Night Terrors

Night Terrors Overview

The sleep disorder of night terrors typically occurs in children aged 3-12 years, with a peak onset in children aged 3½ years.

Sleep is divided into 2 categories: rapid eye movement (REM) and nonrapid eye movement (non-REM). Non-REM sleep is further divided into 4 stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 non-REM sleep to stage 4 non-REM sleep, beginning approximately 90 minutes after the child falls asleep.

Night terrors are distinctly different from the much more common nightmares, which occur during REM sleep. Night terrors are characterized by frequent recurrent episodes of intense crying and fear during sleep, with difficulty arousing the child. Night terrors are frightening episodes that disrupt family life.  

An estimated 1-6% of children experience night terrors. Boys and girls are equally affected. Children of all races also seem to be affected equally. The disorder usually resolves during adolescence.

Night Terrors Causes

Night terrors may be caused by the following: 

• Stressful life events
  
• Fever
  
• Sleep deprivation
  
• Medications that affect the central nervous system (the brain)

Night Terrors Symptoms

In addition to frequent recurrent episodes of intense crying and fear during sleep, with difficulty arousing the child, children with night terrors may also experience the following: 

• Tachycardia (increased heart rate)
  
• Tachypnea (increased breathing rate)
  
• Sweating during episodes 

Unlike nightmares, most children do not recall a dream after a night terror episode, and they usually do not remember the episode the next morning. 

The typical night terror episode usually begins approximately 90 minutes after falling asleep. The child sits up in bed and screams, appearing awake but is confused, disoriented, and unresponsive to stimuli. Although the child seems to be awake, the child does not seem to be aware of the parents’ presence and usually does not talk. The child may thrash around in bed and does not respond to comforting by the parents. 

Most episodes last 1-2 minutes, but they may last up to 30 minutes before the child relaxes and returns to normal sleep. 

If the child does awake during a night terror, only small pieces of the episode may be recalled. Usually, the child does not remember the episode upon waking in the morning.

When to Seek Medical Care

Sleep disruption is parents’ most frequent concern during the first years of a child’s life. Half of all children develop a disrupted sleep pattern serious enough to warrant physician assistance.  

• In children younger than 3½ years, peak frequency of night terrors is at least 1 episode per week.
  
• Among older children, peak frequency of night terrors is 1-2 episodes per month.  

If your child seems to be experiencing night terrors, an evaluation by the child’s pediatrician may be useful. During this evaluation, the pediatrician may also be able to exclude other possible disorders that might cause night terrors.