Sleep Easy without Night Terrors

CNN recently had an article about night terrors written by Lisa Shives, MD the founder of Northshore Sleep Medicine in Evanston, IL. She explains that experts don’t know what causes night terrors, but they are classified among arousal disorders or conditions in which someone is partially awake. The children may have their eyes open but they do not respond to external sounds or know that you are close by. They may scream, kick, panic, sleep walk, thrash, mumble or even think objects or persons are in their room scaring them. Night terrors can occur after two hours of sleep, can last from 10-30 minutes and the child often doesn't remember the episode the next morning. Helping your child sleep easy without night terrors can be difficult especially if your child can not be fully awakened to comfort them.  What can be done?

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If your child will not wake up, try not to do so. Shaking and shouting make cause them to become more upset. If they do respond to you, hold them until they feel better. Turn on a night light if they feel someone or something is in their room so they can feel safe and secure. Protect them against injury if they sleep walk, so they don’t fall down stairs or run into furniture. Sometimes night terrors are triggered when the child is over tired. Make sure they adhere to a regular bedtime schedule so they get enough sleep. Children are born with a polyphasic or multiphasic sleep pattern that does not develop into an adult-like monophasic sleep pattern for a number of years. Infants need approximately 16 hours per day while a typical five year old child needs up to 12-13 hours of sleep that is usually broken into a biphasic sleep routine of 8-9 hours at night with a 2-3 hour nap. It isn’t until they are 17 years old when they full adjust to an 8 hour sleep schedule or monophasic sleep pattern. Thus a normal range of sleep duration can vary in children during their development.

Keep a sleep journal that records when they fall asleep and how long it takes for their night terror to start. You may be able to wake the child before an episode starts, if anything, a sleep journal will help the pediatrician understand what might be causing their night terrors and reduce how often they have them. Other things to record in the child’s sleep journal are how long they last, if their episode includes sleep walking, when they occur during the night, daytime fears and anxiety, and any drooling, jerking or stiffening during an episode.  Note:  many believe night terrors are normal for children under the age of six.

Dr. Shives talked about her patient, Emily an 8-year old girl with no past medical problems but according to her mother has terrible nightmares where she wakes up with a blood-curdling scream. She sits up in bed, with her eyes wide open, appearing terrified, agitated and confused. At first her mother could comfort her but as the episodes continued she pushed her mother away. Emily doesn’t remember having these episodes. Her parents know the night terrors (nightmares) occur two hours after she falls asleep. Emily seems happy during the day, but appears over tired and has frequents sore throats.

Was Emily having a night terror episode or a nightmare? It is rare for children to report a nightmare associated with night terror as they typically remember a nightmare and not a night terror episode. When children have a night terror they have physical symptoms like rapid breathing, a racing heart and sweatiness. The doctor confirmed that Emily had enlarged tonsils causing her to have continued sore throats and tested her for obstructive sleep apnea that can cause sleep deprivation. Also her sleep schedule changed when her episodes started. This was due to her father’s work schedule. He came home later therefore they ate later and she ended up going to bed later. When they changed her bedtime back to her normal hour of 8pm her night terrors decreased to once a week. After she had her tonsils and adenoids removed, resolving her obstructive sleep apnea, the episodes only occurred every two to three months. Dr. Shives concluded saying Emily should outgrow them completely by the time she reaches her teen years.

Know the difference between night terrors and nightmares as nightmares or scary dreams will wake the child and they will be afraid to go back to sleep. There is no known reason we have nightmares, but some occur when we see or hear things that upset or scare us. Bad dreams can start at the age of six months as toddlers may dream about bedtime separation anxiety, 4-5 year olds about the boogie man under their bed and school age children may dream about current events witnessed on the news. Nightmares usually happen during REM sleep. The first sleep cycle of REM is around 90 minutes and lasts for 10 minutes. With each continued sleep cycle the length the REM is longer ending with the final one that lasts an hour. The percentage of REM sleep is highest during infancy and early childhood, drops off during adolescence and young adulthood, and decreases further in older age.

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How to comfort a child that has a nightmare: talk about it during the day, protect your child from hearing and seeing scary things, leave the bedroom door open or leave a nightlight on in their room, check for the boogie man under the bed and in the closet as part of your nightly routine, provide a security object such as a stuffed animal, blanket or toy, talk about happy thoughts right before bedtime as they may visualize a happy place they have been or a friend/family member they love or read a funny book before bedtime.

Call the pediatrician when nightmares are controlling the child's daily life, they happen more often than not or you have questions about related concerns due to the child’s nightmares. The content provided in Sleep Easy without Night Terrors is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.