Dr. Alan Greene on Night Terrors

Why do my kids have these strange episodes?

Question

What are night terrors, and why do children get them?

Answer

Within 15 minutes of falling asleep, your child will probably enter her deepest sleep of the night. This period of slow wave sleep, or deep non-REM sleep, will typically last from 45 to 75 minutes. At this time, most children will transition to a lighter sleep stage or will wake briefly before returning to sleep. Some children, however, get stuck -- unable to completely emerge from slow wave sleep. Caught between stages, these children experience a period of partial arousal.

Partial arousal states are classified in three categories:

  • Sleepwalking
  • Confusional arousal
  • True sleep terrors

These are closely related phenomena that are all part of the same spectrum of behavior.

When most people speak of sleep terrors, they're generally referring to what are called confusional arousals by most pediatric sleep experts. Confusional arousals are quite common, taking place in as many as 15 percent of toddlers and preschoolers. They typically occur in the first third of the night when the child is overtired, or when the sleep-wake schedule has been irregular for several days.

A confusional arousal begins with the child moaning and moving about. It progresses quickly to the child crying out and thrashing wildly. Even if the child does call out her parents' names, she will not recognize them. She will appear to look right through them.

During these frightening episodes, the child is not dreaming and typically will have no memory of the event afterwards. If any memory persists, it will be a vague feeling of being chased, or of being trapped. The event itself seems to be a storm of neural emissions in which the child experiences an intense fight-or-flight sensation. A child usually settles back to quiet sleep without difficulty.

These are very different from nightmares. You won't become aware of your child's nightmares until after she awakens and tells you about them. A child may be fearful following a nightmare, but will recognize you and be reassured by your presence.

True sleep terrors are a more intense form of partial arousal. They are considerably less common than confusional arousals, and are seldom described in popular parenting literature. True sleep terrors are primarily a phenomenon of adolescence. They occur in less than 1 percent of the population. These bizarre episodes begin with the child suddenly sitting bolt upright with the eyes bulging wide open, and emitting a bloodcurdling scream. The child is drenched in sweat with a look of abject terror on his or her face. The child will leap out of bed, heart pounding, and run blindly from an unseen threat, breaking windows and furniture that block the way.

The tendency toward sleepwalking, confusional arousals, and true sleep terrors often runs in families. The events are often triggered by sleep deprivation or by sleep schedules shifting irregularly over the preceding few days. A coincidentally timed external stimulus, such as moving a blanket or making a loud noise, can also trigger a partial arousal.

Treatment usually involves avoiding letting the child get overtired, and keeping the sleep schedule as regular as possible. When an event does occur, don't try to wake the child -- not because it's dangerous, but because it will tend to prolong the event. It's generally best not to hold or restrain the child, since her subjective experience is one of being held or restrained; she would likely arch her back and struggle all the more. Instead, try to relax and to verbally comfort the child if possible. Speak slowly, soothingly, and repetitively. Turning on the lights may also be calming. Protect your child from injury by moving furniture and standing between him or her and windows. In most cases the event will be over in a matter of minutes. True night terrors, or bothersome confusional arousals, can also be treated with medications, with hypnotherapy, or with other types of relaxation training.

 

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

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