a mother reading her child a bedtime story
A recommended treatment for night terrors is co-sleeping, where the parent sleeps in the child's room with them.

What Are Night Terrors?

You might have heard the terms "night terrors" and "nightmares" before — either from old wives’ tales, pop culture references, horror movies or even in ancient mythology. But in the advent of medical and scientific progress, one might wonder, "is there any truth and science behind these so-called night terrors?"

Night terrors or sleep terrors (pavor nocturnus) is a bizarre sleep disorder commonly observed in children. It can be described as being partially awake from a deep sleep with associated cries and screaming, violent body movements, physiological disturbances like increased heart rate, rapid and irregular breathing, dilated pupils and sweating.

The child might be seen with a fearful and confused expression, often talking or screaming nonsense, and may walk around and bump into things. Usually, these episodes are hard to interrupt, and the sleeper does not respond to being forcefully woken, even by means of holding, consoling, or gently shaking the child.

Upon waking up, they will have no recollection of the bad dream and their actions; they will only remember the feeling of fear. Children are inconsolable and visibly stressed, which sometimes prompts the parents to rush for a late-night consultation at the emergency room.

What Is the Difference Between Nightmares and Night Terrors?

Nightmares and night terrors are often used interchangeably. However, there is a difference between the two. Nightmares are bad dreams that cause a feeling of anxiety and usually end with the spontaneous waking of the sleeper. Meanwhile, sufferers of night terrors are less responsive to being woken up.

Also, unlike with sleep terrors that leave no memory of the dream, those who experience nightmares wake up lucid and with a clear recall of almost all the content of the dream. Another difference is that there is little to no aggressive body movements during nightmares. In contrast, there is less muscle involvement, which gives the feeling of “being paralyzed” instead.

Who Is Affected by Night Terrors?

Night terrors are a sleeping disorder that most commonly affects children and, very rarely, adults. Research has shown that night terrors affect school-aged children from 18 months to 13 years, most commonly between one to five years of age.

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What Triggers Night Terrors?

Even today, there is no clear reason why night terrors happen. It has been observed that this occurs during non-REM sleep, while nightmares occur during REM sleep (because this is when dreams happen).

There have been a lot of theories as to why these happen. Here are some of them:

  • terrifying stories or movies before bedtime
  • disorders of the respiratory system (enlarged tonsils or increased carbon dioxide at night)
  • poor circulation to the brain due to heart problems or obesity
  • nervous system problems like seizures and epilepsy, etc.

Despite all these theories, no established reason has been linked to the occurrence of sleep terrors in children.

How to Stop Them

The first thing parents should do during these episodes is to remain calm and wait for the episode to resolve on its own. Do not forcefully wake up the child. Instead, make sure that they are safe from harming others or injuring themselves. Make sure to brief other people such as relatives, teachers and babysitters on what to do in case you (the parents) are not around.

One theory has been studied on how co-sleeping (children sleeping beside their parents) can help with episodes of night terrors. It has been theorized that night terrors may be due to the deeply rooted evolutionary need for both primate and human infants to ask for protection during their vulnerable state of sleep, as part of their survival mechanism.

However, pediatricians recommend room-sharing; this is when the infant or child sleeps in a separate crib or bed but in the same room as the parents. This is recommended to prevent the instances of accidental smothering of the child by the parents during sleep. By doing room-sharing, the parents can quickly assess and respond to the needs of the child without this risk.

When to Seek Help

Night terrors are not harmful, and generally they do not need treatment. They may only last for a few months with the frequency of the episodes decreasing over time.

However, professional help might be needed if the night terrors are frequent (three to four times a week for months) with no signs of slowing down. Medical consultation may also be needed if the night terrors last more than 30–45 minutes per episode, and the child has daytime symptoms of anxiety or fear.

A comprehensive psychological evaluation of the child and the family may help in deciding whether this condition is just part of the child’s normal development, or if some issues within the family could be the cause.

For children and adults whose night terrors are triggered by a traumatic experience, psychotherapy may be considered. Most of the time night terrors do not require any medications or sedation as treatment, but they may be considered by the doctor if the episodes are getting worse.

Parents should also take into consideration asking for immediate and professional help if the child is seen with jerky movements, drooling, stiffening, high fever or upward rolling of the eyeballs, as a seizure episode is dangerous and must be ruled out as well.