Sleep terrors
Night terrors are episodes of intense screaming, crying, thrashing, or fear during sleep that happen again and again, usually in children ages 3 to 12. New cases peak at age 3 1/2. sleep terrors are considered a parasomnia — an undesired occurrence during sleep. A sleep terror episode usually lasts from seconds to a few minutes, but episodes may last longer.
There are two main types of sleep: rapid eye movement (REM) and non-rapid eye movement (non-REM). Night terrors happen during non-REM sleep, usually about 90 minutes after a child falls asleep.
About 1 to 6 in 100 children have night terrors, also known as sleep terrors. They happen to both boys and girls, and to children of all races. Night terrors tend to run in families.
Symptoms
Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don’t remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors.
Sleep terrors generally occur in the first third to first half of the night, and rarely during naps. A sleep terror may lead to sleepwalking.
During a sleep terror episode, a person may:
- Begin with a frightening scream or shout
- Sit up in bed and appear frightened
- Stare wide-eyed
- Sweat, breathe heavily, and have a racing pulse, flushed face and dilated pupils
- Kick and thrash
- 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
Causes
Sleep terrors are classified as a parasomnia — an undesirable behavior or experience during sleep. Sleep 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 sleep terrors.
Various factors can contribute to sleep terrors, such as:
- Sleep deprivation and extreme tiredness
- Stress
- Sleep schedule disruptions, travel or sleep interruptions
- Fever
Sleep 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
When to see Doctor
Occasional sleep terrors aren’t usually a cause for concern. If your child has sleep terrors, you can simply mention them at a routine well-child exam. However, consult your doctor if sleep terrors:
- Become more frequent
- Routinely disrupt the sleep of the person with sleep terrors or other family members
- Lead to safety concerns or injury
- Result in daytime symptoms of excessive sleepiness or problems functioning
- Continue beyond the teen years or start in adulthood
Risk Factor
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.
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
Treatment
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.
- 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.
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.
