Night Terrors in Children

Night terrors, also known as sleep terrors, are episodes of screaming, intense fear and flailing that take place while the sufferer is still asleep. They’re most common in children, particularly between ages 3 and 12 years old, but they can also be present in adults.

Night terrors are not the same as nightmares—symptoms of night terrors are more frequent and recurring. Similar to sleepwalking, night terrors are considered a parasomnia, or an undesired occurrence during sleep. Night terrors aren’t usually a major issue, and most children outgrow them by their teenage years. In some cases, though, sleep terrors can require treatment.

Symptoms and Complications

Night terrors and nightmares are not the same—one big difference is that a dreamer in nightmares wakes up and might remember details, while a person in a night terror remains asleep. Children don’t usually remember night terrors in the morning. Nightmares also generally occur during the last half of the night; night terrors occur in the first half.

Signs or symptoms of a night terror episode might include:

Sitting up in bed
Screaming or shouting
Kicking and thrashing
Seating, breathing heavily and having a racing pulse
Having trouble being awoken and being confused after waking up
Being inconsolable
Staring wide-eyed
Getting out of bed and running around the house
Engaging in aggressive behavior (this is more common in adults)

In most infrequent cases, night terrors aren’t a reason to worry. They’re worth mentioning at a well-child exam, but nothing more. However, if terrors become more frequent (often following similar patterns), routinely disrupt sleep, or lead to fear of sleep or dangerous behavior, consult your doctor. In addition, if night terrors persist beyond teen years or begin in adulthood, speak to your doctor about your specific condition.

Night terrors can lead to a few complications:

Excessive daytime sleepiness, which can lead to trouble with work, school or basic tasks
Disruptions to family members
Embarrassment
Injury to oneself or others

Causes and Risk Factors

There are several factors that can contribute to night terrors:

Sleep deprivation or extreme tiredness
Stress
Fever
Sleeping in an unfamiliar place
Lights or noise
An overfull bladder

In some cases, night terrors can be associated with another underlying condition that may affect sleep, including:

Sleep-disordered breathing: A group of disorders that come with abnormal breathing during sleep. The most common of these is sleep apnea
Restless leg syndrome
Migraines
Head injuries
Certain medications

Risk factors for night terrors can include family history and mental health conditions like depression or anxiety.

Treatment and Management Options

In most cases, treatment for infrequent night terrors isn’t necessary. Simply wait out a child’s night terror—it’s tough to watch, but it isn’t doing any actual harm to the child. If needed, help restrain them and get them back into bed. Speak softly and calmly, and never shake or shout at the child.

If night terrors cause significant problems with function or threaten safety, specific treatments might be required. These can include:

Treating the underlying condition: If the night terrors are associated with another condition or disorder, treatment will be aimed in that direction.
Maintain regular sleep habits: Addressing issues like too little sleep can help reduce night terrors.
• Manage stress: Managing stress and anxiety can help in some cases where these are contributing to night terrors. This may include cognitive behavioral therapy, hypnosis, biofeedback or relaxation therapy with a therapist or counselor.
Take medication as directed: This is a rare treatment, but in some cases, benzodiazepines may be used.

In addition, if night terrors are a regular problem for you or your child, here are a few management methods you can look to:

Make your sleeping area a safe environment: Take precautions to prevent possible injuries, including locking doors and windows, blocking doorways or stairways with a gate, and moving electrical cords or any other tripping hazards.
Get more sleep: Fatigue can contribute to night terrors, so try for an earlier bedtime and a more regular sleep schedule for you or your child.
Keep an easy bedtime routine: Engage in quiet, calming activities before bed.
Avoid stress: Identify stress triggers, and brainstorm management techniques. For children, talk to them about things that might be bothering them.
Look for patterns: If you can spot a pattern for your child’s night terrors, you can begin to wake them about 15 minutes before you expect a terror episode. Keep them awake for five minutes, and then let them fall asleep again.

If you or your child is dealing with night terrors, your family doctor can recommend a course of action based on your diagnosis.

I practice the full range of family medicine including obstetrics, pediatrics, adolescent medicine and adult medicine. I also practice some orthopedics, remove lumps and bumps, and perform colposcopy, cryotherapy and vasectomies. Due to the volume of deliveries we do, my practice has evolved to be more centered on women and children’s medicine, but I enjoy all aspects of family medicine.