Definition of Sleep Terror
Sleep terror disorder is sometimes also referred to as ‘night terrors’, and is a form of parasomniac disorder. It’s important to note that night terrors are not the same thing as nightmares, as they occur in completely different phases of the sleep cycle.
Sleep terror disorder usually affects children between the ages of three to twelve, and is characterized by waking up from sleep with intense feelings of fear or panic.
Many children will scream or call out. Others will sit upright in bed with their eyes open, a fearful look on their faces. In some cases, children may run around in an attempt to evade whatever is frightening them in their dream. Other common characterizations of sleep terror disorder include excessive sweating, rapid breathing rate and increased heart rate.
Symptoms can be as short as a few seconds, or as long as a few minutes.
Parents may simply believe their children are experiencing bad dreams and rush in to comfort the child. Yet, while the child may appear to be awake, with opened eyes and calling out, they often aren’t quite in a fully wakened state. Children may be confused, not recognize parents or other siblings in the room with them, and be completely inconsolable.
While sleep terror disorder is more common among children, there are instances where teenagers and adults may continue to experience symptoms.
Sleep Terror vs Nightmare
The vast majority of people may not fully recognize the differences between a nightmare and night terrors. In order to distinguish the differences between them, it’s important to first understand the characterizations and symptoms of both.
In order to be classified as a nightmare, the dream needs to be frightening enough or severe enough to awaken the sleeper. Vivid nightmares are often easy to recall after waking up, which can cause anxiety and stress. This can lead to some people becoming afraid of going back to sleep.
While it may not be easy to reassure or comfort a child after a bad nightmare, most children will generally settle and go back to sleep after they’ve been made to feel safe and secure following a nightmare.
Nightmares most frequently occur during the REM phase of sleep. This is usually the later part of the sleep cycle, which most commonly occurs in the early morning.
Children who do experience terribly vivid, frightening nightmares may often crawl into a parent’s bed for comfort. It’s wise to reassure the child and encourage him or her to go back to sleep.
For many people experiencing particularly vivid nightmares, these can be a sign that the mind is trying to work through a particular problem, difficulty or stress situation. In children, this can be emotional difficulties or problems, bullying at school, worry about family issues, or any other stressful situation that hasn’t been fully addressed. The same is true for many adults. Most nightmares stop once the problem has been resolved.
Classifying Sleep Terrors
By comparison, night terrors tend to occur most frequently during the deep Stage 3, or slow-wave, phase of Non-REM sleep. This most often occurs in the early part of the night, usually one or two hours after falling asleep, and is commonly referred to as a Non-REM sleep disorder.
Night terrors are also a type of parasomnia. This means the sleeper may exhibit unusual movements or behaviors during sleep. Some people may call out, scream, moan, or thrash around in bed. Others may sit up and look around, while still others may try to scramble out of bed, run around or hit out at things that aren’t there.
During a sleep terror episode, the face and body may appear very expressive and seem to be awake, yet the mind is not fully out of the sleep phase. This is often why children aren’t quite awake during their fearful episode and may not recognize the people around them. This lack of recognition can lead some children to push family members away, or run away from them in fear.
Most children do not remember having night terrors when they wake up the next morning. Yet, they will often remember nightmares. This is the primary distinction between the two.
There is no psychological problem behind a night terror episode. Research suggests that this particular partial-arousal disorder may be more physiological in origin.
Causes of Sleep Terror
On a physiological level, sleep terror occurs when the sleeper is in a deep Stage 3 phase of Non-REM sleep and is partially-aroused. The body activates, but the mind does not fully wake. This causes the sleeper to appear lucid, with eyes often open and sometimes even moving about physically. Yet, as there is no mental recognition of objects or people in the room, the mind has remained within the sleep state.
Research conducted in sleep clinics has verified that it is possible for people to dream during the Non-REM phase of sleep. However, these dreams are very rarely remembered upon waking. This is why most people who have experienced sleep terror will not remember the incident at all. The most vividly recalled dreams occur during REM sleep.
The primary cause of sleep terror episodes in children is being overtired. Any kind of sleep deprivation or interruption of sleep pattern in a young child may bring on night terrors. This includes going to bed later than usual, traveling to different time zones, or not getting enough sleep over successive nights. Poor quality of sleep and fever may also bring on night terrors in children.
It has been suggested in many studies that sleep terror can be genetically passed down to children. If either parent had a partial-arousal disorder, such as sleep walking, sleep-talking, or talking during sleep, it is more likely children may develop similar partial-arousal disorders that include night terrors.
Recent studies have shown a link between sleep apnea and sleep terrors in some children. Epilepsy is also linked to the onset of sleep terrors in a small percentage of children.
Night terror episode emerge in teenagers or adults experiencing extreme periods of stress. As sleep terror disorder is a form of parasomnia, if episodes persist or become more frequent, it may be worth discussing symptoms with a doctor.
In adults, sleep terrors and other forms of parasomnia can be triggered by periods of extreme emotional stress and depression. Sleep deprivation and fever are also known triggers in adult episodes. Drinking excessive amounts of alcohol prior to sleeping can also trigger an episode, as can certain medications, including anti-depressants, anti-histamines and sleeping pills.
Health Effects of Sleep Terror Disorder
Sleep terror disorder is classified as a form of parasomnia. This is a disorder where the sleeper is only partially-aroused during the sleep cycle. In sleep terrors specifically, the sleeper’s body may activate, causing them to cry out or move around, but their mind may still be in the sleep state.
Regularly disrupted sleep patterns can cause excessive day time sleepiness. This can lead to difficulties at school for children, or at work for adults. As being overtired is a trigger for further sleep terrors, this can actually make episodes more frequent.
In children, consistently disrupted sleep patterns can lead to increased risk of childhood obesity and reduced effectiveness of the immune system. Sleep deprivation can also lead to behavioral problems that exhibit symptoms similar to ADHD.
Sleep Terror Disorder Statistics
The prevalence of sleep terror disorder isn’t exactly known, however it’s estimated that approximately 6 percent of children around the world may experience night terrors. Both boys and girls are affected equally. The frequency of sleep terror incidences can be as little as once a month, up to several times a week.
Children as young as one year old can develop night terrors for the first time. This is particularly frightening for parents of very young children. Episodes can occur two or three times a week in very young children up to an approximate age of 3 and a half years old, reducing to around once a month in children older than four years old. The incidence of night terrors may begin to dwindle after this age, reducing down to only a couple of times a year, before the child grows out of them altogether.
It’s estimated that up to 3% of adults will continue to suffer from occasional sleep terror episodes. These are likely to occur at a much lower rate of frequency than in children. In adults, night terrors tend to occur during the Stage 3 phase of sleep.
Sleep Terror Disorder Treatment
What to Do During a Sleep Terror Episode
For parents watching a child experiencing a severe night terror episode, it can look very frightening. Many parents become distressed and worried for their child, especially if the child is screaming, thrashing about, or trying to run from an unseen threat.
In this case, avoid interfering with the episode and definitely do not try to wake the sleeper up. This can often make the severity of the sleep terror even worse. Instead, monitor the sleeper and ensure they are physically safe. Be sure they can’t fall or run into anything harmful if they do tend to run around. Some children may need to be gently restrained until the night terror is over.
As children won’t remember their sleep terror in the morning, it’s wise not to talk about it to them when they do wake up. Children can pick up on your fear and concern. This can cause anxiety and worry in them that they’re doing something wrong during their sleep. This level of stress in a young child may bring on even more sleep terrors.
Monitoring Sleep Terrors
Any child experiencing sleep terror regularly needs to be monitored using a sleep log or sleep journals. This can help to establish a pattern and work out a more effective method of treatment.
If a pattern is recognized, such as usually occurring 2 hours after falling asleep, it may be helpful to gently wake the child 15 minutes before the usual onset time of sleep terror.
If no clear pattern is recognized after filling in sleep journals regularly, have symptoms checked by a doctor or specialist.
Preventing Sleep Terror Episodes
As the primary cause of the onset of sleep terror disorder is being overtired, it’s very important that parents establish a firm bed-time routine and then stick to it consistently. This helps to ensure that the child is getting enough sleep, but is also learning to regulate sleeping patterns by way of routine.
High fevers are another cause of sleep terrors, so it’s advisable to monitor body temperature and keep fevers down wherever possible.
If night terrors become more frequent, it is worth checking with a specialist for any underlying sleep disorders that could be causing a partial-arousal disorder.
Sleep Terror Medical Treatments
In the vast majority of cases, there is no underlying medical or psychological condition causing sleep terror. Yet, if symptoms worsen or continue to be extreme, it’s wise to see a doctor.
A pediatrician may be able to help evaluate whether any other underlying causes may be triggering sleep terrors. Sleep apnea and epilepsy can be linked to night terrors in a small percentage of children, so it’s wise to rule these out if episodes are particularly severe.
Specialist sleep clinics have shown success with use of psychotherapy treatments. There are also some cases reported where hypnotherapy can be an effective remedy in older children and teenagers still experiencing sleep terrors.
Sleep Terror Help
Many parents worry about the effects night terrors may be having on their children. Episodes can be particularly frightening for parents, especially if the child is very young.
It is possible to seek help from other parents going through the same things by seeking out specific sleep terror blogs or community forums. This will allow interaction with other parents who may have had some success in treating symptoms or helping to reduce the frequency of episodes.