night terrors

Night terrors (or sleep terrors) are episodes of screaming and agitation in the middle of the night, generally in toddlers and sometimes preschoolers. They are probably best understood as a variation of sleep walking. They are technically classified as one of the parasomnias, disorders of arousal including sleep walking, sleep talking, and perhaps enuresis.

Differentiating a night terror from a nightmare depends upon a couple of factors. First is the time of the attack. Night terrors, since they are disorders of arousal from the deepest sleep, occur typically in the first part of the night - certainly the first half and usually just a few hours after bedtime. A nightmare - a particularly vivid and scary dream - tends to occur towards the end of the night - in the early morning hours. When a child has a night terror, he can be aroused from it only with great difficulty, if at all. He may have his eyes open, but will "look right through you" as if not seeing you - and he does not. When a child has awakened screaming from a nightmare, he is indeed awake and will cling to you for comfort.

Like sleepwalking and sleeptalking (the more benign form of night activity that often persists into adulthood), it is a disorder of incomplete arousal from deep sleep. Most of the brain is shut down, but certain motor (muscle movement) circuits are active when they should be quiet. Thrashing around, walking up and down in the crib, and seemingly terrified crying out are the result.

The child is not dreaming - he is in deep sleep - stage 3 or 4. He will not remember the night terror in the morning, and parents really should not even mention that it goes on.

If your child has an isolated night terror, hold him close until it passes, then lay him back in his crib or bed. Do not try to awaken him fully, just lay him back down when he begins to quiet. Don't query him about it in the morning - again, your child does not remember a thing about the spell.

If night terrors become a more constant feature of nighttime sleep, it would be wise to take a somewhat different tack and simply observe from the doorway while the attack progresses and winds down. If your child's eyes are closed, or open without making eye contact, his brain is still partially in deep sleep and not only is it not necessary to awaken him, but if you do that too often you may wind up with habit waking in the night from the attention. Then you would have the worst of two worlds!

To prevent night terrors, awaken your child gently before you go to bed (assuming you go to bed several hours after your child does). Tuck him back in, tell him you love him, and go to bed. Often, this "jostling" of the sleep system in the brain will prevent him from having an attack that night. Another approach for the child who has them regularly at a certain time, is to gently awaken the child about 15 minutes before he or she usually has the attack, then tuck him or her back in as above. If this doesn't work, and he has so many or so violent attacks that it is a problem for the family, talk to your doctor about possible medication. Diazepam, imipramine, and amitryptiline have been used successfully, but I have personally only used medication in this manner once in over twenty years of busy practice.

Night terrors seem to occur in cycles. They may happen every night or so for several weeks, then disappear for months at a time. Night terrors are more common in boys than in girls. They are also more common in children whose family members have a history of night terrors, sleep walking or sleep talking, or bedwetting. They are said to be outgrown by 8 years old in half the cases, but about a third of cases continue into adolescence.

Another point to consider is that night terrors are a disorder of awakening from deeper sleep. If your child is stressed and overtired from an extra-active day or from disruption of his normal nap routines by activities, he is more likely to have a spell that night. Pay attention to your child's activities during the day, and try as best you can to keep his routine normal and to see that he has his normal nap if he still takes one routinely.

See also the discussion of confusional arousals.

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