- Sleep terrors in adults: How to help control this potentially dangerous condition
- Things that go “Ahhhhh!” in the Night
- A waking nightmare: The enigma of sleep paralysis
- What can you do to prevent it?
- What A Night Terror Looks Like
- Multiple Triggers
- When To See a Doctor
- Helping Your Child
- Case Report A case of adult night terrors
- What Causes Night Terrors And How Can You Stop Them?
- What is a night terror?
- What causes night terrors?
- What to do if you see someone having a night terror
- How can you prevent your child from having night terrors?
- Natural Wellbeing
- What Are Night Terrors?
- Signs and Symptoms
- Causes and Risk Factors
- Conventional Treatment
- 7 Ways to Help Manage Night Terrors
Sleep terrors in adults: How to help control this potentially dangerous condition
Sleep terrors (STs)—also known as night terrors—are characterized by sudden arousal accompanied by a piercing scream or cry in the first few hours after falling asleep. These parasomnias arise out of slow-wave sleep (stages 3 and 4 of nonrapid eye movement sleep) and affect approximately 5% of adults.1 The condition is twice as common in men than women, and usually affects children but may not develop until adulthood.1
During STs, a patient may act scared, afraid, agitated, anxious, or panicky without being fully aware of his or her surroundings. The episode may last 30 seconds to 5 minutes; most patients don’t remember the event the next morning. STs may leave individuals feeling exhausted and perplexed the next day. Verbalization during the episode is incoherent and a patient’s perception of the environment seems altered. Tachycardia, tachypnea, sweating, flushed skin, or mydriasis are prominent. When ST patients walk, they may do so violently and can cause harm to themselves or others.
The differential diagnosis of STs includes posttraumatic stress disorder; nocturnal seizures characterized by excessive motor activity and organic CNS lesions; REM sleep behavior disorder; sleep choking syndrome; and nocturnal panic attacks. Patients with STs report high rates of stressful events—eg, divorce or bereavement—in the previous year. They are more likely to have a history of mood and anxiety disorders and high levels of depression, anxiety, and obsessive-compulsive and phobic traits. One study found patients with STs were 4.3 times more likely to have had a car accident in the past year.2
Evaluating and treating STs
Rule out comorbid conditions such as obstructive sleep apnea and periodic limb movement disorder. Encourage your patient to improve his or her sleep hygiene by maintaining a regular sleep/wake cycle, exercising, and limiting caffeine and alcohol and exposure to bright light before bedtime.
Self-help techniques. To avoid injury, encourage your patient to remove dangerous objects from their sleeping area. Suggest locking the doors to the room or home, and putting medications in a secure place. Patients also may consider keeping their mattress close to the floor to limit the risk of injury.
Pharmacotherapy and psychotherapy. Along with counseling and support, your patient may benefit from cognitive-behavioral therapy, relaxation therapy, or hypnosis.3 Anticipatory arousal therapy may help by interrupting the altered underlying electrophysiology of partial arousal.
If your patient is concerned about physical injury during STs, consider prescribing clonazepam, temazepam, or diazepam.4 Trazodone and selective serotonin reuptake inhibitors such as paroxetine5 also have been used to treat STs.
Dr. Jain reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
No one wants to hear about your dreams. Their eyes will glaze over when you tell them you only got three hours’ sleep because of that “weird” one about sharing a house with the actor Max von Sydow where you communicated through a gap in a bookcase. Their ears may prick up, however, if you have one of the more fascinating parasomnias. Bruxism (tooth-grinding) may not make the cut, but sleep paralysis, sleep walking and night terrors are fascinating, largely because we really don’t know what causes them or what purpose they serve, not to mention the bafflement and horror they bring with them.
As a species, we have been attempting to unravel the tangled mysteries of our nocturnal habits since long before Freud turned his attention to the symbolism of our dreams. We have all woken from terrifying nightmares, but night terrors are a level beyond that and, uniquely, the sufferer often wakes with little or no recollection of what disturbed their rest.
Unlike sleep paralysis, which often persists into adulthood, night terrors are largely confined to children between three and eight years old (prevalence has been estimated at about 6% of children and 1-2% adults). Symptoms typically include piercing screaming and violent thrashing of the bed, giving the air of someone in a terrible panic. It’s not just covers getting tossed and pillows being disturbed – the howls of terror can be primeval, the sweat running freely. It’s like the sufferer has gone feral. In most cases, their eyes will be open but they are, in fact, asleep.
For a parent or, in the unusual cases of night terrors in adults, a partner, coping can be a challenge. Chances are, you are also being wrenched from sleep, and you will be attempting to calm down someone who appears to be re-enacting scenes from The Exorcist.
There are various triggers that increase the likelihood of a night terror episode. These range from extreme tiredness, sleeping in unfamiliar surroundings and external stimuli such as noise and lights to fever, stress and a full bladder. But even with all these factors eliminated, terrors can still occur, and the wide-eyed, sweating, manic individual experiencing them will be a test of anyone’s coping skills.
It is advised that you do not try to wake someone when they are experiencing night terrors. It is highly likely that if you do, they will be so disoriented that they won’t recognise you, which will further increase their stress and anxiety. It may run against your parenting or loving instincts, especially when the key signifier of someone enduring a night terror is their inconsolability, but you should not try to console them. Instead, simply wait until the terrors subside, monitoring the sufferer to ensure they don’t harm themselves if they get out of bed, as often happens. Once the episode is over, you should wake them, to break their sleep pattern before they return to a heavy sleep. Encourage them to use the toilet, in case it is a full bladder that is acting as the trigger.
The morning will seem bizarre. You will have been through a long, dark night of the soul; they will probably be totally unaware that anything happened. Unaware that, as lab tests have shown, they have experienced increased muscle tone, reddening of the skin, dilated pupils, a heart rate that may have doubled and spikes of electrical activity in the brain. This is because night terrors tend to occur during non-REM sleep, and dreams during this period are less likely to include vivid imagery and emotions than REM sleep.
For children who suffer night terrors, there is almost always a happy ending – it dissipates as they move towards adolescence, and the only way it will have affected their lives materially is through the introduction of poor or erratic sleep patterns.
For the small minority of adults who suffer night terrors, there are different considerations. The physically violent movements of fully grown adults are obviously more of a danger to the person they share their bed with than a child’s – and they are also more prone to injure themselves and be able to leave the house while asleep.
Diet and stress are more important triggers for adults, but night terrors can also signify other issues. Studies have shown a correlation between episodes and other psychiatric symptoms. In fact, the latter were present in most adult sufferers. Another difference is that an adult is much more likely to have vivid memories of what happened during sleep than a child.
There is no magic cure. If you suffer from night terrors, you can attempt to change your sleep patterns, remove stress from your life and empty your bladder before you retire, but the condition can persist. We are only at the beginning of our understanding.
Things that go “Ahhhhh!” in the Night
When I was a teenager, I babysat for a boy who was around 7 years old. We’ll call him Christopher. I usually babysat Christopher on Friday nights and placed him in bed promptly at 9:00 pm.
Now, the first time the following incident occurred, I’m not going to play it cool and say I was the pillar of babysitting strength. Nope, not me. I freaked out. There I was on the phone, as any teenage girl would be, when suddenly, I was horrified to hear blood-curdling screams coming from Christopher’s room. My heart skipped a beat as I looked at the clock—9:30 pm. It couldn’t be Christopher, I told myself. I just placed him in bed. It must have been the TV. But, when I heard the cries again, I immediately knew it was poor Christopher.
I dropped the phone and ran up the stairs to Christopher’s room. What I saw was startling to say the least. Christopher was sitting up straight on his bed, eyes wide open, yelling bloody murder at the top of his lungs. I ran over to him, jumped on the bed, and took him in my arms hoping to stop the horrifying screams. I yelled, “Chris! Chris! Wake up! What’s wrong?” I was practically in tears ready to call 911. Then, all of a sudden, Christopher awoke from the strange ordeal. He looked slowly around the room and asked me what happened. I told him that he must have had a nightmare. Confused, he looked at me and said, “Really? I didn’t have a nightmare.” And immediately fell back to sleep. What the…?
Dazed, I ran downstairs and called his parents. I told his mother what had happened. She calmly replied, “Oh, that. That’s nothing. He always gets night terrors.”
“Night terrors?” I thought. “What the heck are night terrors? And, oh, yeah… Thanks for the warning.”
What are Night Terrors?
Let’s get one thing straight—nightmares and night terrors are not the same thing. In fact, they are very different. On a basic level, nightmares are dreams that a person can vividly remember when they awake. Night terrors, also known as sleep terrors or pavor nocturnus, are not dreams. Pavor nocturnus is a frightening sleep disorder in which a person becomes terrified during a sleep episode, then has no memory of the event after they fully awake.
During a night-terror episode, the person will partially wake up screaming, moaning, or gasping for air. Most of the time, the subject cannot be completely awoken, nor comforted. It is difficult to wake up someone during a night terror, and if left alone, most will simply settle back to sleep without waking. Either awoken or left to sleep, the person oftentimes has no recollection of the episode whatsoever.
Symptoms of Night Terrors
You can usually tell if a person is having a night terror by the bone-chilling screams. Needless to say, it is no fun to have a sleep partner who is prone to this disorder. Other symptoms include—
- Breathing fast
- Rapid heart rate
- A look of fear or panic
- Large pupils
Who are Most Prone to Night Terrors?
Night terrors are most common in children 2 through 6 years old, but can occur at any age. They affect about three percent of children. Episodes usually occur during the first couple hours of sleep, and recur for a couple of weeks. Then, they seem to disappear. The good news is that most children will outgrow night terrors. The number of episodes usually decreases after age 10.
However, this does not mean that everyone will outgrow night terrors. Unfortunatley, adults can experience this problem, too. Although not as prevelent in adults, many older people complain of night terrors when sleeping on their backs.
What Causes Night Terrors?
One cannot definitively say what causes night terrors. In children, emotional stress, high fever, or lack of sleep seem to cause it. Also, evidence has shown that night terrors can be hereditary.
In adults, stress and lack of sleep seem to be triggers, as well as emotional tension and the use of alcohol.
What Can You Do During a Night Terror?
As difficult as this may be (practically impossible if you ask me), do not wake up the person having a night terror. Do not intervene. Let the person scream it out. Unless the person is in danger, do not restrain him or her. If you do try to hold the person, that may cause more confusion and fright.
Instead, try to speak calmly to the individual and tell him or her that you are there. Try to settle the person down with words, not actions. So, in other words, when I screamed “Chris! Chris! Wake up! What’s wrong?” when Christopher experienced a night terror, that was the wrong thing to do. (Try telling that to a scared teenage babysitter!)
How Can Night Terrors be Treated?
As mentioned before, most children will outgrow night terrors. But in the mean time, night terrors are mostly treated by:
- Gentleness and comfort
- Disposal of anything nearby that can potentially be harmful
- Avoidance of loud movements or voices that might frighten the person further
Although usually unnecessary, some doctors may advise other treatment options, such as counseling or psychotherapy. Others may prescribe Benzodiazepine medications, such as diazepam or the over-the-counter Benadryl elixir.
When night terrors hit, keep in mind that the sufferer is completely unaware that he or she is “dreaming.” They believe the night terror is reality. Then, they wake up as if nothing ever happened. Which leads me to question: Are night terrors more frightening for the person who endures them, or for the person who endures hearing them? I think the verdict is out on that one.
Things that go “Ahhhhh!” in the Night
A waking nightmare: The enigma of sleep paralysis
Recurrent isolated sleep paralysis often starts in adolescence, and around 28.3 percent of students apparently experience it.
Moreover, people with poor “sleep hygiene” — for instance, those who sleep too much or too little — may also be more likely to experience sleep paralysis. The authors of a systematic review published in Sleep Medicine Reviews note:
“Specifically, excessively short (fewer than 6 hours) or long (over 9 hours) sleep duration and napping, especially long naps (over 2 hours), were associated with increased odds of sleep paralysis.”
“Long self-reported sleep latency (over 30 minutes) and difficulty initiating sleep were related to an increased likelihood of reporting sleep paralysis,” they add.
Are mental health issues to blame?
Given the frightening nature of the most of the hallucinations associated with sleep paralysis, many have wondered whether individuals experiencing mental health issues — such as depression or anxiety — are more susceptible to these experiences.
The results of existing research, however, are mixed. Some have argued that individuals who have experienced abuse in early life — whether or not they remember it — may be more exposed to sleep paralysis.
According to the study that was published in Sleep Medicine Reviews, “Levels of waking state dissociative experiences, involving depersonalisation, derealisation, and amnesia, were found to be related to both sleep paralysis frequency and the frequency/intensity of all three hallucination types.”
But links to other neurological and psychiatric disorders are more uncertain.
The authors of a study that was published in the journal Consciousness and Cognition note that previous research has tried to make a case that bipolar disorder, post-traumatic stress disorder, depression, panic disorder, and generalized anxiety disorder — to name but a few — may play a role in sleep paralysis.
However, they report that their analysis of the available data has revealed “no general relationship between and major psychopathology.”
Instead, they decided to focus on the most common “symptom” of sleep paralysis — that is, sensed presence hallucinations that induce a feeling of fear — and explained that there may be a link between it and what they call “passive social imagery.”
Passive social imagery refers to the experience of individuals who are prone to being more socially anxious, and to imagining themselves in embarrassing or distressing social situations as the passive victim on the receiving end of abuse.
These individuals, the researchers suggest, appear to be more at risk of experiencing distress due to sensed presence hallucinations.
What can you do to prevent it?
Prevention and coping strategies for sleep paralysis are, unfortunately, mostly anecdotal, but there are some methods that seem to have been repeatedly validated by many individuals who say that they — usually or often — work for them.
- trying not to fall asleep on on your back, since studies have associated episodes of sleep paralysis with lying on one’s back when going to sleep
- trying to ensure, on a regular basis, that your sleep will not be disrupted, since repeatedly waking up during the night has been flagged up as a potential risk factor
- avoiding overuse of stimulants, such as tobacco and alcohol — coffee, surprisingly, has not been deemed risky in this context — though the evidence that these affect the chances of experiencing sleep paralysis is mixed
- learning meditation and muscle relaxation techniques may help you to better cope with the experience
- persisting in the attempt “to move extremities,” such as fingers or toes, during sleep paralysis also seems to help disrupt the experience
Finally, if you regularly experience sleep paralysis with “sensed presence” and you think that this may be related to other experiences of anxiety in your day-to-day life, then it may be worth considering cognitive behavioral therapy.
According to the authors of the Consciousness and Cognition study, there is a distinct “possibility that frightening sensed presence experiences may contribute to maintenance of an individual’s negative social imagery biases.”
If that is the case, they argue, “cognitive behavioral treatment of experiences could help to alleviate the more general social imagery dysfunction,” which may improve the overall situation.
Your child’s first night terror is disconcerting to say the least. It likely involves screaming and flailing about while asleep, and as a parent you want to do whatever it takes to provide comfort. You may even wonder if it’s worth taking a trip to the pediatrician to get to the bottom of the issue. Read on for the answer to this question and more.
What A Night Terror Looks Like
Night terrors and nightmares may seem similar, but there is one important difference: Unlike a nightmare, children typically don’t wake up from night terrors. During the episode, they may scream, shout, flail and kick, sit up in bed, and appear terrorized. But it is very difficult to wake or communicate with a child during a night terror; most often, they are inconsolable.
While the night terrors—which can last from a few seconds to a few minutes—seem traumatizing, children will usually return to normal sleep after the incident and have no memory of the night terror the next morning.
Night terrors occur during the deepest stage of non-rapid eye movement sleep and are most common between midnight and 2am. There are several possible causes: They can be triggered by extreme tiredness or a lack of sleep, stress, a change in sleep schedule, or a fever. Night terrors are more likely to occur with girls than with boys, and most kids grow out of them by their teenage years.
When To See a Doctor
While frightening to witness, occasional night terrors are considered normal for kids and do not warrant a trip to the pediatrician’s office. However, because some children may sleepwalk during a night terror, there is the possibility of injury. Frequent night terrors also cause disrupted sleep, which may lead to daytime fatigue.
Talk to your pediatrician if you notice that the night terrors are becoming more frequent, if they’re raising your child’s daytime fatigue level, or if you’re concerned for your child’s safety. Your doctor may recommend strategies such as waking your child 15 minutes before the time that the night terror typically occurs. Medication is rarely used to treat night terrors in children.
Helping Your Child
While there is no “cure” for night terrors, there are steps you can take to try to prevent them from happening, such as maintaining a consistent bedtime schedule that allows your child to get enough sleep and doing calming activities before bed, including giving your child a bath or reading a book together.
If your child does have an episode, speak calmly and softly, and while using gentle gestures like a hand squeeze to offer reassurance. Do not attempt to wake your child with abrupt shaking, as this can actually make the problem worse. It’s also completely fine to just wait out the night terror. While unpleasant to watch, remember that the episode won’t last long and your child is unlikely to recall any of it in the morning.
A case of adult night terrors
Night terrors are intense, often traumatic, and potentially dangerous events during nonrapid eye movement sleep; their etiology remains unknown and different protocols of variable efficacy have addressed the physiological and psychological aspects of this disorder. We present the case of a 58-year-old man who was treated for night terrors. The patient associated his disorder with persistent nightmares. After diagnosis with the use of ambulatory polysomnography and infrared video recording, sleep-education sessions were used to clarify the differences between the nightmares and night terrors, and help the patient reconceptualize the physiological and psychological dimensions of his condition. The patient exhibited marked improvement after intervention. This study highlights the benefits of providing an alternative explanatory model for a patient who has constructed a dysfunctional explanation of his condition. The study also offers some considerations about the nature of patient perceptions and their impact on the disorder.
What Causes Night Terrors And How Can You Stop Them?
Night terrors are a common sleep phenomenon which usually occur in children between the ages of 3 and 12 years. Though they appear scary, they are not harmful unless they are causing a severe lack of sleep. They are most commonly caused by an extended deep sleep stage or medication.
What is a night terror?
Despite what you may think, a night terror is very different from a nightmare. A nightmare is a frightening or distressing dream which is usually triggered by something which has evoked similar feelings during the day, such as watching a horror film or being stressed.
Night terrors are quite common in children with an estimated 1-6% of children experiencing them. The NHS describes the phenomenon by saying:
‘A child who experiences night terrors may scream, shout and thrash around in extreme panic, and may even jump out of bed. Their eyes will be open, but they’re not fully awake.’
They can also cause an increased heart rate (tachycardia), increased breathing rate (tachypnoea) and sweating, so it can be difficult to return to a relaxed sleep after a night terror episode. They usually last anywhere between a few seconds and a few minutes, but it can take a lot longer to fully recover from the effects.
Adults can also experience night terrors and will have the same symptoms. While it may be worrying to witness a night terror episode, it will not leave any lasting damage to the individual.
Read more: How To Talk To Your Children About Their Nightmares
What causes night terrors?
Night terrors tend to happen to people with a history of them in their family, along with sleepwalking. They happen for different reasons in both children and adults.
Night terrors usually occur due to a disturbance during deep sleep. According to KidsHealth.org, ‘Night terrors are caused by over-arousal of the central nervous system (CNS) during sleep.’
Though nightmares happen during REM sleep, night terrors happen during non-REM sleep, showing that they are very different. It is thought that the attack arises when we move from one type of sleep to another; when this transition is disturbed, a person can become upset or scared.
Night terrors in children:
Children with night terrors usually experience them when they are:
- Very tired and have a long deep sleep stage
- Suffering from a fever
- Taking medication which affects the central nervous system (brain)
- More likely to wake from deep sleep due to excitement or anxiety
- Woken from deep sleep due to sudden noise
- Woken due to a full bladder
What is the cause of night terrors in adults?
Adults who still suffer from occasional night terrors are more likely to have one due to an existing medical condition such as:
- Stress/ trauma
- An existing mental health condition
- Medication such as antidepressants
- Obstructive sleep apnea
- Restless legs syndrome
As with children, night terrors in adults are caused by disturbance during deep sleep and usually last a few minutes.
Related: The Severity of Sleep Walking and Possible Treatments
What to do if you see someone having a night terror
It can be tempting to intervene or wake a person up if they are suffering from a night terror, but this can heighten the stress. As the individual is not fully awake they may not recognise you, so you might add to their fear.
People who suffer from a night terror rarely remember the incident when they wake up, so acting distressed or shaking them out of the experience will only unsettle them more when they come around. When they wake up, they may feel disorientated or embarrassed, but they are unlikely to remember the full experience or what they ‘saw’ that made them scream.
The NHS advises to stay quiet, wait until they calm down and only step in to help if they are in danger of hurting themselves. For example, if your child sleeps in a cabin or bunk bed, you should probably stay near the edge in case they are at risk of falling.
They also say:
‘After the episode has ended, it’s safe to wake your child. If necessary, encourage them to use the toilet before settling them back to sleep. If your child returns quickly into deep sleep, they may have another episode. Making sure they’re fully awake before they go back to sleep can break this cycle.’
The same guidelines apply to adults. However, if you’re an adult who suffers from regular night terrors you should see your GP, as they could be caused by a specific traumatic event. If this is the case, counselling or other psychological treatments could help.
How can you prevent your child from having night terrors?
Since night terrors are often caused by anxiety during the day, the first thing to address or rule out the day after a night terror is any worries your child might be having. Addressing what the upset is and talking through it may enable them to sleep more soundly and eradicate the likelihood of further episodes. But always ensure that you discuss the night terror in a way that won’t scare them, as this could just add to their anxiety, keeping the cycle going.
Bedtime routine is also extremely important. Give your child a warm bath and read them a soothing story before bed to put their mind at rest. It is also advisable not to have a TV in your child’s bedroom, as they could potentially switch on to a show that will give them nightmares or further fuel their anxiety. Inhibiting any noise or light disruption which can delay melatonin production will give them a better chance of a sound sleep. It’s also worth investing in a toddler bed to change your little one’s attitude to sleep.
Read More: Melatonin And Sleep
Helping your child from becoming overtired can also lessen the chances of night terrors. This can be done by maintaining a long enough sleep every night and prohibiting the number of physical activities done during the day.
Read more: What Is A Normal Bedtime For Your Child?
If your child is having regular night terrors, you may be able to break the cycle by waking them at carefully timed intervals.
- Note how many minutes the night terror occurs from your child’s bedtime
- Awaken your child 15 minutes before the expected night terror
- Keep them awake and out of bed for 5 minutes. You may want to take them to the bathroom to check if they need to use it
- Continue the routine for a week
This should break the cycle of their sleep pattern and therefore the night terror episodes should stop. Waking them for only 5 minutes shouldn’t disrupt their sleep quality too much.
If symptoms of night terrors persist always consult your GP.
Having other issues with your sleep? Visit our Sleep Problems section for help and advice.
Nightmares are different from night terrors, although both can be distressing for children and their parents.
Night terrors are quite ordinary childhood sleep disorder that is characterized by too much terror while sleeping and the lack of ability to wake up fully. If a child possibly crying, screaming, and desperately trying to run away from something, with eyes wide open, he/she is in fact still in a sleep state.
In this kind of sleep disorder there is no frightening dream situation or thing that has caused this fright and the sleep state is a non-dreaming state unlike nightmares. Night terrors among children are somewhat mysterious disturbances that happen during deep sleep where children will feel terror and fear with no evident cause.
These episodes can last in few minutes to an hour, and normally the child could not recall the event the next morning.
Difference between Night Terrors and Nightmares
Nightmares and night terrors are very different in many ways. First, night terrors happen during slow wave sleep or deep sleep while nightmares take place during Rapid Eye Movement (REM) sleep or commonly called as dream sleep. Another distinction is that child experiencing nightmares normally wake up and remember the bad dream. Also, children waking up from a nightmare could tell you details of what frightened them and may still be too scared to go back to sleep or go to bed the subsequent night. A child having night terrors is bit aware of the feelings of fear and panic. The fear is generally not accompanied by a terrified circumstances or object unlike in a nightmare and the lack of dream state often leaves the feeling of an individual confused and disorientated upon waking up. Most of the time, many children will wake up in the next morning with no recollection of what happened the night before and the only memory attached to the experience is the distinct sensation of danger.
Night Terrors are a sleep disorder that is caused by many diverse factors. In some children, it is merely a childhood sleeping disorder that they will overcome soon. In other cases, night terrors in children may is a result of several of factors such as:
- Unsettled psychological conflicts such as overheard arguments, anxiety, chaotic home environment, some form of loss or grief
- Stressful life events
- Violence on television
- Traumatic experience
- Post traumatic stress disorder (PTSD)
- Fever or illness
- Fatigue or sleep deprivation
- Withdrawal from addictive drugs, as well as side effects of certain medications such as decongestants, beta blockers, antihistamines, and antidepressants.
Other Disorders that possibly Related to Night Terrors
Several sleeping disorders and other health conditions are related to night terrors like:
- Febrile illness
- Bipolar disorder
- Seizure Disorder
- Attention deficit–hyperactivity disorder (ADHD)
Signs and Symptoms:
During a consultation, the health practitioner or the child’s pediatrician will ask briefly the symptoms, the number of occurrence of night terrors and how it affects the child. A complete physical assessment may be essential to rule out probable medical reasons. The results will determine if some other examination are necessary.
Night terror can be characterized as an overpowering sensation of fright, panic or danger during a state of deep sleep. And it may be accompanied by different factors such as:
- Disorientation and confusion
- Unresponsive stimulus
- Not easily woken
- Intense screaming, crying or attempts to escape
- Increased breathing rate
- Increased heart rate
- Excessive sweating during occurrence
- Inability to remember what happened
Possible Additional Tests
• An electroencephalogram (EEG) may be done if a seizure disorder is suspected to test and measure brain activity,
• Polysomnography may be performed if a breathing disorder is suspected to conduct combination of tests to check for sufficient breathing while asleep
• A psychological assessment if a psychological disorder is assumed
Although night terrors they can occur at any age, they affect around 15% of all children between 2 to 6 years old. Since night terrors in children typically disappear with age, radical treatment is not essential. However, there are some available ways to minimize trauma and prevent episodes from recurring.
In treating night terrors, prescription medication is not normally used. Although Benzodiazepine medications (such as diazepam) can diminish night terrors, these medications are not suggested for children and have severe side effects.
Natural Herbal and Homeopathic Remedies
Nightmares and night terrors are not easy to handle in the middle of the night, especially when children and parents are exhausted and little ones are hard to console. Homeopathic remedies and natural herbal are gentle, yet effective way to assist the child to settle after a night terror and to help them restore healthy sleep patterns in the recurrent night time disturbances. Many natural ingredients are conventionally used to offer comfort and to settle the children in times of panic and anxiety. In therapeutic potencies, homeopathic ingredients such as Kali phos, Aconite, and Nat. sulph can be very useful Furthermore, herbal remedies like Chamomile and PassifloraIncarnata have calming and relaxing effects that are useful in cases of unexpected fright and nervous restlessness. These remedies are not dangerous for children,
There are a lot of treatment guidelines that you can implement at home to aid preventing night terrors and to calm your child during Night Terrors. Fundamentally, treatment is intended to avoid further episodes by getting rid of stressful triggers, preventing harm during episodes and soothing the distressed child back to sleep after the occurrence of night terror.
Medical treatment is rarely required unless night terrors are result of another medical condition.
Home Techniques for Preventing Night Terrors
- Ensure that the child is getting a enough sleep because sleep deprivation is a main cause of night terrors in children.
- Guarantee that the child’s room is secure and safe. If he or she tends to get out of bed during these events, it will prevent physical harm.
- Night terrors frequently happen at a certain time in the sleep cycle and it is usually between the first and second hour of sleep. If you notice the pattern, gently wake up the child 15 minutes ahead of time.
- Don’t let the child read scary stories and watch scary movies before bedtime.
- During a night terror, don’t forcefully wake up the child or cause further fright with loud voices or sudden movements but be gentle and comforting instead. Turning on the TV, radio, or lights can contribute inthe gentle transition of wakefulness.
- Calm the child and assure him or her that you are there.
- Try to help your child back to sleep by comforting him or her.
Tips for Coping with your Child’s Night Terrors
- Don’t hug too tightly or shake the child awake him or her. This will only adds to their fear and need to escape. It’s better to stroke the child and gently speak to them in a gentle voice.
- Don’t leave the child until he or she falls back to sleep. Your presence will soothe to decrease anxiety.
- Create an atmosphere of quiet wakefulness and the lights must be turned on. This is a lot less frightening than a dark quiet room and it will help to gently wake up the child.
- If the night terror causes sleep walking, kindly guide your child to his/her bed without waking him or her. Ensure safety measures to avoid putting your child into danger. Keep the room free of hazardous obstacles and avoid bunk beds.
- Make sure that the child does not have an illness or fever that may caused night terrors.
- Set up an appointment with your child’s psychologist or licensed counselor if you suspect that the night terrors are associated to an excessive stress, emotional issue or anxiety.
Practicing a good bedtime routine will not only contributes in promoting a sense of safety and security in children but it will also ensure that that the child is getting adequate sleep every night. Engaging in less stimulating activities like story time and calm conversation are an excellent way to ease the child into relaxed state prepared for sleep.
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If you, or your child, have ever experienced shouting, thrashing and intense fear during sleep, the cause may be night terrors. For some, the experience will cause you to awaken breathless, sweaty, with a racing heart rate and trembling with fear. But for others, during an episode it can be difficult to awaken the sufferer. While similar to a nightmare, night terrors are much more dramatic and take both a physical and emotional toll on the sufferer. (1)
When a child has a nightmare, the theme or vision often repeats itself for weeks, months or even years. Nightmares occur during the REM (rapid-eye movement) stage of sleep, allowing them to be more readily remembered while night terrors occur during deep, non-REM sleep stages. (1)
Night terrors can happen at any age, from infancy to late in life. It is estimated that only 3 percent to 6 percent of children experience them, while a significantly larger percentage of children experience occasional nightmares.
There are few statistics on night terrors in adults, but they can be related to other sleep disorders including sleepwalking. The American Academy of Sleep Medicine estimates that night terrors affect 2.2 percent of adults. While there are a number of causes including certain medications, too much caffeine, or being over-tired, in adults night terrors may be a sign of underlying health conditions including PTSD, sleep apnea and restless legs syndrome. (2, 3)
In children, night terrors often go away on their own by the age of 12. But during the years when they are active, it can be a significant challenge to both children and their parents.
Treatment for night terrors depends on the cause; if an underlying health condition is determined, like sleep apnea, and it is treated, this sleep disturbance will likely abate. For the vast majority of children and adults who experience night terrors, changing bedtime routines and the sleeping atmosphere, increasing physical activity and removing certain stimulants from the diet can help too.
What Are Night Terrors?
Night terrors, or sleep terrors, are part of a larger category of sleep disorders called as parasomnias. This is a group of abnormal sleep patterns and disruptions that also include sleepwalking, sleep eating, sleep paralysis and sexsomnia. (4)
Night terrors are characterized by the individual trembling and shaking with fear. Some individuals may awaken while others may remain asleep and be very difficult to awaken. A rapid heart rate, being drenched with sweat and being breathless are other common symptoms of night terrors.
Night terrors are often considered just severe nightmares, but this is incorrect. There are significant differences between the two. Nightmares most often occur during lighter sleep phases (REM) and are incredibly realistic and vivid. They can rock you with fear and panic and when you awaken, you can remember being chased, or falling or the terrifying monster hiding under the bed.
Nightmares in children can make for extremely long nights for parents and adults alike. As the vision of the fear is so real and so clear, it can be difficult to comfort the child so they can return to sleep.
Night terrors, on the other hand, occur during non-REM cycles of sleep, and instead of being vivid dreams, you experience feelings of terror, but not actual visions. Often, the physical signs, the breathlessness, trembling and thrashing occur before you wake up, making the symptoms of the night terrors even more frightening. In fact, night terrors may activate your natural fight-or-flight response.
When you do awaken, you don’t remember why you are terrified or shaking. There isn’t a vision of the fear that caused the reaction; just the overwhelming sense of danger and panic. For children, this often means that once the physical signs of night terrors have abated, they can return to sleep, often in just five to 10 minutes. (5)
Signs and Symptoms
- Thrashing about the bed
- Talking nonsensically
- Sitting up in bed
- Acting out violently when touched
- Scratching others or themselves
- Difficult to be awakened
- Unresponsive to commands
- Confusion or disorientation
- Tachycardia (rapid heart rate)
- Tachypnea (rapid breathing)
- Flushed skin
- Sweating, often profusely
- Wetting the bed
- Intense terror
- Wide eyes and dilated pupils
- Elevated blood pressure
Causes and Risk Factors
Night terrors are typically caused by overarousal of the central nervous system during sleep. Other factors that can contribute to this sleep disorder include: (1)
- Being overtired
- Head injuries
- Certain medications for depression, anxiety and high blood pressure (5)
- New sleeping environment
- Lack of sleep
- Too much caffeine
- Sleep apnea
- General Anxiety Disorder
- Restless Legs Syndrome
- Bipolar disorder
- Substance abuse
Generally, treatment is not necessary as most cases resolve on their own. However, if night terrors are accompanied by sleepwalking, the goal needs to be keeping the child, or the adult, safe.
During an episode of night terrors, repeating soothing statements and providing physical comfort can help. And, while it may seem counterintuitive, during an episode waking the child or the adult may not be necessary or advisable. (6)
Prompted awakenings, or anticipatory awakenings, as a nightly routine may help to prevent night terrors and sleepwalking in children, according to Harvard Medical School. The technique involves measuring the length of time between when the child falls asleep and the episode begins. Then, for seven nights in a row, the child is awakened for five minutes in the 15 minutes before night terrors are expected. After seven days, the cycle of night terrors may be broken. (7)
In adults, if the root cause is an underlying health condition like sleep apnea, bipolar disorder, or other conditions, effective treatment of the condition may help relieve the episodes. Like with children, for some adults anticipatory awakening may help too according to the Mayo Clinic. (8)
Sleep medications are rarely recommended. However, if depression or anxiety is believed to be causing the sleep terrors, antidepressants may be prescribed.
7 Ways to Help Manage Night Terrors
Night terrors in children are a stress- and anxiety-inducing event for parents and children alike. For adults, relationships are often strained and productivity at work may suffer. Finding effective ways to help prevent episodes and effective natural sleep aids are key for getting a good night’s sleep.
1. Avoid caffeine, nicotine and alcohol for six hours before bedtime.
Stimulants such as these can prevent restful sleep. Remember, caffeine is found in sodas, chocolate, certain pain relievers and many types of tea. While alcohol may help you fall asleep, it increases the number of times you awaken during the night, according to Harvard Medical School. (9)
2. Create a peaceful sleep environment.
For children and adults alike, creating a sleep-inducing environment can help improve the quality of sleep. The temperature, lighting, noise level and the quality (and comfort) of the mattress are important for restful sleep. A well-ventilated room with a temperature between 60 degrees and 70 degrees is generally recommended.
Lights from electronics can disrupt sleep; turn off electronics before you retire. If children do homework in their room or if your home office is in your room, consider other options to help keep the bedroom a sanctuary for sleep.
3. Practice good sleep hygiene.
Most children have a good bedtime routine that includes bathing and relaxation activities. Adopting a routine as an adult that helps you transition to sleep may be helpful in reducing night terrors. A shower or bath before bed helps to lower the body temperature, promoting drowsiness. Just be sure to crawl into bed with fresh sleepwear and sheets.
Daily exercise is one of the best ways to encourage a good night’s sleep. This is true for children and adults alike. Exercise helps to reduce stress and anxiety and makes you physically tired. But, it is important to avoid both physical activity and mental activity in the three hours before bedtime as it can promote alertness. (9)
Aerobic type exercises including jogging, tennis, dance classes, riding a bike, martial arts and swimming are great activities for both adults and children. Yoga is an excellent activity for adults, and a recent clinical study in the journal Anxiety Stress & Coping found practicing yoga significantly reduces stress, anxiety and insomnia. (10)
5. Try mindfulness and relaxation training.
Promoting a sense of well-being and relaxation before bedtime can help improve sleep quality, insomnia symptoms and overall quality of life. In a recent pilot study, postmenopausal women underwent eight weeks of training and received significant sleep benefits. (11)
Mind-body practices, including meditation, are becoming more and more common in pediatric care for pain, stress and sleep. Meditation and mindfulness can also be made easier for children and teens with guided meditations written for their specific age group. The Chopra Center offers kid-friendly meditations and even a free guided meditation app specifically written for children eight to 12 years old. (12, 13)
6. Get hypnotized.
Long practiced for stress, addiction, pain, anxiety and PTSD, hypnosis may help reduce the severity and the number of episodes of night terrors according to Harvard Medical, and a landmark clinical study from the early 1990s. The study published in The Journal of Nervous and Mental Disease found that hypnosis was effective in 74 percent of adults studied for reducing or eliminating sleep terrors and sleepwalking. (6, 14)
A more recent study conducted by researchers from Hurley Children’s Hospital at Michigan State University College of Human Medicine and Seattle Children’s Hospital found that clinical hypnosis is an effective tool for children and adolescents in managing pain, anxiety, depression, grief, phobias and sleep disorders. The researchers also note the relationship and similarity of hypnosis to mind-body practices including biofeedback, yoga, guided imagery, meditation and prayer. (15)
7. Use essential oils.
Certain essential oils including lavender oil and frankincense are associated with relaxation and better sleep quality. In a clinical trial published in the journal Complementary Therapies in Clinical Practice aromatherapy improved sleep quality in 64 percent of those in the study. (16)
Safe for adults and children alike, my DIY Sleep Aid recipe features lavender, bergamot, cedarwood and frankincense essential oils. As you are preparing for bedtime, place 10 drops of the blend in a diffuser to encourage restful sleep.
While not considered a serious medical condition, night terrors can lead to the following complications and challenges: (18)
- Excessive daytime sleepiness
- Disturbed sleep
- Relationship problems
- Injury to self or others
- May be a sign of an underlying health condition
- Anxiety and stress
If sleepwalking occurs with sleep terrors, it is important that bunk beds aren’t used. For children and adults, if there are stairs in the home, gates to prevent falling down the stairs are recommended. Keeping windows closed and locked, as well as doors, is also extremely important.
- Night terrors are part of larger sleep disorder group called parasomnias. Also in this group are sleepwalking, sleep eating and sexsomnia.
- Night terrors are not just severe nightmares; the two occur at two different cycles of sleep.
- In a night terror, you don’t remember vivid details like a nightmare,. Instead you experience the physical and emotional trauma of intense fear.
- Night terrors most often occur in children, but they can occur at any life stage.
- Night terrors may be caused by an underlying health condition like sleep apnea, too much caffeine, being overstimulated or from other sleep disorders like restless legs syndrome.
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Four times a week, in the middle of the night, while I was asleep, my ceiling would fall in. Sometimes I’d try to prop it up while screaming for help; sometimes I’d just leap out of bed and run.
Other strange things were happening, usually around 2am. Spiders and other bugs would get into my bed and I would scream my head off. It must have sounded pretty alarming – one new flatmate who kept waking in the night to hear unexplained moans and shouts stuck a rosary above her bed.
What I experienced were not nightmares – dreams that ended badly – but concentrated moments of pure terror. If that sounds like something from a B-movie, so does the medical name for it: parasomnia. This week our understanding of the condition has increased slightly with a study finding sleepwalking and night terrors in children are genetically inherited, with those whose parents suffered from them much likelier to experience them too.
My sleep problems began in childhood. Many people grow out of them in adolescence, so my family didn’t take it any further. “You were calling out in the night again,” my mum would say as I got ready for school, grumpy after another night’s unrefreshing sleep. I’d cheerfully tell my friends how I had gone downstairs and turned the TV on, or turned the bath taps on. I’d keep quiet about how I’d walked to the landing, thought I was by the toilet, and peed through the banisters.
I reached 13, the age when night terrors typically stop, but although I left behind other childish things – practising my signature and refusing vegetables – I was stuck with them. People who slept in the same room would delightedly repeat the nonsense I had come out with the previous night; on a campsite in southern Italy, I was found wandering around babbling about the mafia.
It took me until my mid-20s to seek help from the NHS; before that, I just assumed it was a personal quirk I had to live with. A consultant discussed my symptoms, and how stress made them worse; I acknowledged my work as a journalist was stressful, secretly worrying that he would tell me to find a new career as a basketweaver. Instead, he booked me in for a sleep study.
“If something happens in the night, you can press this button and someone will come in,” said a nurse as she attached the last of a series of wires to my face and body at St Thomas’s Hospital in London. “But, to be honest, if something does happen, we’ll know about it before you do.” Someone did come in that night, and re-attached the wire that was on the bottom of my mouth. It was like the point in a horror movie where they catch the demon in a photograph: whatever it was that was happening to me was now caught forever on record.
A few weeks later, I saw my night’s sleep as a graph. “Normal sleep would progress from stage one, stage two, stage three, REM,” the consultant said, moving his pen down the axis. By contrast, my graph looked like it was constantly short-circuiting and having to start again. “This is where you are in the automaton phase,” he said, circling one bit, before adding darkly, “as it would be called in court.” A man in Wales was acquitted of murder after using “automatism” in his defence.
I collected the heavy drugs I would be on for the next few years with all the good grace of someone in their 20s who has just been handed responsibility for a serious medical condition.
Trimiperamene is an antidepressant used to sedate people who suffer from major psychotic disorders. Clonazepam is a muscle relaxant used for epilepsy and panic attacks. I would be taking both, and worried what effect they would have on my personality. Ridiculously, I saw having to take antidepressants to have better dreams as a sign of weakness; it was gloomy to think that I couldn’t control my own unconscious. But the sleep was incredible. I could nod off on demand and would wake up when the alarm clock went off, hazy and dry-mouthed, but calm and refreshed.
Every six months, after sitting in a waiting room with half a dozen exhausted looking patients, my medication would be reviewed. After a good period, my consultant decided to cut them right back.
This wasn’t exactly a success. One morning, staying in my childhood bedroom, I woke to unfamiliar sounds. A tap was running somewhere. I rushed to the bathroom and realised I had run a bath in my sleep. Water was pouring through the ceiling into the lounge downstairs. The flooding left my mother with repairs that took six months to fix.
Thankfully the next time my medication was cut down, it worked. I had been warned the drugs were addictive, and it wasn’t easy to give up the guarantee of a brilliant night’s sleep. But I was 95% cured – for the first time since I was a small child the ceiling in my bedroom was solid, and nothing was crawling about in the dark.
The 5% is a problem only when I change time zones, or am under particular stress – when my daughter was born I would wake up terrified that she was suffocating in the bedclothes. “Classy touch, bringing a baby into this,” I told my unconscious. But I knew it would pass.
Sleep disorders are hardly a priority for the NHS, so I feel lucky to have had the treatment I did. I’m sure thousands are unaware medical help is even available. I still don’t know what triggered the parasomnia – genes or a forgotten trauma – but it taught me that none of us are truly in control of our brains. The weirdness always breaks free eventually.