Night Terrors

Night terrors affect children. The child would typically wake up abruptly from deep sleep, sits up on the side of bed with eyes open, pupils dilated and a face full of fear and dread (terror), while creaming their lungs out and looking confused- not aware of their surroundings. Their heart rate and breathing are very fast, typical of a panic. Parents who often come to their aid but find their consolidation unhelpful- the child will continue his or her ordeal. Children cannot recall the event and no specific nightmare is associated with it. Sometimes, the child might walk or run around the house, screaming.

Night terrors belongs to a class of sleep disorders called parasomnias. Night terrors come out of the deeper stages of sleep (slow wave sleep or stages 3 sleep). Sleep walking and confusional arousals are examples of parasomnias. Pavor nocturnes is the older name for night terrors. They are not to be confused with nightmares. Night terrors occurs in the first third of the night when deep sleep predominates. Nightmares occur during REM sleep which is more frequent in the later part of the night/early morning and associated with dream recollection and typically occurs in all ages.

Night terrors typically affect young children around age 3 years but it can also occur, although rarely, in adults. Children “grow out of them” so it resolves during early teen years.  There is a genetic component and it can run in families. It affects both boys and girls but a little more the boys. Triggers include fever, emotional stress, chronic sleep deprivation or other sleep disorders such as sleep apnea. Night terrors are not caused by a psychiatric illness.

Night terrors in adults occur in association with alcohol or with emotional stress. Adults with night terrors may run and cause violent events, in contrast to children who are less likely to show violence.

Night terrors can disrupt the sleep quality and the child can suffer from daytime symptoms of sleep deprivation such as fatigue, grumpiness, and being sleepy in school.

Treatment

  • If your child has night terrors, it is best to talk to your pediatrician. They can look for triggers and exclude other sleep disorders such as sleep apnea and make sure these are not mimics of other disorders such as seizures.
  • Keep track of the events in a sleep log or sleep diary. Note symptoms of sleep deprivation during the day (fatigue, irritable child). Take a video of one of the events if you can. It will help the doctor.
  • As a parent, ensure that the child gets adequate amount of sleep and regular bed and wake times. Eliminate stress from their lives if possible.
  • Another treatment is to wake up the child just before the onset of these events if regular timing is established.
  • During the event, provide comfort and watch the child to make sure they don’t injure themselves especially if they have a tendency for running. Remember, each event typically lasts 10 minutes or a little more and the child will go back to sleep. Do not try to wake them up because it will make it worse.
  • If there is emotional stress as a trigger, counseling can be suggested to improve coping mechanism.
  • In certain situations, medications can be considered. Benzodiazepines can be used in severe cases, but it is best to avoid their use due to the side effect.