A night terror (also called sleep terror) is a sleep disorder belonging to the parasomnias category. Parasomnias are a category of sleep disorders where abnormal behaviors, emotions and dreams happen. Parasomnias happen at any phase of sleep but night terrors in children occur specifically during the first hours of the last stage of non-rapid eye movement sleep (NREM sleep). Children might also get night terrors during daytime naps despite the fact that by the age of four, most children no longer require a daytime nap.
Night terrors cause the child to jolt upright in bed, screaming and shouting out of sleep. Breathing, heartbeat and sweating increase and the child becomes violent at times. The child’s fear is usually inconsolable for up to 30 minutes –sometimes more- no matter what you tried. The child will mostly appear confused and half awake so it’s your responsibility as a parent to keep him/her out of harm’s way.
Causes of Night Terrors in Children:
The underlying causes for night terrors in children are usually indefinite.
Night terrors in children are more common than you think. They typically occur in children aged 3-12 years, the majority being kids aged 3½ years. Children of all races seem to be affected equally. There are many triggering factors to night terrors. Illness, stress, sleep deprivation and erratic sleep schedule are only a few. Fever is also a major cause of night terrors, especially in case of gravely high body temperature.
The main problem behind cases of night terrors in children is hereditary. Night terrors run in families and children are more prone to getting them if a family member used to suffer from them before. Scientific publications in the British Journal of Psychiatry suggest that sleepwalking and night terrors share a common genetic predisposition. They both occur during slow-wave (deep) sleep. They have similar clinical manifestations and they are both related to central nervous system immaturity and are often outgrown.
One of the most common underlying causes for night terrors in children is sleep apnea. Obstructive sleep apnea in children occurs when tonsils and adenoids grow unnaturally large. This results in narrowing of airways at the back of the nose and in the throat during sleep. As a result, the child has difficulty in breathing or pauses during sleep. The child’s sleep is interrupted with a snort or a loud gasp. Sleep apnea predisposes to night terrors because the child’s sleep patterns become erratic and interrupted by snoring and noisy breathing.
Night Terrors vs. Nightmares:
Night terrors and nightmares are often confused with each other when parents are not sure as to what disrupts their child’s sleep. There are various factors that distinguish night terrors from nightmares in children.
Night terrors in children occur during NREM sleep while nightmares occur during rapid-eye movement REM sleep. Many studies suggest that night terrors are predominant in boys while both genders suffer from nightmares equally. Nightmares are easily calmed down and you can easily put your child back to bed. Night terrors are inconsolable and they might get really violent so it is important to maintain the child’s safety as well as that of accompanying adults or siblings. Unlike nightmares, children don’t have any memory of a night terror episode (retrograde amnesia).
Sleep expert Jodi A. Mindell poses an interesting to distinguish between night terrors and nightmares. You should ask yourself in the morning “Who’s more upset about it?” If you are the one disturbed then it is an episode of night terror. If your child is the one disturbed, then it was just a nightmare.
Nightmares and night terrors also differ in handling. You should wake your child from a nightmare but you should leave a night terror episode undisturbed. Most kids wake up disturbed and disoriented, not to mention that symptoms of night terrors are inconsolable, so waking a kid in the middle of an episode would only lead to traumatizing results.
Dream content differs in night terrors from that of nightmares. The whole ordeal is related to the type of sleep that the disorder belongs to and mainly the fight or flight response. Children, who suffer from NREM sleep disorders (e.g. night terrors) flee from a stressful stimulus, while those suffering from REM sleep disorders (e.g. nightmares) fight back against the stressful stimulus. The dream content of nightmares is far more aggressive than that of night terrors.
Complications of Night Terrors in Children:
Night terrors in children are among the most common concerns that face parents. They are extremely disruptive to a family due to the special care and need that have to be given to the kid suffering from them. Due to repeated interruptions during sleep, the child suffers impairment in learning and cognitive behavior, daytime sleepiness, irritability and poor performance in school.
Management and Treatment of Night Terrors in Children:
Most cases of night terrors in children are self-limiting. No medical intervention is advised unless the episodes are pretty disruptive and even with changes in the child’s environment and sleep patterns, night terrors exist.
As a parent, you should accustom on your child on self-management techniques when it comes to sleeping. By the age of three, a child should be put to bed still awake and learn to fall asleep using self-comfort measures.
A scheduled awakening is also a very effective technique in managing night terrors in children. Parents should take note of the time of the night –or how long into sleep- does their kid wake up. You should awaken your child shortly in anticipation of the night terror episode. As the frequency of the spontaneous awakenings decreases, increase the length of intervals between the scheduled awakenings.
Parents should set firm limits within their child’s sleeping cycle. A constant bedtime is a must and you shouldn’t accede to your kid’s protest to delay it no matter how insisting or annoying he/she can get.
You should develop a predictable bedtime routine with fixed components that help your child get in “sleeping mood”. These components may include bedtime stories, lullabies, warm baths, playing mind games, rocking the cradle (for infants), a gentle back rub or a hot drink before bed.
The sleeping environment should always be safe and quiet. It should also be kept separate from dining and watching television. All sharp objects and toys should be removed from the sleeping environment, especially near the bed. The position of the bed is very important relative to the bedroom window.
You should also make sure every night to lock all the windows in the house as well as doors to dangerous areas like the kitchen or the basement. Fasten a gate at the top of the stairs to prevent accidents.
Co-sleeping (parents sharing their children’s bed) is an unhealthy habit. It gives way to complete dependence of the children on their parents and interferes with normal character building. Co-sleeping is also a predisposing factor to accidental infantile deaths due to suffocation or strangulation.
Medications and Home Remedies for Night Terrors in Children:
Medications are rarely used to treat night terrors in children. In severe cases, benzodiazepines (such as diazepam) are prescribed to reduce their occurrence and calm the child down.
There are tons of home remedies and folk recipes on the internet for parents to protect their kids from night terrors. Full dependence on these remedies is not suggested, but they could be a good complementary companion to the formal safety measures:
- Hanging a dream catcher above the child’s bed (or crib) has been said to alleviate bad dreams and sleep disturbances. Dream catchers also have a positive influence on your kid’s imagination and psyche.
- Giving a child a protein shake or snack before bedtime.
- Keeping a fan going in the bedroom creates a constant rhythm that helps soothe the child to sleep.
- Playing classical music.
- Make sure your child empties his/her bladder before going to bed. The urge to go to the bathroom manifests itself sometimes as an episode of night terror and might lead to bedwetting.
- Try to leave a gap between TV time and bedtime.
- Cover your kid with heavy blankets. This creates a comforting, hug sensation that fills the child with safety.
- Massage the child’s feet with oil blends containing flower essences (e.g. St. John’s Wort, Lavender) to calm down irritable nerves and create a positive atmosphere in the room.
- Guided meditation before bedtime.