What is Night Terrors?
Night terrors are a type of sleep issue often seen in preschool-age children that cause them to suddenly wake up, terrified. After these scary episodes, most children do not remember them happening.
Night terror is classified as a parasomnia, which refers to unusual physical and verbal behaviors during sleep. Although parasomnias can occur at any time during sleep, night terrors specifically happen during non-rapid eye movement (non-REM) sleep stages. This is the point when the child is transitioning between sleep and wakefulness.
Sleep can be divided into several stages and states. These can generally be grouped into three primary states: awake, non-REM sleep, and REM sleep. Non-REM sleep is further divided into sleep stages 1, 2, 3, and 4, while REM sleep is stage 5. These different sleep stages result in varying electrical patterns and frequencies in the brain, which can be tracked with a special tool called an electroencephalogram (EEG). Parasomnias like night terrors can occur during the switch between these stages.
Night terrors can bring about severe worry, panic, and feelings of helplessness. These episodes typically last between 45-90 minutes and occur most frequently when the person is transitioning through stages 3 and 4 of non-REM sleep. Night terrors are most commonly seen in children between ages 4 until puberty.
What Causes Night Terrors?
Sleep isn’t as simple as being either awake or asleep. There are multiple points during a typical sleep cycle where you may find yourself in a mix of both states. This is considered the widely accepted theory behind parasomnia, which includes sleep disorders like sleepwalking and night terrors.
Some people believe that these sleep disorders might be passed down through families, but this hasn’t been scientifically confirmed and is still mostly based on personal stories. The truth is, we don’t know exactly what causes these disorders, but there are some factors that seem to play a big role. These include having a fever or being sick, doing a lot of physical activity, drinking a lot of caffeine or alcohol, not getting enough sleep, and dealing with emotional stress.
Risk Factors and Frequency for Night Terrors
Night terrors are typically experienced by children aged 3 to 7, and they usually stop by the age of 10. They occur equally in both boys and girls, affecting about 30% of children. While adults can also have night terrors, it’s quite uncommon and may suggest the presence of neurological disorders that require further examination.
- Night terrors are most common in children between the ages of 3 and 7.
- They usually stop by the time a child reaches the age of 10.
- Both boys and girls are equally affected, with around 30% of children experiencing them.
- Night terrors can occur in adults, but they’re rare and could indicate underlying neurological disorders.
Signs and Symptoms of Night Terrors
Night terrors commonly happen in children during the first part of their sleep. This is when they shift between being awake and falling asleep, which is known as the arousal state.
During a night terror, a child may scream, thrash around, and seem unaware of their surroundings. Other signs can include a rapid heartbeat, fast breathing, dilated pupils, and heavy sweating. Some children might also wet the bed during a night terror.
Children experiencing night terrors typically do not respond to verbal reassurance, comforting, or attempts to wake them. It is often very hard to awaken a child during a night terror episode. Each episode can last between 10 and 20 minutes, and then the child will suddenly go back to sleep. Most of the time, children do not remember having had a night terror.
Testing for Night Terrors
You don’t usually need any specific tests in an emergency situation to diagnose night terrors. Doctors can usually determine if a child is experiencing night terrors simply by talking to the child’s parents or caregivers and others who have witnessed the episodes. On occasion, the doctor may need to order some lab tests or imaging scans. But these are not to confirm night terrors; instead, they are to make sure the child does not have any other medical conditions that could be causing their symptoms.
In some cases, children might have to undergo an EEG (a test that records the electrical activity in the brain) or polysomnography (a sleep study) to rule out seizures. This is because nocturnal frontal lobe epilepsy, a type of seizure disorder, can mimic the symptoms of night terrors.
Treatment Options for Night Terrors
Night terrors don’t have a specific treatment, and the usual response is to console and comfort the child experiencing them. It’s very important that parents or guardians are educated about night terrors, especially about how to keep the child safe during an episode.
If a child is undergoing a lot of stress or conflict, they might benefit from therapy and learning different ways to deal with stress. This might help reduce the number of night terror episodes they have. Typically, it’s strongly advised against giving medication for night terrors as it’s generally not necessary.
Typically a sleep study, which is a test to observe a person’s sleep, isn’t needed because night terrors usually improve over time and resolve on their own. However, some new research is looking at scheduled awakenings during the night using a vibration machine, which might help improve sleep quality.
What else can Night Terrors be?
The conditions that can be mistaken for night terrors include a wide range of sleep disorders and other health issues. These include:
- Seizures, which are characterized by abnormal and excessive discharging electrical activity in the brain.
- Somnambulism, also known as sleepwalking, a disorder marked by excessive movement or even walking while asleep.
- Nightmares, which involve intense fear or distress and occur during the rapid eye movement (REM) sleep phase.
- Narcolepsy, a long-term sleep disorder that involves feeling excessively sleepy during the daytime.
- Sleep Apnea Hypersomnia, where continuous feelings of extreme sleepiness and sleep deprivation go hand in hand with instances of stopped breathing during sleep.
- Breath-holding spells, occurring most often with toddlers, where irritation triggers a voluntary stop in the child’s breathing. It’s not unusual for affected children to turn blue during these events.
- Syncope, which is a temporary and sudden loss of consciousness and muscle tone for a range of reasons.
- Benign myoclonus, a condition where the limbs jerk suddenly in the early stages of sleep.
- Shuddering attacks, where whole body tremors occur.
- Tics, which include repetitive movements like twitching, blinking, or head shaking that are done unknowingly by the patient.
- Gastroesophageal reflux, where stomach contents or acid reflux into the esophagus, causing an arching or unusual posturing (known as Sandifer’s positioning).
- Psychogenic Nonepileptic Seizures (PNES), also formerly known as “Pseudoseizures.” They look like seizures but do not show any abnormal brain activity and are usually related to mental health conditions.
What to expect with Night Terrors
The outlook for kids who experience night terrors is generally positive, with most children naturally stopping these episodes by the time they turn 10. However, excessive movements during these episodes can disrupt the child’s or the family’s way of life, particularly during more severe periods.
There are new treatments being developed that involve scheduling awakenings. The goal of these treatments is to prevent further episodes of night terrors.
