As a parent you’ve probably had nights when your child has awakened, screaming and describing “night terrors,” or the child has awakened very confused. Maybe there’s even been an isolated incidence of, or pattern of, sleep walking or sleep talking. These moments may have given you some pause as a parent, or been downright frightening, but let me assure you - they’re likely not serious.
These incidences are all known as a group of sleep disorders called Parasomnias.** Night terrors** are mostly encountered in children between 4 and 12 years of age, and tend to become less intense as the child reaches adolesence. However, the experience can be quite dramatic for a parent. Imagine a child bolting upright in the bed with a loud yell, cry, or scream. Once awake, the child expresses intense fear, and, usually accompanied by profuse sweating and rapid breathing, but with no clear recollection of the precipitating event, because they were in deep sleep.
This is very different from nightmares. With nightmares, there is clear recollection of the content that led to the waking and feeling of fear. Even though the dream may be frightening, there is a surprising clarity and serenity. Nightmares, along with all dreams, occur during the latter part of the night, specifically during a period of sleep called** REM.** The purpose of the nightmare is to desensitize the child (or adult) to powerful emotional experiences that occurred during waking hours.
In contrast, night terrors occur in the first part of the sleeping experience, or non-REM sleep. They have no content and are all about emotion. Usually the child will readily going back to sleep, since the terrors typically occur during the smooth transition from non-REM to light REM sleep. The theory is that night terrors are the result of disinhibition of the basic drive states that may involve aggression. There is over-arousal of the CNS (central nervous system) during sleep, possibly because the CNS is still maturing. Often times, there is a family history of this phenomenon.
Technically, the child is awake, but in reality he or she is still in what is known as “sleep inertia.” This is a drowsy period after fisrt waking up when we are still not fully alert. This phenomenon tends to be more pronounced in children, since they have deeper sleep, and it takes more to waken them.
It is very important to not forcefully wake your child (also true in sleep walking). Doing this will only increase their confusion. Remove sharp objects from the general vicinity and make sure if the child sleep walks that the normal pathway they take is clear.Night terrors are usually benign events that do not require specific therapy. Do consider the environmental safety issues just mentioned, if the child has more than one episode. There has been a technique developed called anticipatory awakening that has yielded some mixed results. It consists of the parent wakening the child about 15-20 minutes before the usual time of the occurrence (generally by wiping the child’s face with a wet washcloth) in an effort to shift the patient into a lighter stage of sleep and thus abort the event.
Is any treatment necessary?
In most cases, treatment is not necessary. In the case of repetitive incidences, the guidelines recommend looking for an underlying medical disorder such as obstructive sleep apnea (OSA) cause by enlarged tonsils, or restless legs syndrome, since children do not manifest typical signs of either of these problems. But, if there is no apparent evidence of underlying medical problems, then parents can rest easy and allow the events take their normal course, since they will resolve as the child matures.
One important consideration is tvoileep deprivation.
Remember, children have higher needs for sleep.
- A toddler between one to three years of age needs 11-12 hours of sleep.
- Preschoolers, between 3 and 5 years of age, need 10-12 hours of sleep nightly.
- Pre-adolescents need on average 8 to 11 hours a night.
- Adolescents need 7 to 9 hours of sleep every night.
As I alluded to in earlier shareposts, insufficient sleep is very prevalent among teenagers** in our culture with significant consequences.**** Are there medications that can help?**
The FDA has not approved any medications for use in children for the treatment of parasomnias. The American Academy of Sleep Medicine does not have any recommendations for medication use in children off label.
What do I recommend to parents?
Be patient and supportive. Sleep, and all that comes with it, is essential for a growing child. During childhood, the brain is developing, with all the cognitive and emotional learning experiences necessary for them to adapt to our very complicated world. Think of dreams and night terrors as part of that learning and growth process.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.