Night terrors. Sleep on it!

Night terrors or nightmares, how can I tell which is which?

The term “terror” accurately defines what those who remember night terror episodes describe. Night terrors are characterized by physical symptoms associated with fear such as accelerated heartbeat and sweating. This makes them look more like panic attacks than nightmares, but they’re not.

Night terrors usually occur at the beginning of the night. While still asleep, the sleeper could:

  • Appear inconsolable, unable to answer questions
  • Sit upright in bed, eyes open with a look of fear and panic, appearing awake
  • Act upset, scared, confused, agitated
  • Struggle, act panicky
  • Scream in distress or shout
  • Breathe fast with a quick heartbeat and sweat
  • If awoken, experience feelings of terror or dread

Typical night terror episodes can be terrifying to witness but it’s good to know that they often stop as suddenly as they start, and for no apparent reason. If you witness a night terror, keep in mind that they only last between one and five minutes, but they can be longer for some, for example, younger children. Once over, sleepers return to their sleep pattern and sleep soundly. The next day, they won’t remember what happened or feel any associated fear, unless they woke up during the episode.

Nightmares and night terrors are often confused but the latter occur much less frequently than nightmares. The table below shows the difference between the two. Even though both arouse a strong sense of fear after waking, several characteristics help tell them apart, and what action to take:

Characteristics Night terrors Nightmares
Physical symptoms of fear
None or very mild physical manifestations.
Physical manifestations of intense fear or terror, such as accelerated heartbeat , sweating, screaming and mental confusion
What is remembered at waking
No recollection or very vague at waking in the morning. However, if awoken during the night terror, a terrifying feeling or horrifying flashes can be recalled more than a story.
A story or piece of the dream can be recalled at waking.
Intervention
Since awakening may spark fear, avoid waking the sleeper to comfort him or her. It will be difficult to awaken and to comfort the sleeper due to the feelings of fear and terror.
The sleeper can be awoken to stop the nightmare and to be comforted. Not difficult to awaken the sleeper and more or less difficult to comfort depending on how much or how little the sleeper remembers of the nightmare.
When it occurs
Mostly during the first part of the night when first deep sleep stages occur (slow wave sleep).
Mostly during the last part of the night when the last paradoxical sleep stages, also known as rapid eye movement (REM) sleep, occur.
Who is affected
Predominantly during early childhood (preschoolers) but seen in all ages.
Predominantly during childhood (school age) but seen in all ages.

Since children are more often affected than adults, parents can often report how an episode of night terror is far more dramatic and harder to witness than most nightmares. That’s mainly because nothing seems to comfort the child. Up to forty percent of children experience night terrors before they reach adolescence yet fewer than two percent of adults get them. There is a peak in preschoolers for boys and girls alike.

What to do or not do?

Avoid sleep deprivation and stress, which are major contributors to night terrors. Keep in mind that getting enough sleep and sticking to a regular sleep-wake schedule (regular bedtime and waketime) are key factors to prevent night terrors.  There are no psychological treatments or medications for night terrors specifically. However, a medical or psychological follow-up can be of great help to change what causes night terrors, such as adopting a regular sleep routine and schedule along with a healthy lifestyle that involves coping with stress.

It is natural if you feel helpless or panicked in the face of an  inconsolable mood, a  state of agitation and an  expression of fear of someone experiencing night terrors. These are daunting moments, as every parent who’s experienced night terrors will tell you! Remember, the best way to react is to remain calm, don’t try to wake up the person and make sure that the sleeper does not get hurt. Waking a child or an adult during a night terror is not the best thing to do since it may increase their state of fear and confusion, and may prolong the event by making it take longer to calm down and fall back to calmer sleep. Sleepers of all ages experiencing a night terror settle down within minutes and find on their own a more peaceful sleep. Parents or bed partners can help to  guide the sleeper out of the episode, without waking him, by talking very soothingly and staying by his side to avoid injuries.

In the morning or in the following  days, there is no need to talk about the episode unless the child or adult brings it up. When it comes to protecting sleep quality, it is as crucial to have positive, soothing and stress  free sleep routine, as it is essential for it to be regular. Given that the vast majority don’t remember the episode, talking about how terrifying the event was may instill a fear of going to sleep and may create or amplify what could  be responsible for it in the first place, namely, stress.

What are the causes of night terrors?

Even though what causes night terrors is not fully understood, it has been established that the following factors may trigger night terrors in both children and adults:

  • Become overtired, experiencing occasional sleep loss or chronic sleep deprivation
  • Getting stressed out (moving, breakups, change at school or at work) or the stress of sleeping in a new environment (change in sleep routine)
  • Falling sick such as catching the flu
  • Starting a new medication
  • Having other sleep disorders, such as narcolepsy in adults

There might be a genetic origin because family members, for example the parents, also report having episodes of night terrors or sleepwalking. Actually, night terrors share more characteristics with sleepwalking than with nightmares. Moreover, new studies found that children with night terrors have more chances to have sleepwalking episodes later in their life. In fact, both conditions arise as the brain develops during childhood (i.e. a neurodevelopmental phenomenon). So as children get older and their central nervous system develops, the risks of experiencing night terrors diminishes.

What are the consequences of night terrors?

Night terrors are not a problem by themselves for the affected child or adult. Aside from the potential risk of accidental injury, night terrors are relatively benign. Most children will outgrow night terrors, as they get older. Moreover, for most, night terrors are occasional or circumstantial by nature.

For adults with night terrors, more than for children, a fear of having terrifying episodes can escalate into fear or stress over going to bed or even anxiety in more problematic cases. Depending on how often episodes occur, fatigue can develop due to the poor sleep quality associated with night terrors. As a result, in rare cases, this could have an impact on daytime functioning.

Like most sleep disorders, they are a major cause of sleep disruption and deprivation in parents or people living under the same roof.