by Dr. Pamela Bandelaria, pediatrician

After a long day of learning and playing, the best feeling in the world is to tuck that sleepy little face into bed.   You hope that your little one will fall sound asleep and not wake up until the morning. However, many children experience night terrors or sleep disturbances, which can make life difficult for everyone.  Night terrors can cause long-term sleep issues, so it is essential that you know how to deal with them.  In this article, you will learn about night terrors, what they are, why they occur, and how to prevent them.

What is the normal sleep cycle for a child?

Sleep, as well as some sleep disturbances, are slightly different in children when compared to adults. When your child is young, sleep is vital for their development, and babies usually sleep between 10 and 19 hours a day.  Sleep periods at this stage are separated by one or two hours of awake time. At around the two-year mark, a child has spent approximately 9500 hours of their time asleep, more hours than they have been awake. Between the ages of 2 to 5 years old, the amount of time children sleep is around the same amount of time as they are awake (approximately 12 hours).

As the child grows older, the average 24-hour sleep duration declines slowly. By five years old, children usually do not take naps anymore.  Some sleeping patterns can make children more prone to brief arousals, awakenings, or sleepwalking. 

What are night terrors?

Night terrors are a form of parasomnia or a sleep disorder. It is a complex behavior observed during deep sleep (Non-REM sleep) and usually occurs a few hours after sleep onset and may last for a few minutes, but can occur for as long as 45 minutes. In night terrors, children are in a state of deep sleep and then become partially awake. Children sometimes cry or scream, and this is often accompanied by a physical manifestation such as sweating, a rapid heartbeat, or a glass-eyed look. They may also kick and flail their arms around hysterically. 

Night terrors affect boys more than girls between the ages of 2 to 7, with a lifetime prevalence of 50%.  Night terrors usually disappear by age 10, but in some instances, children experience these disturbances up until the age of 13 years. Sometimes investigation by EEG is performed in addition to other laboratory tests to distinguish it from other medical causes. 

What can cause night terrors?

There are no specific causes of night terrors. However, certain factors can increase the likelihood of them occurring.  Research shows that genetics can play a role in night terrors. Children with a family history of sleep disorders (parasomnia) such as sleepwalking or night terrors are more likely to experience this phenomenon.

Other factors or triggers have been identified that can lead to night terrors. For example, stress can increase the risk of having night terrors in children. Other factors include fever, intake of medications, and fatigue, as they contribute to increased sleep duration, increasing the chances of night terrors. In addition, anxiety, loud noises, excitement, or a full bladder can also set the stage for night terrors. 

How are night terrors different from nightmares?

You can differentiate night terrors from nightmares based on the time the symptoms occur. Night terrors occur earlier in the night (during non-REM sleep), while nightmares tend to occur later in the night (during REM sleep). During nightmares, children often remember the event and can describe what happened in their dream. On the other hand, in night terrors,  children often have no memory.

Night terrors are characterized by the child appearing fearful. They often scream and seem agitated. They may also lash out, even when being consoled. They may also not be responsive, or you might have difficulty arousing them or getting their attention. Their pupils are often dilated, they breathe rapidly, and they have a fast heartbeat. During nightmares, physical manifestations are also present as the child can also move violently, but they are not as noticeable or severe. Children experiencing nightmares are also easier to arouse compared to those experiencing night terrors. Children experiencing nightmares wake up in distress, anxious and afraid, but they will remember the incident, whereas children experiencing night terrors do not. Children with nightmares, once fully awake, can also immediately recognize their parents, while those with night terrors might experience confusion upon waking up and may not immediately recognize their parents. In both cases, the quality of sleep is affected.

What should I do if my child has a night terror?

When night terrors occur, children may move around a lot. However, it is best that when you witness your child experiencing a night terror, you observe and let them be. It is essential to be calm and in control of the situation. It might be instinctual to wake them up, but this will not be helpful and will usually not be effective. If you purposefully wake your child, your child can wake up confused and may have further difficulty going back to sleep. 

To help them calm down, you can provide encouragement and emotional support by saying soothing words and holding them. Try to avoid sudden noises and movements, loud sounds, or raising your voice, as this can stress and make them agitated.

Keeping a sleep diary is also helpful, especially if these night terror episodes become frequent and recurring. A sleep diary usually contains the duration of sleep periods, the time they experience sleep disturbances (in this case, the time the child experiences night terrors), any events leading up to the night terror episode, and a description of what they do when they experience the night terrors. Documenting these details is essential, as triggers and other patterns leading to night terrors can then be identified.  For example, if a pattern is identified in terms of the time they experience night terrors, try to wake the child up a few minutes before this expected time. By doing this daily, it can potentially alter their sleeping pattern to prevent future episodes from occurring.

As previously mentioned, potential triggers of night terrors include stress, fever, medications, fatigue, loud noises, and a full bladder. By controlling these potential triggers, you can avoid night terrors. Having a routine before sleeping which includes emptying the bladder, can help. Additionally, providing a calming, quiet, and relaxing environment in the bedroom can also help decrease stress. Finally, early bedtime and naps throughout the day can provide adequate sleeping time to avoid fatigue.

How can night terrors be prevented?

 Night terrors are usually not emergencies; however, their symptoms are similar to other medical conditions. For example, they are similar to seizures which also can exhibit thrashing or jerking movements, drooling, or stiffening of the extremities. Other medical conditions include tics, breath-holding spells, or sleep apnea. If symptoms occur, it is best to have your child checked, especially if it happens frequently. Frequent episodes of night terrors should also be a cause of concern, as well as night terrors that last for longer than 30 minutes.

Furthermore, if the occurrence of night terrors involve movements or actions that threaten the safety of your child (dangerous actions such as breaking objects or falling off the bed), it is also best to seek the help of a physician.  In this case, it is best to consult a doctor, who may prescribe appropriate medications.   If you have a sleep diary, it is also best to show it to your doctor as it can provide some information with regards to the condition of your child.  

Conclusion

 Night terrors and nightmares are events that many children may experience throughout their childhood. Though this can be shocking, they are not often related to any long-term mental or psychological harm to your child. It may even be more terrifying for a parent to witness night terrors. Therefore, it is essential to identify when your child is experiencing night terrors so that you can adequately address the situation and know when to bring your child to the doctor.