What are night terrors

A child having night terrors (sleep terrors) may scream, shout and thrash around in extreme panic, and may even jump out of bed, and may not recognize you if you try to comfort them. He or she may be sweating and breathing fast. He or she will be confused and might not answer when you ask what’s wrong. Your child may be difficult to wake. This behavior occurs on waking abruptly from deep, non-dream sleep. A child eyes will be open and your child’s pupils (the black center of the eye) may look larger than normal, but he/she won’t be fully awake or may still be asleep with open eyes, during these episodes and will have no memory of it the next morning. The episodes usually occur in the early part of the night (usually between 1 A.M. and 3 A.M.), continue for several minutes (up to 15 minutes), and sometimes occur more than once during the night. Children who have night terrors may also sleepwalk.

Be sure your home is safe (use toddler gates on staircases and don’t use bunk beds for children who have nightmares or night terrors often).

Though night terrors can be alarming and upsetting for parents who witness them and who might feel helpless when they can’t comfort their child. Night terrors not usually cause for concern or a sign of a deeper medical issue.

It’s best not to try to wake kids during a night terror. This usually doesn’t work, and kids who do wake are likely to be disoriented and confused, and may take longer to settle down and go back to sleep.

When a night terror happens, stay with your child until it is finished. If necessary, gently restrain the child from getting out of bed, or lead the child back to bed. Speak softly and calmly. Don’t try to wake your child. The phase of sleep during which a night terror happens makes it unlikely that a child will respond to attempts to wake him or her.

Shouting or shaking a child during a night terror could make the episode last longer. In most cases, a night terror will stop on its own. Never punish a child for having a night terror or threaten punishment if it happens again. That only increases a child’s stress and could worsen the situation.

Night terrors are relatively rare — they happen in only 3%–6% of kids, while almost every child will have a nightmare occasionally. Night terrors are common in children aged between 3 and 8 years old, but have been reported in babies as young as 18 months. They seem to be a little more common among boys.

Some kids may inherit a tendency for night terrors — about 80% who have them have a family member who also had them or sleepwalking (a similar type of sleep disturbance).

A child might have a single night terror or several before they stop. Most of the time, night terrors simply disappear on their own as the nervous system matures.

Many children experience nightmares and night terrors, but most grow out of them. They don’t cause any long-term psychological harm to your child.

Often, nightmares and night terrors stop completely when your child is a teenager. However, some people, especially people who have active imaginations and are creative, may keep having nightmares and night terrors when they are adults.

Treatment usually isn’t necessary for night terrors. But if they significantly disrupt your home regularly, make an appointment with your child’s health care provider. He or she can help evaluate the situation. In rare cases, a child who has frequent night terrors may benefit from an evaluation with a sleep medicine specialist. In most cases, however, night terrors fade away as a child ages, without any medical intervention.

Why they happen

Night terrors are more common in children with a family history of night terrors or sleepwalking behavior.

Nightmares and night terrors in children are usually not caused by mental or physical illness. Often nightmares happen after a stressful physical or emotional event. In the first 6 months after the event, a child might have nightmares while he or she gets used to what happened in the event. If nightmares or night terrors keep happening and disturb your child’s sleep, they can affect your child’s ability to function during the day. Talk with your doctor about whether treatment will help your child.

A night terror attack may be triggered by anything that:

• increases how much deep sleep your child has, such as tiredness, fever or certain types of medication
• makes your child more likely to wake from deep sleep, such as excitement, anxiety, sudden noise or a full bladder

How to stop night terrors

The best thing to do if your child is having an episode of night terrors is to stay calm and wait until they calm down. Don’t intervene or interact with them, unless they’re not safe.

Night terrors can be frightening to witness, but they don’t harm your child.

You shouldn’t attempt to wake your child when they’re having an episode. They may not recognize you and may become more agitated if you try to comfort them.

After the episode has ended, it’s safe to wake your child. If necessary, encourage them to use the toilet before settling them back to sleep.

If your child returns quickly into deep sleep, they may have another episode. Making sure they’re fully awake before they go back to sleep can break this cycle.

Your child won’t remember the episode the next morning, but it may still help to have a general chat to find out if anything is worrying them and triggering the episodes. It’ll also help if they have a relaxing bedtime routine.

Try not to discuss the episodes with your child in a way that worries them as this may increase their anxiety.

If the night terror episodes are frequent and occur at a specific time every night, you may find that waking your child breaks the cycle.

Wake your child 15 minutes before the anticipated time of the episode every night for 7 days. This can disrupt their sleep pattern enough to stop the episodes without affecting sleep quality.

Night terrors vs Nightmares

Night terrors are very different from nightmares. A child having night terrors (sleep terrors) may scream, shout and thrash around in extreme panic, and may even jump out of bed, and may not recognize you if you try to comfort them. This behavior occurs on waking abruptly from deep, non-dream sleep. A child eyes will be open, but he/she won’t be fully awake during these episodes and will have no memory of it the next morning.

Nightmares are scary dreams. Most children have them from time to time. Most nightmares happen very late in the sleep period (usually between 4 a.m. and 6 a.m.). Your child may wake up and come to you for comfort. Usually, he or she will be able to tell you what happened in the dream and why it was scary. Your child may have trouble going back to sleep. Your child might have the same dream again on other nights.

Nightmares occur from dream sleep (rapid eye movement or REM sleep). Nightmares like most dreams occur during the stage of sleep when the brain is very active and sorting through experiences and new information for learning and memory. The vivid images the brain is processing can seem as real as the emotions they might trigger. Nightmares tend to happen during the second half of a night’s sleep, when REM intervals are longer.

Your child may wake up from the nightmare and, depending on their age, may be able to remember and describe the bad dream to you. When kids awaken from a nightmare, its images are still fresh and can seem real. So it’s natural for them to feel afraid and upset and to call out to a parent for comfort.

Nightmares are common in children aged 3 to 6 years old. Nightmares seem to peak during the preschool years when fear of the dark is common. By about preschool age, kids begin to understand that a nightmare is only a dream — and that what’s happening isn’t real and can’t hurt them. But knowing that doesn’t prevent them from feeling scared. Even older kids feel frightened when they awaken from a nightmare and may need your reassurance and comfort. Most children grow out of nightmares.

Older kids (and even adults) have occasional nightmares, too.

Nightmares usually occur later in the night and cause strong feelings of terror, fear, distress or anxiety. Your child may wake up and be able to remember and describe the dream to you.

Nightmares in children can be caused by a frightening experience, such as watching a scary film, or by something that’s worrying them.

After a Nightmare

Here’s how to help your child cope after a nightmare:

• Reassure your child that you’re there. Your calm presence helps your child feel safe and protected after waking up feeling afraid. Knowing you’ll be there helps strengthen your child’s sense of security.
• Label what’s happened. Let your child know that it was a nightmare and now it’s over. You might say something like, “You had a bad dream, but now you’re awake and everything is OK.” Reassure your child that the scary stuff in the nightmare didn’t happen in the real world.
• Offer comfort. Show that you understand that your child feels afraid and it’s OK. Remind your child that everyone dreams and sometimes the dreams are scary, upsetting, and can seem very real, so it’s natural to feel scared by them.
• Do your magic. With preschoolers and young school-age kids who have vivid imaginations, the magical powers of your love and protection can work wonders. You might be able to make the pretend monsters disappear with a dose of pretend monster spray. Go ahead and check the closet and under the bed, reassuring your child that all’s clear.
• Mood lighting. A nightlight or a hall light can help kids feel safe in a darkened room as they get ready to go back to sleep. A bedside flashlight can be a good nightmare-chaser.
• Help your child go back to sleep. Offering something comforting might help change the mood. Try any of these to aid the transition back to sleep: a favorite stuffed animal to hold, a blanket, pillow, nightlight, dreamcatcher, or soft music. Or discuss some pleasant dreams your child would like to have. And maybe seal it by giving your child a kiss to hold — in the palm of his or her hand — as you tiptoe out of the room.
• Be a good listener. No need to talk more than briefly about the nightmare in the wee hours — just help your child feel calm, safe, and protected, and ready to go back to sleep. But in the morning, your child may want to tell you all about last night’s scary dream. By talking about it — maybe even drawing the dream or writing about it — in the daylight, many scary images lose their power. Your child might enjoy thinking up a new (more satisfying) ending to the scary dream.

What Causes Nightmares?

No one knows exactly what causes nightmares. Dreams — and nightmares — seem to be one way kids process thoughts and feelings about situations they face, and to work through worries and concerns.

Most times nightmares occur for no apparent reason. Other times they happen when a child is experiencing stress or change. Events or situations that might feel unsettling — such as moving, attending a new school, the birth of a sibling, or family tensions — might also be reflected in unsettling dreams.

Sometimes nightmares occur as part of a child’s reaction to trauma — such as a natural disaster, accident, or injury. For some kids, especially those with a good imagination, reading scary books or watching scary movies or TV shows just before bedtime can inspire nightmares.

Themes of a nightmare tend to reflect whatever the child is going through at that age, whether it’s struggles with aggressive feelings, independence, or fears of separation. The cast of characters might include monsters, bad guys, animals, imaginary creatures, or familiar people, places, and events combined in unusual ways.

Young kids might have nightmares of being gobbled up, lost, chased, or punished. Sometimes a nightmare contains recognizable bits and pieces of the day’s events and experiences, but with a scary twist. A child might not remember every detail, but can usually recall some of the images, characters, or situations, and the scary parts.

For most kids, nightmares happen only now and then, are not cause for concern, and simply require a parent’s comfort and reassurance. Talk to your doctor if nightmares often prevent your child from getting enough sleep or if they occur along with other emotional or behavioral troubles.

What you should do

Talk to your child to find out whether anything is worrying them that could be triggering their nightmares.

As with night terrors, making sure your child has a relaxing bedtime routine will also help.

Parents can’t prevent nightmares, but can help kids get a good night’s sleep and that encourages sweet dreams.

To help them relax when it’s time to sleep and associate bedtime with safety and comfort, be sure that kids:

• have a regular bedtime and wake-up time
• have a sleep routine that helps them slow down, and feel safe and secure as they drift off to sleep. This might include a bath, a snuggle from you, reading, or some quiet talk about the pleasant events of the day.
• have a bed that’s a cozy, peaceful place to quiet down. A favorite toy, stuffed animal, night-light, or dream catcher can help.
• avoid scary movies, TV shows, and stories before bed — especially if they’ve triggered nightmares before
• know that nightmares aren’t real, that they’re just dreams and can’t hurt them

Take your child to see your doctor if they’re having repeated nightmares (a series of nightmares with a recurring theme).

If your child’s nightmares are being caused by a stressful past experience, they may need counseling.

Nightmares in adults

Nightmares and night terrors are usually associated with children, but they can sometimes also affect adults.

There are many possible causes of adult nightmares, but they’re often linked to stress, trauma or an existing mental health condition.

They can also occur after taking certain types of medication, such as antidepressants.

Sometimes a condition that affects sleep can be a trigger for night terrors.

For example:

• obstructive sleep apnea
• restless legs syndrome
• migraines

Nightmares don’t usually cause any physical harm, but they can be disturbing or upsetting. They may also prevent you getting a good night’s sleep.

See your doctor if you’re having regular nightmares that are affecting your sleep and day-to-day life.

If your nightmares are caused by a particular traumatic event, your doctor may recommend psychological treatment, such as counseling.

Night terrors complications

Some complications that may result from experiencing sleep terrors include:

• Excessive daytime sleepiness, which can lead to difficulties at school or work, or problems with everyday tasks
• Disturbed sleep
• Embarrassment about the sleep terrors or problems with relationships
• Injury to oneself or rarely to someone nearby

Night terrors causes

Night terrors are classified as a parasomnia — an undesirable behavior or experience during sleep. Night terrors are a disorder of arousal, meaning they occur during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleepwalking, which can occur together with Night terrors.

Night terrors are caused by over-arousal of the central nervous system (CNS) during sleep.

Sleep happens in several stages. You have dreams — including nightmares — during the rapid eye movement (REM) stage. Night terrors happen during deep non-REM sleep. A night terror is not technically a dream, but more like a sudden reaction of fear that happens during the transition from one sleep stage to another.

Night terrors usually happen about 2 or 3 hours after a child falls asleep, when sleep moves from the deepest stage of non-REM sleep to lighter REM sleep. Usually this transition is a smooth one. But sometimes, a child becomes upset and frightened — and that fear reaction is a night terror.

Night terrors tend to run in families. So if a parent had them as a child, then his or her children are at an increased risk for them, too. Night terrors are most likely to happen when a child is overtired or feeling a significant amount of stress. Sleeping in new surroundings or in a loud or noisy environment may contribute to night terrors. In children, fevers may sometimes trigger a sleep terror.

Night terrors have been noted in kids who are:

• sleep deprivation and extreme tiredness
• fever
• taking a new medicine
• sleep schedule disruptions, travel or sleep interruptions
• sleeping in a new environment or away from home
• not getting enough sleep
• having too much caffeine.

Night terrors sometimes can be triggered by underlying conditions that interfere with sleep, such as:

• Sleep-disordered breathing — a group of disorders that include abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea
• Restless legs syndrome
• Some medications
• Mood disorders, such as depression and anxiety
• In adults, alcohol use

Risk factors for night terrors

Sleep terrors are more common if family members have a history of sleep terrors or sleepwalking. In children, sleep terrors are more common in females.

Night terrors symptoms

Night terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a night terror episode remains asleep. Children usually don’t remember anything about their night terrors in the morning. Adults may recall a dream fragment they had during the night terrors.

Night terrors generally occur in the first third to first half of the night, and rarely during naps. A night terror may lead to sleepwalking.

During a night terror, a child might:

• Suddenly sit upright in bed and appear frightened
• Shout out or scream in distress
• Have faster breathing and a quicker heartbeat
• Be sweating
• Have a racing pulse, flushed face and dilated pupils
• Kick and thrash around
• Stare wide-eyed
• Act upset and scared
• Be hard to awaken, and be confused if awakened
• Be inconsolable
• Have no or little memory of the event the next morning
• Possibly, get out of bed and run around the house or have aggressive behavior if blocked or restrained

After a few minutes, or sometimes longer, the child simply calms down and returns to sleep.

Unlike nightmares, which kids often remember, kids won’t have any memory of a night terror the next day because they were in deep sleep when it happened and there are no mental images to recall.

Night terrors diagnosis

To diagnose night terrors, your doctor reviews your medical history and your symptoms. Your evaluation may include:

• Physical exam. Your doctor may do a physical exam to identify any conditions that may be contributing to the night terrors.
• Discussing your symptoms. Night terrors are usually diagnosed by your doctor based on your description of the events. Your doctor may ask about your family history of sleep problems. Your doctor may also ask you or your partner to fill out a questionnaire about your sleep behaviors.
• Nocturnal sleep study (polysomnography). In some cases, your doctor may recommend an overnight study in a sleep lab. Sensors placed on your body record and monitor brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements while you sleep. You may be videotaped to document your behavior during sleep cycles.

Night terrors treatment

One of the best steps you can take to help prevent night terrors is to make sure your child is well-rested. A regular bedtime routine that is relaxing and doesn’t involve any electronics — including cellphones, TV, computers and video games — also can help. Read books together, play a quiet game, or spend time talking to help your child wind down before bed. If a child doesn’t seem to be able to get enough sleep at night, consider a daytime nap. As much as possible, keep the stress level in your home low, and help your child work through stressful or upsetting situations.

There’s no treatment for night terrors, but you can help prevent them. Try to:

• Reduce your child’s stress
• Create a bedtime routine that’s simple and relaxing. Pleasant activities, such as reading, may help your child relax.
• Make sure your child gets enough rest
• Help your child from becoming overtired. Fatigue may contribute to night terrors. Make sure your child gets enough sleep every night.
• Don’t let your child stay up too late
• If your child is stressed or anxious, talk to your child about what is stressing him or her. Together, try to come up with a plan to handle the stress.

If your child has a night terror around the same time every night, you can try waking him or her up about 15–30 minutes before then to see if that helps prevent it.

To reduce the risk of a child hurting himself or herself during a sleep terror, create a safe bedroom environment. Place sharp, heavy or fragile objects out of your child’s reach at night. Securely lock doors and windows. Put gates across stairways. Children who have night terrors shouldn’t sleep on the top level of a bunk bed.

Understanding night terrors can ease your worry and help you get a good night’s sleep yourself. But if night terrors happen repeatedly, talk to your doctor about whether a referral to a sleep specialist is needed.

Lifestyle and home remedies

If sleep terrors are a problem for you or your child, here are some strategies to try:

• Get adequate sleep. Fatigue can contribute to sleep terrors. If you’re sleep deprived, try an earlier bedtime and a more regular sleep schedule. Sometimes a short nap may help. If possible, avoid sleep-time noises or other stimuli that could interrupt sleep.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed. Meditation or relaxation exercises may help, too. Make the bedroom comfortable and quiet for sleep.
• Make the environment safe. To help prevent injury, close and lock all windows and exterior doors at night. You might even lock interior doors or put alarms or bells on them. Block doorways or stairways with a gate, and move electrical cords or other objects that pose a tripping hazard. Avoid using bunk beds.
• Place any sharp or fragile objects out of reach, and lock up all weapons.
• Put stress in its place. Identify the things that stress you out, and brainstorm possible ways to handle the stress. If your child seems anxious or stressed, talk about what’s bothering him or her. A mental health professional can help.
• Offer comfort. If your child has a sleep terror episode, consider simply waiting it out. It may be distressing to watch, but it won’t harm your child. You might cuddle and gently soothe your child and try to get him or her back into bed. Speak softly and calmly. Shaking your child or shouting may make things worse.
• Usually the episode will shortly stop on its own.
• Look for a pattern. If your child has sleep terrors, keep a sleep diary. For several nights, note how many minutes after bedtime a sleep terror episode occurs. If the timing is fairly consistent, anticipatory awakenings may help.

If the sleep terrors lead to the potential for injury, are disruptive to family members, or result in embarrassment or sleep disruption for the person who has sleep terrors, treatment may be needed. Treatment generally focuses on promoting safety and eliminating causes or triggers.

Treatment options may include:

• Treating any underlying condition. If the sleep terrors are associated with an underlying medical or mental health condition or another sleep disorder, such as obstructive sleep apnea, treatment is aimed at the underlying problem.
• Addressing stress. If stress or anxiety seems to be contributing to the sleep terrors, your doctor may suggest meeting with a therapist or counselor.
• Cognitive behavioral therapy, hypnosis, biofeedback or relaxation therapy may help.
• Anticipatory awakening. This involves waking the person who has sleep terrors about 15 minutes before he or she usually experiences the event. Then the person stays awake for a few minutes before falling asleep again.
• Medication. Medication is rarely used to treat sleep terrors, particularly for children. If necessary, however, use of benzodiazepines or certain antidepressants may be effective.