Night Terrors

Every parent has hurried to their child’s side in the middle of the night to provide comfort after hearing them cry. But what if your child is inconsolable?

According to Priya Prashad M.D., a pediatric sleep specialist at Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network, up to 6 percent of children suffer from night terrors, a sleep disorder that presents far more dramatically than nightmares.

“The medical term for night terrors and nightmares is parasomnias,” says Prashad. “These undesirable physical events or experiences can occur during entry to sleep, within sleep, or during arousal from sleep. They emerge and peak during the childhood years. The most common parasomnias are arousal parasomnias which include sleep terrors, nightmares, and sleepwalking.”

Different forms of parasomnias can occur at any point in the sleep cycle; REM (Rapid Eye Movement) sleep, non-REM sleep, or even during transitions between sleep and wake. They tend to begin by the ages of 3 to 4 years, and escalate during the school ages before decreasing in frequency in early adolescence.

Night terrors differ from nightmares in a number of specific ways. They are more likely to occur during the first portion of the night during non-REM (rapid eye movement) sleep. “They usually begin with a loud scream, and an intense look of fear,” says Prashad. “The children could have sweating or a rapid heartbeat, and they typically are unaware of the caregiver’s presence. They will be confused and disoriented if awakened and attempts to console the child can make the episode worse.” Children are often unable to remember having a night terror the next morning.

With sleepwalking “the child is usually caught in the transition between sleep and wake, which is why they are able to get up and walk,” says Prashad. “But are still asleep.” There are precautions you can take if your child is prone to sleepwalking, such as installing extra locks on doors and windows, or a bell or alarm on the child’s bedroom door to alert parents if they walk outside their bedroom. It’s also important to keep the child’s floor as clear of debris as possible to prevent tripping if they begin to sleepwalk.

For many parents, night terrors are worse than nightmares for the simple reason that the child cannot be consoled during the episode. “When a parent tries to comfort their child and is not able to do so easily, it appears more frightening,” says Prashad. “You cannot stop a night terror. The best thing to do, if the child is out of bed or sitting up in bed, is to guide them back to bed without awakening them. This will usually help shorten the episode and not prolong it.”

While not as terrifying appearing as night terrors, persistent nightmares can also cause stress. “Night terrors come from an unspecific fear that children are not able to convey, but nightmares usually come from an identifiable source, a frightening movie or video game, or a fear of monsters,” says Prashad. There is generally something that the child can verbally communicate as a reason for the nightmare.

Unlike during a night terror, a child suffering a nightmare can usually be gently woken by a parent of caregiver, ending the traumatic experience. Nightmares generally do not leave the child confused or disoriented, and can usually be recalled and described once the child is awake, often in vivid detail.

According to Prashad, any number of things can trigger a night terror. Possible causes include sleep deprivation, illness or fever and sleeping in a new environment. “It generally happens when there’s a disruption in the child’s sleep/ wake schedule,” says Prashad. “When not getting enough sleep one night, the amount of slow wave [deep] sleep increases the next night to make up for the sleep deprivation. And slow wave sleep is when the night terrors occur, so with more of it, the probability of having a night terror is greater.” She also notes that night terrors tend to run in families, so there may also be a genetic factor at play.

The best preventative measure a parent can take is to ensure their child is getting the right amount of sleep. “Generally 12 to14 hours of sleep a day is appropriate for infants. School age children should sleep anywhere from 10 to 12 hours, and adolescents need about 8 to 9 hours of sleep a night.”

Hearing your child cry out in the middle of the night is an awful experience for a parent. Just remember, the night terror will pass, and eventually, when your child is older, they will stop having them altogether.

However, persistent and complex cases may require referral to a pediatric sleep medicine specialist and can be aided by the appropriate use of diagnostic studies (such as a sleep study or EEG recording) and possible treatment with medication. Also if the parasomnia is resulting in anxiety, fear, embarrassment, sleep avoidance or deprivation, physical injury or affecting daytime function by causing sleepiness, referral to sleep medicine specialist is also warranted.

For more information about the pediatric sleep center at Maria Fareri Children’s Hospital, parents can call 914-493-1105 or visit www.westchestermedicalcenter.org/sleep-medicine.