash about or even sleep walk. Their eyes may be wide open but they are not actually awake. These episodes typically last from 10 to 30 minutes. Similar to an individual experiencing panic attacks, they will be inconsolable.

Night terrors can occur in both children and adults. They most commonly occur between the ages of 3 and 12, and 20 to 30, typically subsiding in adolescence. They are likely to occur in the first hours of sleep, during stage 3 and 4 non-rapid eye movement (NREM) sleep, and tend to happen when an individual is aroused from a state of delta sleep, or “slow-wave sleep”.  Because night terrors occur during NREM sleep, they are a disorder of arousal. They could be thought of as a ‘glitch’ in the transitions made between sleep stages.

Nightmares or Night Terrors?

While night terrors bear some similarities to nightmares, there are key differences. An individual experiencing a nightmare will be having vivid dreams that involve feelings of fear and dread. These dreams typically cause the individual to suddenly wake from their sleep. The dreams can involve many different things, and dream content will often be remembered upon awakening. Nightmares occur in almost all people during childhood.

An individual experiencing a night terror exhibits partial arousal during the episode and cannot be woken or consoled. They are likely to remain asleep after the episode and unlikely to remember anything that happened during the night terror. Children are less likely than adults to recall details.

Night terrors

Night terrors

How to Recognize Night Terrors

Individuals experiencing a night terror may exhibit the following symptoms:

  • screaming or shouting
  • kicking and thrashing
  • suddenly sitting up in bed
  • a wide-eyed stare
  • distressed mumbling or moaning
  • increased heart rate
  • increased breathing rate
  • sweating
  • not able to be awaken
  • kicking and thrashing
  • little or no memory of the event
  • cannot be soothed or comforted
  • sleep walking, running

Causes of Night Terrors

There is some evidence that susceptibility to night terrors is congenital. Individuals who report that their family members have experienced either night terrors or sleepwalking are more prone to these conditions themselves.  Some studies have found that those with first-degree relatives who have experienced night terrors are ten times more likely to experience the condition themselves. Research suggests an autosomal mode of inheritance.

If you or your child is experiencing night terrors, there are some potential contributing factors to consider. These include:

  • Sleep deprivation / extreme fatigue
  • Attention problems
  • Interrupted sleep schedule
  • Stress
  • Fever

Furthermore, there are some underlying conditions that can cause night terrors:

  • Restless leg syndrome
  • Asthma
  • Sleep apnea, or other sleep disordered breathing
  • Acid Reflux
  • Mood disorders
  • Drug use
  • Central nervous system medications

Night Terrors in Children: What to do?

Night terrors in children are not abnormal in their development.  A study of almost 2,000 between the ages of 2.5 and 6 found that 40% have experienced night terrors.  In most children, they will eventually diminish.  By the time a child reaches adolescence (around 12 years old), that child is unlikely to be experiencing them.

While there is no way to definitively stop a night terror from occurring, there are some measures that can prevent harm and reduce distress. A more regular bedtime routine can go a long way in preventing episodes. A lack of sleep will make night terrors worse. Since there is no way to end a night terror, the best thing to do is wait it out. Make sure the child’s environment is safe by removing anything that they could hurt themselves with during an episode. Picking up potentially harmful objects, closing and locking doors and windows, and gating off stairways are all recommended. Once the episode has subsided it is recommended to wake the child and keep them awake for a very short duration. If a child continues to sleep or falls back asleep too quickly, they are more likely to experience another episode.

A list of tips regarding your child’s night terrors:

  • Keep calm. Comfort your child. It is very unlikely that your child is suffering any trauma.
  • Make sure your child is getting a full night’s sleep, every night.
  • Do not try to force your child to wake up during a night terror.  This is unlikely to work and can leave them extremely disorientated.
  • Consider your child’s diet.  Caffeine should especially be avoided.  Sweetened food and bad carbs are not ideal before bedtime.
  • Minimize stress in your child’s life.
  • Cut out television time.  TV has been shown to cause stress in very young children.
  • Make a comforting bedtime ritual.  This can include a warm bath, or read to your child.
  • Keep the room at a good temperature.
  • Keep the room dark and quiet.
  • Make sure your child is not being accidentally awakened by noises, such as from telephones and TVs.
  • Keep a young child sleeping in a crib if possible.  This is a good way to prevent injury.
  • Don’t let your child overheat in their sleep.
  • Remember that fever, colds, and allergies can make night terrors worse.
A bright room may make night terrors worse

A bright room may make night terrors worse

Scheduled Awakening for Night Terrors

If your child is experiencing a night terror at the same time night after night, waking them before the episode occurs may prevent it. Doing this repeatedly may break the cycle completely. This strategy is known as scheduled awakening. The ideal time to wake them is 15-30 minute before the night terror is expected. It is important not to take this too far or else the child will not be able to fall asleep. You want to interrupt the child’s sleep, but you don’t want the child to be wide awake in the middle of the night. If done right, scheduled awakenings are extremely effective.  Clinical studies since 1988 have shown that scheduled awakenings reduce or prevent night terrors in 90% of cases.

If your child’s night terrors are frequent and severe enough, you may want to speak with a specialist. Episodes that occur multiple times a night, every night, are not normal.  If you fear that your child could be seriously harmed, you should seek help. In some cases, psychotherapy or counseling can be helpful.

 

References:

Association, published by the American Psychiatric (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders. (4TH ed.). United States: AMERICAN PSYCHIATRIC PRESS INC (DC).

Connelly, K. P., Murro, A. M., Windle, M. L., & Armon, C. (2015, October 12). Night Terrors: Get the Facts on Symptoms and Causes. Retrieved August 29, 2017, from 

Reviewed by the BabyCenter Medical Advisory BoardLast updated: May 2016. (2016, May 12). Night terrors: Why they happen and what to do about them. 

Richards, D. W. (2006). Night Terrors Resource Center. 

Ben-Joseph, E. P. (Ed.). (2017, June). Night Terrors. 

Julien is a recent graduate and holds a Bachelor’s of Science in Psychology with a concentration in Biology. He is interested in the neuroscience of psychiatric disorders as well as all aspects of psychology, and would love to pursue a career in these fields. He is always open to learning more regarding current research.