How to stop night terrors
Commonly experienced from infancy through to the preschool years, night terrors have no detrimental impact on the child but can be unexpectedly traumatic for the parents.
Night terrors, like many medical afflictions, have a curious history. Once thought to be devil possession, with exorcism as the "cure", they are now understood to be a common physical disorder affecting around five percent of children under the age of five.
What are night terrors?
Night terrors are a known sleep disorder that typically affects infants and toddlers. As a child moves from slow-wave sleep (non-dream sleep) to Rapid Eye Movement (REM) sleep (dream sleep), he will often bolt up in his bed or cot with his eyes open, and scream, kick and cry as if in awful pain.
The behaviour is believed to be caused by electrical currents in the brain that arouse the child from deep sleep but not enough to fully wake him. It can go on for as little as five minutes or last up to 45 minutes depending on the child, and can be very distressing for the parent or caregiver; however solace can be found in knowing that the child is not in any pain, is not frightened, is still asleep and is not aware of his actions.
In fact, children will not have any recollection of their nighttime activity and will be bright eyed and bushy tailed the next morning. It’s the parents who are bleary eyed and sleep deprived.
There is no known external cause for these disturbances; however they do have a genetic link. They are a type of parasomnia, a medical classification that also includes sleep walking, sleep talking, teeth grinding, body rocking and head banging.
'In most instances there is a first-degree relative who suffered from a parasomnia in childhood,' explains Dr Arthur Teng, Director of the Sleep Medicine Unit at Sydney Children's Hospital Randwick. It is rare to see children with night terrors where some sort of nighttime activity is not part of the family history.
When should you worry?
Although most of the time children will outgrow night terrors, in cases where they are repetitive and disruptive, and the child does not outgrow them, they should not be ignored. Chris Guilleminault of Stanford University (California, US) found that in 60 percent of chronic cases the terrors are a symptom of an underlying sleep disorder such as Sleep Disordered Breathing (SDB) or Periodic Limb Movement Disorder (PLMD). 'Do not dismiss the night terrors, but ask the pertinent questions,' advises Dr Teng. 'Snoring and sleep apnoea are part of the SDB group and can often be identified by looking for the following signs: does the child snore most nights of the week? Does he have pauses in his breathing where you wonder when will he take his next one? Does the child look like he is struggling to breathe?'
'PLMD, as the name suggests, has to do with limb movement and is exhibited by children who are very restless in their sleep, often kicking their legs uncontrollably and writhing in their sleep. They can be restless during the day as well,' says Dr Teng.
What can be done to stop night terrors?
Even when the night terrors are a result of an underlying SDB, there are some simple things you can do to address the behaviour. Most importantly, try to relax and get some sleep yourself. You'll need it; after all, your child's had a good night's rest and will be raring to go in the morning! In fact, night terrors are often more difficult on the parents than on the child. While it is upsetting to watch your baby scream and thrash about, touching or picking your child up while he is having a terror will only make it worse. It may feel counterintuitive, but the best thing you can do for your child during one of these episodes is to leave him be.
Dr Chris Seton, staff specialist in the Sleep Investigation Unit at The Children’s Hospital at Westmead, says two approaches can be taken to help your child: the hands-off approach and, if this is ineffective, the waking program.
'The worst thing a parent can do is to touch or wake the child. Such action will only make the child sleep deprived, which can make the sleep terrors even worse. The best management tool parents can apply is the hands-off approach. I tell parents, "For the next few weeks, instead of running in, grabbing your child and trying to console them, do the opposite: don’t run, walk. Stand in the room, but in the background. Don’t say anything, because the child can't hear you and, in particular, don’t touch them or pick them up,"' he explains. According to Dr Seton, after about a month, the majority of parents will find the night terrors will stop completely.
If the hands-off approach does not work, and there is regularity to the occurrence of the night terrors (they happen at the same time each night), Dr Seton recommends the waking program where you wake the child 20 minutes before the predicted episode. 'If the night terrors are happening at 10.30 every night, I'll tell parents to wake the child at 10.10pm. Wake the child up fully, give him a sip of water, get him out of bed if necessary. If you do this for 10 consecutive nights, in the right child - the child with regular night terrors - two-thirds of the time the night terrors will stop, not just for the night but subsequently. By disrupting the sleep cycle the electrical trigger that prevents the child from reaching the final stage of sleep is also broken. Both the hands-off approach and waking program are good non-drug treatments.'
In a small number of cases a drug treatment is prescribed, however most often the child will either stop on his own or with the help of one of the management tools described above.
Management of night terrors also includes ensuring that your child follows a sleep routine and that he gets enough sleep during the day. Sleep deprivation does not cause terrors, but in kids where they occur, it can make them worse.
When to seek help
If none of the techniques mentioned above work and your child is still having the night terrors, or you are concerned that the nighttime activity is the result of a sleep disorder, you should speak with your family doctor and consider visiting a sleep clinic. There are paediatric sleep clinics in each capital city.
'As a child I had a lot of nightmares, and I remember the way I was when I'd wake up, and Shayley's not like that. Her whole body starts to shake, and she has sharp, jumpy movements.
If I try to touch her to calm her down it only makes it worse. This can last anywhere from five to 30 minutes with her screaming.
I'm happy if I get four hours of broken sleep a night. By the time morning comes around, I'm so tired that I'm lucky if a half hour after breakfast, I can remember if I’ve even eaten. Yet it doesn’t seem to be impacting her at all. She wakes up a happy little girl, gives me a big kiss and is all smiles. She doesn’t remember any of it.'
Five fast facts about Night Terrors
- Parasomnias, including night terrors, sleep walking and sleep talking are genetic. Talk to your family and you might discover Aunty Harriet was a sleep walker.
- The child is not losing sleep over it. They are not nightmares: the child is not awake, he is not afraid of anything and will have no memory of the nighttime activity in the morning.
- The best thing you can do is leave him be. Do not touch or pick him up. If you are concerned that he may hurt himself, like fall out of bed, stay in the room, but try not to let your presence be known. He will not recognise you.
- If the hands-off approach doesn’t work, and his night terrors happen at the same time every night, you can try the waking program. Wake him 20 minutes before the predicted time. In the majority of cases this will stop the night terrors after about 10 days.
- Most kids grow out of them but if your child has belaboured breathing or restless limbs you may like to see if there is an underlying sleep disorder.