Brief overview: Night terrors
- What is night terrors? Sleep disorder with brief incomplete awakenings, coupled with crying, widened eyes, confusion, profuse sweating, and rapid breathing.
- Who is affected? Mostly infants and children up to preschool age.
- Cause: developmental phenomenon of the central nervous system. There is usually a family history of the condition.
- What to do? Do not try to wake the child, wait, secure the environment and protect the child from injury.
- When to see a doctor? In case of night terrors that occur more frequently or after traumatic experiences, persist beyond the age of six or recur after a longer break; in case of first night terrors in older childhood or adulthood; in case of mental illness or suspicion of epilepsy.
- Prognosis: usually overcome by school age due to normal development
Night terrors: what is it?
Night terrors occur mainly in the first one to four hours after falling asleep, i.e. in the first third of the night. A sudden fear startles your child out of a deep sleep: he wakes up screaming, but only incompletely – he is neither asleep nor really awake.
He sits up, his face shows great fear or even anger. The eyes are wide open, the pulse is racing and the heart is beating violently. The child is breathing rapidly and sweating profusely.
Since he is not completely awake, he seems confused. It may speak unintelligibly. In addition, it does not recognize you and cannot be calmed down – on the contrary, if you stroke it or take it in your arms, the child may lash out. It is very difficult to wake them up in this state.
How common is night terrors?
About one-third of toddlers and preschoolers between the ages of two and seven experience night terrors. Three- to five-year-olds are most commonly affected. It is rare for a baby to experience night terrors by the end of the first year of life. Girls and boys are affected equally often.
The sleep of most affected children is disturbed by night terrors only sporadically, i.e. one or a few times. Some children get night terrors every few months for one to two years. Only in a few cases is every night interrupted by it.
By school age, episodes of night terrors are usually over. Pavor nocturnus occurs very rarely in adults and adolescents.
Differences to other sleep disorders
Night terrors are classified as parasomnias of the non-REM sleep phase. It belongs to the so-called waking or arousal disorders as well as sleep drunkenness and sleepwalking. It is therefore possible that children affected by Pavor nocturnus also sleepwalk from time to time or that night terrors turn into sleepwalking.
In contrast to night terrors and other parasomnias of the non-REM sleep phase, parasomnias of the REM sleep phase usually occur in the second half of the night. They include nightmares, for example. They are similar to night terrors. In the following table you can read how to distinguish nightmares and night terrors:
|
Pavor nocturnus (night terrors) |
Nightmare |
|
|
Time |
One to four hours after falling asleep, in the first third of the night |
in the second half of the night |
|
Behavior of the sleeper |
||
|
Reminder |
none |
yes, also the following day |
Night terrors: causes
- REM sleep phase: superficial sleep phase with rapid, involuntary eye movements (“rapid eye movements” = REM) and increased brain activity.
- Non-REM sleep phases: sleep phases of varying depths without the typical eye movements of REM sleep and with reduced brain activity.
In between, the person may awaken briefly – so briefly that he or she does not even remember it the next day.
On average, a cyclical alternation between the different sleep stages and the brief awakening takes place five times per night. This sleep pattern and the length of the sleep cycles develop according to age: A sleep cycle in infants lasts 30 to 70 minutes and lengthens to 90 to 120 minutes by adulthood.
You can read more about the different sleep phases in the article “Slumber phases – how sleep works”.
Night terrors – a developmental phenomenon
Night terrors in children are therefore a developmental phenomenon of the central nervous system and are not related to a mental disorder or other illness. Incidentally, this is also true of sleepwalking (somnambulism). Both night terrors and sleepwalking in children are not dangerous or harmful. As soon as the nervous system matures, these forms of sleep disturbance disappear.
If night terrors occur in adults, mental illnesses such as anxiety disorders, depression or schizophrenia are often involved.
Night terrors run in the family
Night terrors and sleepwalking are often related. Genetic factors are involved in both sleep disorders. If your child experiences such nocturnal episodes, you can usually find at least one relative who also experienced night terrors or sleepwalking in childhood. Often, parents or grandparents were affected.
Night terrors: triggers
Some factors favor night terrors in children:
- emotional stress
- febrile diseases
- medication
- an eventful day, many impressions
- spending the night in a foreign environment
Night terrors: when do you need to see a doctor?
Night terrors are related to the development of the nervous system and usually disappear on their own with time. However, you should see a doctor in the following cases:
- Night terrors occur frequently.
- First episodes occur only in older children (e.g., twelve-year-olds) or in adulthood.
- Night terrors persist beyond the age of six.
- Night terrors recur after a prolonged hiatus.
- Night terrors occur after traumatic experiences.
- The subject has a diagnosed mental illness.
- The subject is suspected of having epilepsy.
Night terrors: What does the doctor do?
First, the doctor will clarify whether it is actually night terrors or another sleep disorder. Then, if necessary, he can initiate treatment.
Night terrors: examinations
First, the doctor obtains important information about the patient’s medical history (anamnesis). For this purpose, the doctor talks to the patient (if he or she is old enough) or to the parents or other adults who have observed the sleep disorder. Questions to be clarified include:
- What about evening activities and eating habits?
- What is the preparation for bedtime (e.g., bedtime story, brushing teeth, etc.)?
- What is the usual bedtime? Are there any problems falling asleep or staying asleep?
- What is the exact course of a night terrors episode (symptomatology, frequency, duration)?
- When did the night terrors first occur? Are there possible triggers (e.g. traumatic experiences, physical illness, etc.)?
- How much does the person sleep per night on average?
- What is the usual waking time? Is the person woken up or does he wake up by himself?
- How does the person feel after waking up? Does the person concerned remember the disturbed night sleep?
- What is the behavior like during the day (e.g. unusual tiredness, sleepiness)?
- How much of a burden does the sleep disorder place on the individual or family?
- How high is the media consumption of the person affected (e.g. daily TV time, cell phone usage time, etc.)?
- Is the affected person often anxious or emotionally very sensitive?
- Is the affected person taking or taking any medications or drugs?
- Are episodes of night terrors or sleepwalking known to parents or other relatives (from childhood)?
To clarify such questions, the physician can also use special sleep questionnaires such as the questionnaire from the Munich Parasomnia Screening.
Sleep diary and actigraphy
In some cases, actigraphy can also help. In this case, the person concerned wears a wristwatch-like device for several days, which continuously records the activity and rest phases. Analysis of the data can reveal disturbances in the sleep-wake rhythm.
Diagnostics in the sleep laboratory: polysomnography
The movement pattern in sleep disorders such as night terrors can be very similar to that of nocturnal epileptic seizures. Therefore, a so-called polysomnography in a sleep laboratory can be useful for clarification:
The affected person spends the night in the sleep laboratory. During sleep, the patient is connected to measuring devices that measure parameters such as brain waves, heart rate, respiration, oxygen saturation and carbon dioxide concentration in the blood. Video surveillance also records eye movements and other movements during sleep.
If the examination reveals evidence of nocturnal epileptic seizures, the affected person is referred to an epilepsy center.
Night terrors: Treatment
Night terrors in children are a developmental phenomenon and therefore do not usually require therapy. To prevent the night terrors, the child’s stress level should be reduced and sleep hygiene optimized (see “Preventing night terrors” below).
Other measures that may be useful for night terrors:
Scheduled waking.
If the sleep log has shown that your child always experiences night terrors at the same time, you can implement planned “anticipatory awakenings” under the guidance of your doctor: For one week, wake your child completely about 15 minutes before the usual time when night terrors normally occur. After five minutes, he or she may resume sleeping. If the night terror still occurs again, repeat the wake-ups for another week.
In some studies, self-hypnosis and professional hypnosis proved successful for night terrors. If you want to know more about this, ask the doctor treating you.
Medication
Treatment with medication is only considered for night terrors if daily activities are impaired by the sleep disorder, psychosocial sequelae occur, or the level of suffering for the affected child or family is very high.
However, there are no clear recommendations for drug therapy for night terrors. Only experience with individual sufferers or a group of several sufferers (case series) shows that some agents can be helpful. These include benzodiazepines (such as diazepam) with their sedative and anxiety-relieving effects. Tricyclic antidepressants (such as imipramine), which are normally given for depression, may also be prescribed for night terrors.
Attempts to wake a child from night terrors or to comfort him are, unfortunately, in vain. They may even upset the child even more. But what then helps with night terrors?
Night terrors: How to react correctly
It’s best to try the following tips when your child experiences a Pavor nocturnus:
- Wait and do not wake the child, do not pet him or her or take him or her in your arms – even if it is hard to do so
- Speak softly and reassuringly to reassure your child that you are there and that he or she is safe
- Secure sleep environment to protect child from injury
After five to ten minutes, your child will calm down abruptly and quickly go back to sleep on their own.
Prevent night terrors
To prevent night terrors, the first thing you should do with your child is to maintain good sleep hygiene. It includes:
- regular bedtimes adapted to the child’s needs
- @ regular daytime sleep for younger children
- no exciting or strenuous activities before falling asleep
- quiet, darkened, comfortable temperature sleeping environment
- comfortable place to sleep that is not associated with other activities such as playing, watching TV, doing homework, or being punished
- regular bedtime ritual, e.g. a bedtime story
- if desired, leave a dim night light on
In addition to these measures, the following additional tips can prevent night terrors:
- Avoid overtiredness
- compensate for lack of sleep at night with daytime sleep (e.g. nap)
- Reduce stress, e.g. schedule fewer appointments per week or day
- try relaxation methods such as age-appropriate progressive muscle relaxation or autogenic training
- get plenty of exercise in the fresh air
- regular daily rhythm
