Night terrors
Definition
Childhood night terrors are a parasomnia, or partial-sleep disorder, common in young children. They occur in the deepest stage of sleep and are characterized by an abrupt arousal, usually within the first hour of sleep. The child may sit bolt upright in acute terror, screaming inconsolably. Night terrors are a confusional arousal resulting from immature sleep patterns with an intense activation of the flight or fight emotion.
Description
Night terrors are not a dream or typical nightmare. They occur in non-REM, slow-wave sleep. The panicked screaming, kicking, thrashing, and flailing is alarming in its intensity. Sleepwalking, another parasomnia disorder, may also occur in as many as one third of children with night terrors. While experiencing the night terror the child is extremely disoriented and may stare straight ahead, eyes wide open, with the dark centers (pupils) enlarged. There is profuse sweating, the heartbeat is rapid, the breathing fast, and the blood pressure is elevated. As the child is not fully awake, she is unable to see or recognize her parent or caretaker and cannot be easily awakened. The night terror may last from one to 15 minutes or more and is usually followed by a return to deep sleep. Afterwards the child may have no memory of the experience.
Night terrors appear to run in families, though there is no scientific evidence of genetic factors. They are a developmental process and not typically a result of mental or physical illness.
Demographics
Childhood night terrors occur more frequently in boys. Children between the ages of three and five years of age are most likely to experience such nocturnal episodes. Such confusional arousals rarely persist beyond childhood, and they are significantly less frequent or cease entirely after age 12.
Causes and symptoms
Childhood night terrors appear to be a normal physiological process of the immature and developing nervous system. These confusional arousals can be triggered by stressful circumstances such as when a child is overly tired, when there is a loud noise or other unusual disruption, a change in the child's regular sleep-wake schedule, or even a full bladder. Night terrors occurring in adolescence and adult life may be more severe and are often linked with trauma and post-traumatic stress disorders.
When to call the doctor
Consult a pediatrician for night terrors if any of the following occur:
- Episodes occur more than once a week.
- Episodes persist after a schedule of preventive awakenings.
- Episodes last more than 45 minutes.
- The child exhibits drooling, jerking, and stiffening of the body.
- The child is physically endangered during an episode.
- Episodes occur later during the sleep cycle, more than two hours after going to sleep.
- The child has fears that persist throughout the day.
Diagnosis
Diagnosis is based on observation of the following characteristic symptoms:
- recurring episodes of abrupt and partial awakening from deep sleep with panicked screaming and disorientation
- increased heart rate, rapid breathing, and profuse sweating during an episode
- child is unresponsive to efforts to arouse or console during an episode
- child has little or no memory of the event after a full awakening
Treatment
Parents should not attempt to awaken a child experiencing a night terror. Efforts to console may be futile, though holding the child firmly and speaking with soothing words may facilitate the return to deep sleep. The primary effort should be to protect the child from possible harm to herself and others and ease them back to sleep.
In some severe cases, a pediatrician may prescribe a benzodiazepine tranquilizer, such as diazepam, known to suppress the stage four level of deep sleep. Though tranquilizers may be used for short-term control of night terrors, the result is uncertain and not generally advised.
Alternative treatment
Hypnosis, biofeedback, and various relaxation techniques have been used with some success to reduce or eliminate occurrence of childhood night terrors. Calming music or bedtime stories can help lull a child into deep sleep. Maintaining a quiet home without sudden disruptive noise will minimize some of the external stimuli that may trigger night terrors.
Nutritional concerns
Unusually heavy or spicy meals should be avoided before bedtime as indigestion might act as a trigger for night terror arousals.
Prognosis
Childhood night terrors are usually outgrown by the age of seven and rarely persist beyond adolescence.
Prevention
Some pediatricians suggest that parents maintain a sleep diary and observe the child throughout several night terror episodes, noting the amount of time following sleep when the night terror begins. After the sleep-wake pattern is determined, a series of 15–20 minutes prior to the usual occurrence of the night terror and keep the child awake and out of bed for a full five minutes. This may help to break the disruptive sleep pattern that has resulted in the night terrors.
Children often experience night terrors during the toilet-training years. The night terror might be triggered by a full bladder. Assisting the child to the toilet prior to bedtime and even during the course of a night-terror might be beneficial in reducing reoccurrence.
Parental concerns
Childhood night terrors are alarming to witness. Parents may find it particularly difficult when efforts to console the child fail and the child does not recognize them even though his or her eyes may be wide open. The screaming, flailing, and kicking that accompany a night terror may frighten parents who fear the child is having a seizure. It is not a seizure unless the behavior includes eyes rolling back in the head, stiffening of the body, and drooling. Most childhood night terrors will last about 10 minutes.
KEY TERMS
Benzodiazepine —One of a class of drugs that have a hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety. Diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium) are all benzodiazepines.
Confusional arousal —A partial arousal state occurring during the fourth stage of deepest sleep. Childhood night terrors are a form of confusional arousal.
Parasomnia —A type of sleep disorder characterized by abnormal changes in behavior or body functions during sleep, specific stages of sleep, or the transition from sleeping to waking.
Rapid eye movement (REM) sleep —A phase of sleep during which the person's eyes move rapidly beneath the lids. It accounts for 20–25% of sleep time. Dreaming occurs during REM sleep.
Resources
BOOKS
Schroeder, Carolyn S., and Betty N. Gordon. Assessment & Treatment of Childhood Problems , 2nd ed. New York: Guilford Press, 2002.
ORGANIZATIONS
National Sleep Foundation. 1522 K Street, NW, Suite 500, Washington, DC 20005. Web site: http://www.livingwithillness.com/id174.htm.
WEB SITES
Driver, Helen. "Parasomnias." Canadian Sleep Society . Available online at http://www.css.to/sleep/disorders/parasomnia.htm (accessed October 12, 2004).
Harvie, Jeni. "Disorders: A Wake-up Call for Parents." Sydney Morning Herald , January 29, 2004. Available online at http://www.smh.com.au/articles/2004/01/29/10750881124899.html (accessed October 7, 2004).
"Nightmares and Night Terrors." Cincinnati Children's Hospital Medical Center. Available online at http://www.cincinnatichildrens.org/health/info/growth/diagnose/nightmares.htm (accessed October 12, 2004).
"Nightmares and Night Terrors in Children." American Academy of Family Physicians. Available online at http://familydoctor.org/566.xml (accessed October 12, 2004).
Night Terror Resource Center. Available online at http://www.nightterrors.org (accessed October 12, 2004).
"Sleep Behavior Problems (Parasomnias)." Kids Health for Parents. Available online at http://www.kidshealth.org/parent/general/sleep/parasomnia.html (accessed October 12, 2004).
"Sleep Problems in Children." Sleep Matters , March 31, 2004. Available online at http://www.sleepfoundation.org/features/children_sleep_problems.cfm#nightmares (accessed October 12, 2004).
Clare Hanrahan