| It’s not long after bedtime, and your child is lunging around his crib or throwing the covers off his bed. He’s screaming, fighting with some imaginary foe, and refuses to be comforted. His eyes are wide open, but when he looks at you, there’s no recognition there; he seems to stare right through you, and keeps crying and struggling.Centuries ago, sleep terrors — also known as night terrors — were sometimes mistaken for demon possession. Although that might seem an extreme interpretation now, they can still be greatly distressing to parents, especially those who have never seen one in progress. Some might suspect there’s something psychologically wrong with their child — especially when the terror recurs night after night, around roughly the same time.“The way I describe night terrors is, I think of them almost as a kid being sharply focused into a dream, and then not awakening from that dream, even though their body gets up,” said Dr. Daniel Parrish, a pediatrician with Western Mass. Pediatrics. “It’s as if someone is hypnotized or meditating — they’re very focused on something, and they don’t pay attention to any other kind of stimulation. You may get up, and your body might be moving as if awake, but your brain is still very much concentrated in that nightmare.”
Parrish uses that term even though a sleep terror is anything but a normal nightmare, which tends to occur during rapid eye movement (REM) sleep, usually more than 90 minutes after falling asleep. Conventional nightmares tend to take a narrative form, often deal with imminent danger or some other distress, and are often easy to remember upon waking.
Sleep terrors, on the other hand, typically occur in the first hour to 90 minutes of sleep, in ‘stage 4’ sleep, which is the deepest level. The sleeper, usually a child, will wake with a start, typically crying, screaming, and displaying a look of intense fear, and will be completely unresponsive to any efforts to comfort or wake him or her. Many sufferers see spiders, snakes, or people in the room, while some simply experience a general dread. Typically, the episode lasts five to 15 minutes, sometimes longer, and the dreamer almost always has no recollection of the episode come morning.
Considering how upsetting sleep terrors can be, that might not be a bad thing.
Evening Shadows
There are no universally accepted theories on why some children are more prone than others to sleep terrors. Some evidence suggests a genetic link if one or both parents have a history of terrors. Other experts see a connection with sudden changes in a child’s routine or family life.
“Dreams — and, to some degree, nightmares — are the brain’s way of making sense of and decompartmentalizing your thoughts,” Parrish said. “If there’s something stressful going on in your life, or your child’s life, that’s going to affect sleeping thoughts as well. If the child has something that’s bothering them — a big change, or if there’s a divorce, or mommy and daddy are fighting — that stressor in the child’s life is likely to be carried over into the troublesome sleeping period.
“Sleep terrors are more common in younger kids than older ones,” he added, “and in general, it’s a benign thing, something a child might have for a few days and then grow out of.” Other children struggle with these deep-sleep dreams for years, however, and they occasionally plague adults as well.
“They should know that this is basically a normal part of psychological development in the brain of a toddler,” said Dr. Anthony Jackson, medical director of the Neurodiagnostic and Sleep Center at Baystate Medical Center, and also chief of Pediatric Neurology at Baystate Children’s Hospital.
Some experts say it’s best for a child not to awaken too much, but just to slip back into sleep, because that will ease a transition into normal REM sleep, while waking up completely could start the whole sleep routine over and trigger another episode an hour or so later. Others say that’s not necessarily true.
“It’s a difficult thing because every child is different, and every situation is different,” Parrish said. “Sometimes you can transition them back to consciousness and talk to them about it, and then settle them down. Either way, there’s no pat answer or magic words to break them out of it.”
Reacting naturally is a good start, Parrish said, since any external stimuli — even something as trivial as traffic noise outside — can become part of the terror. “When you approach the child during the night terror, you become integrated what’s happening in the child’s narrative. I suggest saying something like, ‘Daddy’s here, and we’re going to chase the monster away,’ or ‘the monster left.’ Just comfort them as you would if they were aware. And when the child calms down, you can just settle them back into sleep.”
The key, said Jackson, is not to over-restrain a child during a sleep terror, even in the guise of hugging or holding, because that tends to become incorporated into the dream, often as something attacking the child. “It’s best to leave them be — keep them safe, but let them scream five or 10 minutes, and eventually they’ll go back to sleep.”
Routine Disturbances
Compared to other parasomnias, or arousal-related sleep disorders, night terrors are relatively uncommon.
According to the American Academy of Sleep Medicine, up to 85{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults report having at least an occasional nightmare, and about 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children can remember having at least one nightmare during childhood. Confusional arousals — a disorientation upon waking that resemble sleep terrors without the terror, and sometimes involve sleepwalking — occur in about 17{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children and fewer than 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults, while visual or auditory hallucinations at the cusp of falling asleep or waking occur in between 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of people. On the other hand, fewer than 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults suffer from sleep terrors, and no more than 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children.
Parrish said many sleeping issues can be resolved by introducing the correct patterns and routines into a child’s bedtime experience, and nightmares and sleep terrors are no exception.
“A bigger issue for many is kids just waking up and getting them to go back to sleep,” he explained. “If, every time a child wakes up, mommy sings a song, brings a snack, and brings him to bed with her, without any sort of change, it can be trouble for everyone’s sleeping habits. But if you’re a meanie and let them settle themselves for three or four days in a row, the kid will get used to that and sleep through the night.”
Jackson said parents might even be able to manipulate the child’s routine after he falls asleep to bring an end to sleep terrors. “If persistent night terrors occur every night at the same time, you can try waking him up 15 to 20 minutes before that time. Do it every night for a week or two, and maybe you can reset their sleep and obliterate the sleep terrors for awhile, or even permanently.”
He stressed, however, that the event is not dangerous in itself — except in the sense that any physical behavior poses risks, because sleep terrors almost always involve aggressive movement. “They can possibly run around and get out doors and windows, so you want to protect them.”
Beyond that, parents can only wait out the storm — no matter how fiercely it rages. |
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