Night Terrors in Children

What are night terrors?

Night terrors are a common occurrence seen in children between 3 to 12 years old. It is a sleep disorder, which tends to peak when the child is three and a half years old. 

Sleep is divided into two categories:

• Rapid eye movement or REM sleep
• Non-rapid eye movement or NREM sleep 

The NREM sleep is further divided into four different stages, wherein it would progress from stage 1 to stage 4.

Do not confuse night terrors with nightmares since they are different from each other. The symptoms of night terrors are seen as frequent recurrent episodes, which involve intense crying and fear of sleeping in children. It also involves a difficulty in waking up the child.

There has been an estimated 1-6 percent of children who may experience night terrors. However, as the child reaches the period of adolescence, this issue tends to naturally fade away. Boys and girls are equally affected by night terrors.

Causes

Below are a few causes of night terrors:

• Fever
• Any kind of stressful events in the life of the child
• Deprivation of sleep
• Medications that affect the child's central nervous system (CNS)

Night terrors are usually due to the over-arousal of the central nervous system while children are sleeping. In humans, sleep happens in varied stages. We all have dreams, which also include nightmares during rapid eye movement or REM.

Night terrors are known to happen during the non-rapid eye movement (NREM) sleep. A night terror cannot be considered as a dream but instead regarded as a sudden form of fear, which tends to happen while children are transitioning from one stage of the sleep to another.

These night terrors are known to occur about two to three hours after the child has fallen asleep and when the sleep is moving from the deepest stage of the non-rapid eye movement sleep to the lighter one of rapid eye movement sleep. Most of the time, the transition from one stage to another is quite smooth. However, in certain cases, the child tends to become frightened and upset. This reaction of fear then leads to the occurrence of night terrors.

Symptoms

Apart from the common occurrence of continuous episodes of intense crying and the fear of getting sleep along with the difficulty in waking up the child, the following symptoms may also be experienced by children:

• Tachycardia or increased heart rate 
• Tachypnea or increased breathing rate 
• The child would scream out or shout out loudly in distress
• They would also act scared and upset
• Sweating profusely
• Sitting upright on the bed all of a sudden

Unlike episodes of nightmares, the child would often find it difficult to recollect their dream after experiencing night terrors. The next morning, they would completely forget about the episode.

Diagnosis

For the diagnosis of night terrors, the doctor would first review the medical history of the child along with understanding the symptoms. Below are certain evaluations that would be carried out as part of the diagnosis:

• Physical Examination: The doctor will conduct a physical examination of the child to identify other conditions, which may have been contributing to the night terrors.

• Nocturnal Sleep Study or Polysomnography: In certain cases, the doctor may recommend an overnight study in the night or sleep lab. There would be sensors placed on the body, which would record as well as monitor the brain waves of the patient. The patient's oxygen level in the blood, breathing pattern, any kind of eye or leg movement during sleep, and heart rate are also monitored. There can be instances that all of these observations would be documented in a videotape to accurately check the behavior of the patient during sleep cycles.

• Discuss the Symptoms: Night terrors are best diagnosed by the doctor based on the description of the events, which occur during night terrors. The doctor would also inquire if the child has a family history of sleep-related problems.

What happens during night terror episodes?

A general episode would mostly begin approximately 90 minutes after the child has fallen asleep. The child would suddenly sit up and cry and scream aloud. While they appear to be awake, the child is confused, disoriented, and doesn't respond to stimuli.

Children in such a confused state are often unaware of the presence of their parents, which is the reason why they would not respond to anything asked by their parents. There are instances wherein the child would thrash in the bed and not respond to any kind of comfort provided by the parents. Most of the time, such episodes of night terror would only last for a few minutes. However, in certain cases, it can last for around 30 minutes before the child completely relaxes and returns back to sleep.

The next day, the child may look tired due to not sleeping properly at night. They would also have a decrease in attention span. In such cases, parents who are worried about their child’s behavior should immediately speak with a doctor about how it can be taken ahead.

Who are likely to get night terrors?

Night terrors are mostly seen in children who fall into any of the following categories:

• Children who are stressed or very tired
• Children who are sick or have a fever
• Those who are taking new medications
• Children that consume too much caffeine 

Night terrors are known to be relatively rare and do not occur in every child. They are known to happen in about 5% of children.  While night terrors typically occur between the ages of 3-12, it is sometimes seen in toddlers or small babies who are as young as 18 months old. It mostly happens to boys. 

Children can inherit this sleep disorder from their parents. It has been reported that approximately 80% of children who experience night terrors, have other family members who have sleepwalking issues. Sleep walking is another kind of sleep disturbance issue. There can be instances wherein the child may have either just a single episode or multiple episodes of night terror before it gets completely stopped. Usually, it has been seen that the night terrors would just disappear on their own when the central nervous system of the child matures.

Treatment

Night terrors in children can be disturbing for the parents as well since they would not want to see their child in that state. Parents may also feel helpless when they are unable to comfort their child. When it comes to dealing with night terrors in children, the best method is to patiently wait and ensure that the child does not hurt himself or does not get hurt in case if they are thrashing around.

In most of the cases, it has been seen that children would settle down in a few minutes and return back to sleep on their own. It is also advisable not to wake up children during a night terror since waking them up would not go in their favor, and instead, would become disoriented and confused. It may also take a longer duration to settle down and then go back to sleep normally.

The best way is to reduce night terror sprevent it as much as possible. One can try to:

• Reduce the amount of stress the child is undergoing
• Make sure that the child goes to sleep on time and does not stay up too late
• Ensure that the child gets enough amount of rest throughout the day
• Create a regular bedtime routine 
• Avoid overtiring the child with any activity        

In case if you find a pattern of night terror in your child, wherein the child gets night terror around the same time every night, then try to wake up the child 15 to 20 minutes before the episode and see if they can prevent the episodes of night terror in the future. However, if there are repeated episodes of night terror in your child, then it would be advisable to speak with a doctor if there is a need to consult a sleep specialist.

Changes in Lifestyle and Home Remedies

Below are certain strategies you can try if night terrors pose a problem for your child:

• Adequate amount of sleep: Being fatigued or having a tired mind is known to contribute to night terrors. If your child is deprived of sleep, then try to ensure that you have set a routine of going earlier to bed and follow a more regular schedule of sleeping. In a certain time of the day, ensure that the child takes a small nap to relax their mind and body. In case if it is possible, avoid sleep time noises or any other kind of stimuli that can interrupt your child's sleep.

• The sleeping environment should be safe enough: To ensure that the sleeping environment is safe and to prevent any form of injury, it is advisable to close and lock all windows and exterior doors during nighttime. Block the doorways or stairways with a gate and try to keep all electrical cords or other objects that would pose a potential hazard. Moreover, avoid the use of bunk beds. Any sharp objects or fragile items should be out of reach of the child.

• Try to offer comfort: Comfort is very much important when the child is undergoing night terror. Wait out patiently instead of jumping to offer comfort. As a parent, it would be distressing to watch your kid suffer, but remember that it would not in any way harm your child. You can gently calm your child down, soothe them, cuddle them in your arms, and try to get them back to sleep. Do not shout at them during such time, but speak softly and calmly instead. Avoid shaking or shouting at your child since it can worsen the situation. Most of the time, night terror episodes do not last for long.