21 May Night terrors: what are they and how can you treat them?

I remember not wanting to close my eyes, but I couldn’t help it. No matter how hard I tried, I could not stay awake. Inevitably, same thing would happen every night: I would wake up in a panic, drenched in sweat and crying… The next thing I knew, my mother would be at my side telling me, “It was just a dream, Sammy¨.

Sam, 33 years old (childhood memory)

Night terrors are episodes where people wake up with a fright, screaming or crying and covered in sweat. These episodes are caused by an unpleasant experience in a dream, also known as parasomnia.

This condition is more common in children between the ages of 3 and 12, who experience situations similar to Sam´s when he was a child. Nevertheless, adults can also have night terrors and they can be associated with sleep disorders like sleepwalking.

Why do night terrors occur?

In order to understand why these episodes occur, first you need to know how the sleep cycle works. The brain generates brain waves that determine whether we are awake or asleep.

When we sleep, we go through 5 different stages of sleep and our brain activity changes in each phases:

Stage I

You know that feeling when your mind is still awake, but you can feel yourself drifting off? This is the lightest phase of sleep, when your eyes and muscles in your body are still moving slightly. It is easy to float in and out of consciousness in this stage, and you are not aware of what is happening around you. The dominant brain waves associated with this stage are alpha and theta.

Stage II

Sleep is deeper in this stage and you feel more and more relaxed. Eye movement stops, brain waves slow down, your body temperature lowers, and so do your heart rate and breathing rate.

Stage III

This is the stage when real rest starts to happen. If you wake up during this stage, you are probably going to feel disoriented and slightly groggy. You may experience night terrors or other sleep disorders, like sleepwalking.

Stage IV

This is the deepest stage of sleep where you rest both your body and your mind. You can see images, but they are not like the stories that form dreams.

REM Stage

This is when you start dreaming in a sequence of images that form a story. You are so relaxed, that almost every single muscle is completely relaxed. Did you know this is why you when you scream in a dream, no sound comes out?

A complete sleep cycle, from stage I to the REM stage, usually lasts between 90-110 minutes. Generally, we have five sleep cycles per night.

A night terror is technically not a dream, but a sudden fear response that occurs during the transition from one stage of sleep to another. Specifically, night terrors occur between stages III and IV.

Night terrors can last anywhere between 5 and 30 minutes and, generally, happen approximately 90 minutes after the person falls asleep. Night terrors are often confused with nightmares, but they are actually very different:

Remember, this disorder is more common in children, affecting approximately 1% to 6% of children between the ages of 3 and 12. It is usually outgrown by adolescence, but it can be triggered by anxiety, traumatic events or substance abuse (drugs or alcohol).

How to tell if someone is experiencing night terrors?

The most characteristic symptom of night terrors is that the episodes are recurring. They may repeat several nights a week, or even every night. They occur between the first third of the night (3 or 4 hours after falling asleep) and tend to have the following characteristics:

• Partially or completely waking up from sleep very suddenly
• Shouting at or hitting people nearby
• Unexplained anger
• Wide eyes and dilated pupils
• Rapid breathing
• Raised heart rate
• Excessive sweating
• Confusion upon waking
• Little to no memory of the incident
• No response to external stimuli

Children usually do not remember what woke them up, whereas adults are much more likely to remember their night terrors, either the same night or the following day.

What causes night terrors?

The causes of night terrors vary between children and adults:

Between the ages of 3 and 12

In children, these episodes are produced by an activation of the central nervous system (CNS), which causes a fight-or-flight response to be triggered at the wrong time. Other causes may include:

• Fever
• Lack of sleep
• Stressful situations
• Use of certain medications.

Usually, the transition between the deepest stage to the lightest stage of sleep is smooth. But sometimes, a child may becomes agitated or frightened and that fear reaction is a night terror.

It is not usually necessary to see a psychiatrist, as long as the frequency and intensity of the night terrors do not increase. If these episodes do get worse, a specialist should carry out an evaluation to rule out a seizure disorder.

Adults

In adults, causes can be due to psychological factors such as:

• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Depressive disorder
• General anxiety disorder
• Substance abuse, particularly alcohol.

In adults, night terrors are milder, but they are usually accompanied by other sleep disorders like insomnia or sleep apnea. In these cases, it is recommended to see a specialist.

What do I do if my child is having night terrors?

In children, as we mentioned above, it is not necessary to seek treatment for night terrors if they only occur a few nights a week and your child falls asleep easily afterwards. To avoid needing treatment, try to maintain a healthy bedtime routine:

• Establish a sleep schedule and stick to it everyday (between 18:00 and 19:00)
• Remove any distractions like cell phones, computers, tablets and TVs
• Give them a light dinner, ideally, two hours before bed
• Put on comfortable clothes (pyjamas)
• Give them a bath before bed to help calm them down
• Leave a night light on and the door slightly open so that they feel safe.

During a night terror, the best thing you can do is help them calm down:

• Do not try to wake them
• Stop them from hurting themself, ensuring they do not fall out of bed
• Talk to them calmly, reassure them that everything is fine
• After a short while, they should relax and go back to sleep
• Stay by their side until they are comfortably asleep again.

If your child appears to be having a night terror, but they stop crying as soon as you get to their room, they may not actually have a sleep disorder. It could be that they are simply crying out to get attention, in which case you should adjust their sleep habits accordingly.

How to treat night terrors

In adults, night terrors are usually treated with relaxation techniques and therapy. Management depends on the causes, since treatment is aimed at alleviating the factors that produce night terrors. For example, panic attacks, depression or some type of trauma. If you are having night terrors, try to incorporate the following habits into your nighttime routine:

• Meditate
• Take a warm bath or shower
• Read a book
• Practice calming yoga postures

Understanding night terrors may be the key to the overcoming them. Remember that dealing with night terrors depends on your age. If you do feel like you need professional help, do not hesitate to see a doctor.

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Sources

Los ciclos del sueño [Instituto del sueño, 2019]

Miedos del sueño (terrores nocturnos) [Mayo Clinic, 2018]

Trastornos del sueño [Protocolos de la Asociación Española de Psiquiatría Infanto-Juvenil, 2008]

Fenómenos pseudoictales del sueño [Asociación Colombiana de Neurología]