Night Terrors: A Need-to-Know Guide for Parents

Featured Article, Growth and Development, Health and Safety

When visiting her sister Laura, Marguerite Jones recalls being cautioned by her sister not to worry if she heard shrieks in the night. “My sister’s middle child, Cathleen, had night terrors,” says Jones. “Her blood-curdling screams would wake everyone in the house. It sounded like someone being killed.”

The night terrors occurred on a regular basis. “My sister would say don’t go running in her room and wake her up,” recalls Jones, who says Cathleen still has occasional night terrors and reports seeing things in the dark. “She never completely grew out of them.”

Dr. Judith Owens, director of sleep medicine at Boston Children’s Hospital, says there’s no evidence that night terrors are linked to deep-seated psychological problems. “They’re more distressing to the observer,” she says. Research indicates night terrors occur when the central nervous system, which regulates sleep and brain activity, becomes over-aroused during sleep.

Sleep Terrors Explained

Common characteristics of night terrors include kicking and screaming, crying and yelling or leaping out of bed and running around. Physiologically, a child experiences a heightened sense of arousal — sweating, rapid heart rate or heavy breathing.

Night terrors fall within a category of disruptive sleep behaviors called parasomnias and usually occur during deep sleep, or non-REM sleep, 60 to 90 minutes after a child falls asleep. Unlike nightmares that occur during light sleep, or REM sleep, night terrors resemble a fear response as a child transitions from one sleep stage to the next.

Nightmares vs. Night Terrors 

There are distinct differences between nightmares and night terrors. Nightmares are vivid dreams that occur during the second half of the night, and oftentimes a child will remember the bad dream that woke them up the next morning.

During a night terror, a child’s eyes may be open, and they may have partial motor control of their body, but they’re caught in a no man’s land between sleeping and waking and won’t remember the events the next day. Night terrors can occur multiple times throughout the night or sporadically and vary in duration based on the individual. The majority of night terrors last 15 minutes or less.

“It can be very frustrating and scary for parents,” says Dr. Shalini Paruthi, director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children’s Medical Center. “Parents want to know why they can’t make their child stop screaming.”

According to the National Sleep Foundation, night terrors and sleepwalking can occur in conjunction with each other. Both parasomnias occur during deep sleep and share a lot of commonalties. Sleepwalking is prevalent in young children, occurs when a child is sleep-deprived, and the child typically doesn’t remember the event. Both parasomnias run in families.

Night terrors are rare and affect two to three percent of young children, according to Dr. Owens. They typically start around age 3 or 4 years of age but have been reported in children as young as 6 months. Children for the most part outgrow them by adolescence. “Younger children spend a greater percentage of time in slow wave [deep] sleep,” she explains.

Dr. Paruthi says parents just need to wait it out when their child is having a night terror and keep them safe. During a night terror, your child may not recognize you or be aware of their surroundings, and waking your child can make them more aggressive. “It has to run its course,” she says. Speak gently to your child and guide them back to bed, where they generally fall back asleep within five minutes.

Causes of Night Terrors

The most common trigger for night terrors is sleep deprivation. “It’s hard for parents to make sure everybody gets enough sleep,” says Dr. Paruthi. It’s important to establish a soothing bedtime routine to ensure your child falls asleep at the same time every night to promote healthy sleep. Cuddle together in bed, read their favorite book together or play silly games to help your child relax and get ready for sleep. You want to make their bedroom a warm, comfortable safe haven.

If your child’s night terrors are causing problems during the day, such as excessive daytime sleepiness or disrupting the household every night, you may want to schedule an appointment with their pediatrician to rule out underlying medical problems like sleep apnea or restless legs syndrome or a common illness that can interfere with sleep. Your pediatrician can refer you to a sleep physician who specializes in treating sleep problems.

It helps if you have a video or recording of your child’s behavior so their pediatrician can see or hear what you’re describing. If the problem is caused by snoring, for example, he may refer your child to an ear, nose and throat specialist.

Dr. Paruthi said it’s important to calculate the actual amount of sleep your child gets between the time they go to bed and fall asleep and when they wake up in the morning. “It’s recommended that children in kindergarten through eighth grade sleep 10 hours every night,” she suggests.

There currently is no treatment for night terrors, but there are things you can do to minimize or reduce the chances of your child experiencing them. Dr. Owens recommends scheduled awakenings. Keep track of when your child’s night terrors occur and wake them up 30 minutes before the first episode and then allow them to fall back asleep. “You want to prevent or minimize the trigger,” she says.

As a parent, it’s hard to watch your child when they’re deep in a night terror. However, it’s reassuring to know that, according to Dr. Paruthi, “There is no lasting impact.”

To learn more about night terrors, visit the National Sleep Foundation website.

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