Night Terrors
Your little angel wakes up screaming in the middle of the night, calling for
his mommy – but his mommy is right there, unrecognized. You try to comfort
him, but he shrieks even louder, eyes bulging. He might be having a night
terror.
What is it?
Within fifteen minutes of your child’s falling asleep, he will probably enter
his deepest sleep of the night. This period of slow wave sleep, or deep non-
REM sleep, will typically last from forty-five to seventy-five minutes. At this
time, most children will transition to a lighter sleep stage or will wake briefly
before returning to sleep. Some children, however, become stuck and are
unable to completely emerge from slow wave sleep. Caught between
stages, these children experience a period of partial arousal.
Partial arousal states are classified in three categories: 1) sleep walking, 2)
confusional arousal, and 3) true sleep terrors. These closely related
phenomena are all part of the same spectrum of behavior.
When most people (including the popular press and popular parenting
literature) speak of night terrors they are generally referring to what are
called confusional arousals by most pediatric sleep experts.
During these frightening episodes, the child is not dreaming and typically
will have no memory of the event afterwards (unlike a nightmare). If any
memory persists, it will be a vague feeling of being chased or of being
trapped. The event itself seems to be a storm of neural emissions in which
the child experiences an intense flight or fight sensation. Once it is finally
over, the child usually settles back to quiet sleep without difficulty.
These are very different from nightmares.
True sleep terrors are a more intense form of partial arousal. They are
considerably less common than confusional arousals and are seldom
described in popular parenting literature. True sleep terrors are primarily a
phenomenon of adolescence.
Who gets it?
The tendency toward sleepwalking, confusional arousals, and true sleep
terrors often runs in families. They tend to be more common in boys, and are
much less common after age 7.
The events are often triggered by sleep deprivation or by the sleep
schedule's shifting irregularly over the preceding few days. A coincidentally
timed external stimulus, such as moving a blanket or making a loud noise,
can also trigger a partial arousal (which again shows that the event is a
sudden neural storm rather than a result of a complicated dream).
What are the symptoms?
Typically, a confusional arousal begins with the child moaning and moving
about. It progresses quickly to the child crying out and thrashing wildly. The
eyes may be open or closed, and perspiration is common. The child will look
confused, upset, or even "possessed" (a description volunteered by many
parents). Even if the child does call out his parents' names, he will not
recognize them. He will appear to look right through them, unable to see
them. Parental attempts to comfort the child by holding or cuddling often
prolong the situation.
Is it contagious?
No
How long does it last?
Most often, a confusional arousal will last for about ten minutes, although it
may be as short as one minute, and it is not unusual for the episode to last
for a seemingly eternal forty minutes.
How is it diagnosed?
The diagnosis is based on the history. When a question remains, a physical
exam or tests may be run to rule out other possibilities.
How is it treated?
When an event does occur, do not try to wake the child -- not because it is
dangerous, but because it will tend to prolong the event. It is generally best
not to hold or restrain the child, since his subjective experience is one of
being held or restrained; he would likely arch his back and struggle all the
more.
Instead, try to relax and to verbally comfort the child if possible. Speak
slowly, soothingly, and repetitively. Turning on the lights may also be
calming. Protect your child from injury by moving furniture and standing
between him or her and windows. In most cases, the event will be over in a
matter of minutes.
Night terrors can also be treated with medications, hypnotherapy, or with
other types of relaxation training if they become a significant problem.
A Novel Approach – The Greene Technique
When my youngest child was going though night terrors, I observed that he
was also “working on” achieving nighttime dryness. In fact, night terrors are
most common at the same ages that children are becoming aware of the
bladder feeling full during sleep. It dawned on me that perhaps some of
these kids just need to go to the bathroom, but are not yet able to wake up
fully when their bladders are full. I’ve now treated many kids by having the
parents take them to toilet while they’re still asleep. For many of these
children, even though they do not recognize their parents, they will often
recognize the toilet and urinate. For these children, the episodes stop
abruptly and they return to sleep. The calm is dramatic.
How can it be prevented?
Prevention usually involves trying to avoid letting the child get over-tired,
and trying to keep the wake/sleep schedule as regular as possible. Taking
the child to the bathroom before the parents go to bed can also prevent
some night terrors.
Night Terrors