For most parents, awakening to the sounds of a child screaming is an alarming occurrence, particularly when attempts to comfort your child are met with an unresponsive expression and flailing limbs. This isn’t a nightmare; it’s a night terror.
While the moments that pass during a night terror may feel long and stressful for a parent, these episodes usually last only a few minutes, afterward your child quickly falls back to sleep, and they will not have any memory of the episode the next morning.
Parents often have questions and concerns about night terrors. Knowing about their causes, consequences, and differences from other unusual sleep behaviors can help parents understand these episodes and how to best care for their child.
What Are Night Terrors?
Night terrors, also called sleep terrors, are a type of parasomnia, classified as an arousal disorder, that occurs during non-REM (NREM) sleep. They usually occur during the first 3 to 4 hours of the night.
A person experiencing a night terror will suddenly begin to show signs of panic and terror while sleeping such as screaming, flailing, or kicking. This is usually accompanied by other symptoms like rapid heart rate and breathing, flushing of the skin, sweating, dilation of the pupils, and tensing of the muscles1.
Although the child may open their eyes and appear to be intensely afraid of someone or something in the room, they are typically not responsive to those who try to wake them or provide comfort. They may even attempt to fight or escape, causing accidental injury to themselves or family members.
Most night terrors last about 10 minutes, but they can continue for 30 to 40 minutes in some children. After the episode, children often fall back into a deep sleep and typically have no memory of the night terror the next morning.
The frequency of night terrors can be hard to predict. Some children may experience them very rarely while others may have one to two episodes per month.
Nightmares Versus Night Terrors
Nightmares are unpleasant or frightening dreams that cause emotional distress. Unlike night terrors, nightmares usually occur during REM sleep and don’t involve physical or vocal behaviors. It is common to remember the details or feelings of the nightmare and some may even become recurring dreams.
Both nightmares and night terrors begin in childhood. It is estimated that 10% to 50% of children ages 3 to 5 have nightmares that are severe enough to disturb parents or caregivers. While night terrors are considered less common, prevalence rates are not well documented. In general, the prevalence in children has been reported as 1-6.5%. However, one study found up to 40% of children under age 5 experienced night terrors.
Who is Affected by Night Terrors?
Night terrors can affect people of any age but are much more common in young children than in adolescents or adults.
Night Terrors in Children
The most common age in which night terrors occur is a matter of ongoing debate. Most often, these episodes emerge when a child is between 4 and 12 years of age and resolve spontaneously by adolescence or puberty. However, a recent study showed the most common age for night terrors was 1.5 years old, with up to 35% of children this age having these episodes.
Night Terrors in Adolescents
While detailed evidence is lacking, the prevalence of night terrors in children over 12 appears to be low. Most adolescents who have night terrors experienced them when they were younger and will outgrow these episodes as they move into adulthood. One study describes that only 4% of parasomnias like night terrors will persist past adolescence. New onset of night terrors in teenagers may be related to trauma or a psychiatric disorder.
In certain social settings at this age, like sleepovers or summer camps, a teen with a history of night terrors may feel some anxiety or embarrassment. It may help to consult with a doctor to help identify triggers or other contributing health conditions.
Night Terrors in Adults
Adults experience night terrors much less frequently than young children. 2.2% of adults have reported experiencing night terrors, and very few people over the age of 65 (<1%) describe having night terrors.
Adults with a childhood history of night terrors may have a recurrence of the episodes, triggered by stress, sleep deprivation, or the development of another sleep disorder. As with adolescents, sleep terrors in adults may be of particular concern due to a greater risk of injury to oneself or other household members if violent behavior occurs during the episode. Rarely, adolescents and adults may recall details of the night terror.
What Causes Night Terrors?
Like other parasomnias, there is some evidence that night terrors have a genetic component and are more likely to occur in individuals who have a family history of parasomnia, specifically a parent or sibling.
Additionally, people who have other sleep disorders like nocturnal asthma, obstructive sleep apnea, restless leg syndrome, or gastroesophageal reflux are increasingly recognized in those with night terrors. In particular, obstructive sleep apnea (OSA), a breathing disorder, is present in more than one-half of children who are referred to doctors for sleep terrors.
In general, there is no significant association between night terrors and psychological disorders, in contrast to what has been suggested in other types of parasomnias.
While the conditions described above can predispose someone for parasomnias, a number of factors have been shown to trigger them:
- Sleep deprivation
- Separation anxiety in children
- Periods of emotional distress or conflict
- Disruption of sleep schedule
- Certain medications
- Alcohol use and abuse
- Migraine headaches
- Head injury
When to See a Doctor About Night Terrors
Most children will outgrow night terror episodes, without treatment, and prevalence rates drop steeply in adolescents and adults. However, seeking medical advice about night terrors should always be considered, particularly in the following scenarios:
- Episodes occur 2 or more times per week
- Episodes result in injury or near injury
- Night terrors are accompanied by sleepwalking or sleep talking
- A person has disrupted sleep and/or daytime sleepiness or problems functioning
- Sleep terrors begin in adolescence or adulthood
A diagnosis can usually be made by reporting symptoms and sleep behaviors to your doctor. Other tests may be recommended if a person is experiencing other symptoms, such as sleep apnea, bedwetting, or seizures. A referral to a sleep specialist may be needed to rule out other sleep disorders or diagnose underlying health conditions.
How Are Night Terrors Prevented and Treated?
There are a number of approaches to address night terrors, and it’s best to work with a doctor to tailor treatment to your specific needs. Knowing how to respond to night terrors in the moment is beneficial to minimize adverse events when they occur and thankfully the episodes are generally self-limited.
Should You Wake Up a Child Who is Having Night Terrors?
When a child has a night terror, it’s natural to want to provide comfort. It’s best to stay close by and ensure that they do not fall or hurt themselves. However, do not try to wake a child during a night terror. Attempts at arousal may make the episode last longer or provoke a physical response that could lead to injury. Most often these episodes are short, and your child will fall quickly back to sleep.
If night terrors occur repeatedly, ensure that your child’s bedroom is a safe environment by removing any potentially dangerous items and securing doors and windows. Make sure other caregivers and family members also know what to do if a night terror occurs.
What is the Treatment for Night Terrors?
Parents should be assured that treatment may not be needed for children who experience night terrors less than twice per month. Most children will naturally outgrow these episodes as they get older and their nervous systems develop.
Even if night terrors are infrequent, it’s important to consider things you can do to improve your child’s sleep hygiene. Better sleep habits can reduce the likelihood of night terrors, facilitate better growth and development, and establish healthy sleep routines as your child grows up. Given that sleep deprivation is a known trigger of night terrors, improving sleep quality is a common approach for addressing more frequent night terrors
If an underlying medical problem is contributing to night terrors, treating that medical condition may play an integral role in reducing and/or treating night terrors. A doctor can help determine whether any underlying medical conditions are contributing to the parasomnia, and offer a specific treatment plan.
In some cases, medications may be considered for children with persistent night terrors. Some children respond to treatment with drugs like sedatives and certain antidepressants.
Night Terror Treatment in Adolescents and Adults
Adolescents and adults who experience repeated night terrors may benefit from working with a sleep specialist who can help to identify whether there is an underlying cause that can be treated. They may also prescribe therapy to manage the symptoms of night terrors.
A doctor or sleep specialist may ask you to keep a sleep diary, which is a record of your recent sleep habits and how sleep is affecting your daily life. They may ask for information from a bed partner or family member who can describe night terror episodes. Some individuals may be referred for a sleep study to further evaluate and diagnose underlying/concurrent sleep disorders