Sometimes called sleep terrors, night terrors involve feelings of fear, flailing, and potentially screaming while asleep. In some cases it’s accompanied by sleepwalking and they’re both considered a parasomnia (an unwanted event during sleep).
Depending on the individual, a single episode can last seconds or minutes; extreme cases may continue for longer. According to some studies around four in ten children experience night terrors and they get less common as we age.
They may seem scary, but night terrors generally provide no major medical concern. Most children grow out of night terrors by the teenage years. If the problem continues, or starts to affect the safety and lives of the sufferers, medical attention is required.
So what’s the difference between night terrors and nightmares? This is a great question, and the main difference is our memory in the morning after. While we tend to remember details of nightmares and may actually wake up from them, it’s more common to stay asleep and not remember night terrors in the morning.
Rarely occurring during naps, night terrors normally take place during the first third of the night. Alongside the possibility of sleepwalking, common symptoms include:
- Dilated pupils and a flushed face
- No memory of the event the next morning
- Kicking and flailing
- Breathing heavily with fast pulse
- Staring wide-eyed into the darkness
- Sitting up in bed with an alarming shout
- Aggressive behavior when restrained or stopped from sleepwalking.
The sufferer is often also hard to console and difficult to wake up; this leaves partners and loved ones a little fragile.
The causes of night terrors
Why do we suffer from this problem? Why do some people experience it frequently and others not at all? In most cases night terrors tend to occur when we partially wake from nonREM sleep. As we transition from one stage of sleep to another, we’re half awake and half asleep. As a result, and although scientists aren’t quite sure why, we experience night terrors.
Though we can’t be certain yet, potential factors include:
Including sleep apnea, some experts have suggested that respiratory issues increase the chances of experiencing night terrors. 20 participants were monitored in a study in 2003. Pressure placed on the esophagus was measured overnight to see whether this played a role in night terrors.
The results suggest that people with disruptive sleep disorders (such as night terrors) are more likely to also have breathing problems. As the body requires more effort to breathe, the authors suggest that this may trigger other conditions such as night terrors.
Mental health conditions
Interestingly, there’s also a correlation between mood-related mental health conditions - such as anxiety, bipolar disorder, and depression - and night terrors. The correlation continues to people with long-term stress and previous trauma.
Other potential issues
Other factors that might contribute to night terrors include alcohol use, fever or illness, medications (including stimulants and some antidepressants), fatigue, sleep deprivation, restless leg syndrome, and travel related sleep disruptions.
Sleep terrors are more common when other family members experience the problem. In children they’re more common in girls than boys.
When to see a doctor
In the majority of cases an occasional night terror is nothing too concerning. If it’s your child, you can bring night terrors up at his or her checkup. If it is an adult, there are certain circumstances in which we recommend talking to a professional. This is when night terrors:
- don’t disappear as you move into adulthood
- cause tiredness and fatigue during the day
- present a safety concern
- start to affect partners and family members
- become more frequent.
Diagnosing night terrors
As we mentioned earlier, people often don’t remember night terrors. Once you consider their irregularity, this makes them hard to identify and diagnose. However, if you have a reason for concern or a partner has spotted the problem, you can talk to a doctor.
Initially a doctor is likely to ask you to keep a sleep diary to learn more and also to discount sleep deprivation or other issues. In some cases s/he may also ask to talk to your partner for more details of the episodes. You’re likely to be asked about:
- medical history
- use of medication and natural remedies of sleep problems
- symptoms of problems related to breathing
- symptoms of mental health problems
- previous treatment of sleep issues
- stressful situations at work or home
- family history (with regards to night terrors, sleepwalking, and other problems related to sleep)
- use of substances.
If all potential medical causes are ruled out, you may visit a sleep specialist (assuming that the problem continues to affect your life).
Treatments - home remedies
Before we look at what the doctor may suggest, here’re home remedies that many people use to prevent or limit night terrors (they’re also good tips for life in general!).
Safe living environment - If it’s safety that worries you, improve all the locks on your doors and windows. You could also invest in an alarm system. If you’re accustomed to walking, make the route around your home clear from trip hazards (hide fragile and delicate items too).
Reduce stress - wherever possible. It’s worth asking children if something is on their mind. Allow yourself time to relax and talk through difficult situations.
Sleep more - Whenever we’re deprived of sleep, the risk of sleep related side effects increases. If you can’t sleep for longer in the night, can you squeeze in an afternoon nap?
Keep a journal - by writing down the details of your night terrors (with the help of a partner) you might spot a pattern. We’ve seen parents wake their children up for five minutes when the night terrors normally occur and let them sleep again.
For those struggling to get to sleep in the evening we recommend introducing a bedtime routine and turning off all technology for at least an hour before going to bed.
Treatments - doctor’s advice
If you’re diagnosed by a medical professional, the first thing to know is that medication isn’t really an option. Whether it’s you or your child, the second important note is that night terrors normally pass without huge intervention; don’t worry no matter how distressing it may look. To shorten an episode for a child, comfort them, keep a calm tone, and hold their hand.
These days treatments are only offered when the problem starts to affect either the individual’s or family members’ safety. If you struggle to concentrate at work or feel fatigued, treatments are also considered here. There are four main areas of treatment:
- Stress - this could include counselling or therapy.
- Medication - although we said medication isn’t an option, it will be deployed in rare cases. This includes serotonin re-uptake inhibitors (SSRIs) and benzodiazepines.
- Sleep conditions - you may receive advice for improving the sleep environment whenever sleep deprivation is a problem.
- Underlying condition - treatment for an underlying issue such as a mental health problem or sleep apnea.
Helping a partner with night terrors
You might be reading this on behalf of your partner. So what do you do? Don’t try to wake them up during an episode. Not only will you struggle, but you may also cause confusion. In severe cases the individual could become physically aggressive and cause injury to themselves or you.
Instead use a calm tone and try to comfort them as much as possible without getting physically involved. If they climb out of the bed, you can guide them to a seat or back into bed without trying to wake them up. If there’s aggression or hesitation, back off a little and give them a moment.
When we tell sufferers about their behavior the next day, they often feel a little embarrassed. At this point show them that they aren’t alone and that you understand the problem (remember, they aren’t in control). Show support, help them track episodes in a sleep diary, and start working towards a solution together; you could also attend doctor’s appointments and therapy sessions.
Night terrors can cause tears and startling screams in adults and children, so it’s a problem for which we desperately seek a solution. We’re still unsure of their exact cause, but there are many factors that have the potential to make night terrors worse.
If night terrors start to negatively impact your life or the lives of those around you, contact a doctor. You’ll work on identifying the issue and potential solutions.