Night terrors
Sabrina Kempe is a freelance writer for the medical team. She studied biology, specializing in molecular biology, human genetics and pharmacology. After her training as a medical editor in a renowned specialist publisher, she was responsible for specialist journals and a patient magazine. Now she writes articles on medical and scientific topics for experts and laypeople and edits scientific articles by doctors.
More about the experts All content is checked by medical journalists.Night terrors (night terror) is a form of sleep disorder in children. A few hours after falling asleep, the child can scream, lash around, open its eyes wide, but recognize no one and cannot be woken up or comforted. You can read more about the causes of night terrors, how you should react and when you need to see a doctor here.
Brief overview: night terrors
- What is night terrors? Sleep disorder with short-term incomplete waking, coupled with screaming, wide eyes, confusion, profuse sweating and rapid breathing
- Who is affected? mostly toddlers and children up to preschool age
- Cause: developmental phenomenon of the central nervous system. Usually there is a family history.
- What to do? Do not try to wake the child, just wait, secure the environment and protect the child from injury
- When to the doctor night terrors that occur more frequently or after traumatic experiences, persist beyond the age of 6 or return after a long break; at the first night terrors in older childhood or adulthood; if you have mental illness or suspected epilepsy
- Forecast: mostly overcome at school age due to normal development
Night fright: what is it?
The scientific term for the night terrors is "Pavor nocturnus", which means nocturnal fear or night terrors. The sleep disorder usually affects toddlers and preschoolers.
The night terrors mainly occur in the first one to four hours after falling asleep, i.e. in the first third of the night. A fear that suddenly appears can startle your child from deep sleep: They wake up screaming, but only incompletely - they are neither sleeping nor really awake.
It sits up and there is great fear or anger on its face. The eyes are wide open, the pulse is racing and the heart is beating violently. The child is breathing quickly and sweating profusely.
Since it is not fully awake, it appears confused. Maybe it speaks incomprehensibly. In addition, they do not recognize you and cannot be reassured - on the contrary, if you stroke them or hold them in your arms, the child can lash out. It is very difficult to wake up in this state.
After five to ten minutes the ghost is over: your child wakes up on its own, pulse and breathing are suddenly back to normal. After that, it quickly falls asleep again. The next day, despite the night terrors, your child wakes up relaxed and cannot remember the incident.
How common is the night terrors?
About a third of toddlers and preschoolers between the ages of two and seven experience the night terrors. 3 to 5 year olds are most commonly affected. Only rarely does a baby experience a night terrors at the end of the first year of life. Girls and boys are affected equally often.
The sleep of most of the affected children is only sporadically disturbed by the night terrors, i.e. once or a few times. Some children experience night terrors every few months for one to two years. Only in a few cases is it interrupted every night.
Even at school age, the episodes of night terrors are usually over. Pavor nocturnus occurs very rarely in adults and adolescents.
Differences from other sleep disorders
The night terrors belong to the so-called parasomnias. These are disturbances in sleep in which the person concerned wakes up incompletely. The result is involuntary and undesirable behavior. They can occur both in the REM phase and in the non-REM sleep phases.
The night terrors are assigned to the parasomnias of the non-REM sleep phase. It belongs to the so-called wake-up or arousal disorders as well as sleep-drunkenness and sleepwalking. It can therefore happen that children affected by Pavor nocturnus also sleepwalk from time to time or that the night terrors turn into sleepwalking.
In contrast to night terrors and other parasomnias of the non-REM sleep phase, the parasomnias of the REM sleep phase usually occur in the second half of the night. They include nightmares, for example. They resemble the night terrors. The following table shows you how to distinguish between nightmares and night terrors:
|
Pavor nocturnus (night terrors) |
nightmare | |
|
time |
1–4 hours after falling asleep, during the first third of the night
|
in the second half of the night |
|
Behavior of the sleeper |
|
|
|
reminder |
no |
yes, also the following day |
Night terrors: causes
The brains of toddlers and preschoolers are still immature, and the intricate architecture of sleep has yet to be developed. In the course of a night, different sleep phases of varying depth and activity alternate regularly with one another:
- REM sleep phase: superficial sleep phase with rapid, involuntary eye movements ("rapid eye movements" = REM) and increased brain activity.
- Non-REM sleep phases: different depths of sleep without the typical eye movements of REM sleep and with reduced brain activity.
In between, the person concerned can wake up briefly - so briefly that he does not even remember it the next day.
On average, there is a cyclical change between the various stages of sleep and the brief waking up five times a night. This sleep pattern and the length of the sleep cycles develop in accordance with age: a sleep cycle in an infant lasts 30 to 70 minutes and extends to 90 to 120 minutes until adulthood.
You can read more about the different phases of sleep in the article "Sleep phases - how sleep works".
Night terrors - a developmental phenomenon
Switching between sleep phases does not always work smoothly for some small children. A kind of overexcitation of the developing brain can then trigger a night terrors out of the deep sleep phase.
Night terrors in children are therefore a developmental phenomenon of the central nervous system and are not related to a mental disorder or other illness. Incidentally, this also applies to sleepwalking (somnambulism). Both night terrors and sleepwalking in children are neither dangerous nor harmful. Once the nervous system matures, these forms of sleep disorder disappear.
If adults experience night terrors, mental illnesses such as anxiety disorders, depression or schizophrenia are often involved.
Night fright runs in the family
Night terrors and sleepwalking are often related. Genetic factors are involved in both sleep disorders. If your child experiences such nocturnal episodes, there is usually at least one relative who also experienced night terrors or sleepwalking in their childhood. Often the parents or grandparents were affected.
Night terrors: trigger
Some factors promote night terrors in children:
- Fatigue, lack of sleep
- emotional stress
- febrile illnesses
- Medication
- an eventful day, many impressions
- Spend the night in a strange environment
Night fright: when do you have to see a doctor?
The night terrors are related to the development of the nervous system and usually go away on their own over time. However, you should consult a doctor in the following cases:
- The night terrors occur frequently.
- The first episodes only occur in older children (e.g. 12-year-olds) or in adulthood.
- The night terrors persist beyond the age of six.
- The night terrors reappear after a long break.
- The night terror occurs after traumatic experiences.
- The person has a diagnosed mental illness.
- The person is suspected of having epilepsy.
Tip: If you are unsure whether your child suffers from a night terrors, you can record a nocturnal episode with your mobile phone and show it to the pediatrician. If possible, tell them when the child fell asleep and when they experienced the night terrors.
Night fright: what does the doctor do?
First, the doctor will clarify whether it is actually a night terrors or another sleep disorder. Thereafter, if necessary, he can initiate treatment.
Night fright: investigations
First, the doctor collects important information about the medical history (anamnesis). To do this, he or she has a conversation with the person affected (if they are old enough) or the parents or other adults who have observed the sleep disorder. Questions to be clarified include:
- What about evening activities and eating habits?
- How do you prepare for going to bed (e.g. bedtime story, brushing your teeth, etc.)?
- When is the usual bedtime? Are there problems falling or staying asleep?
- How exactly does a night terrors episode work (symptoms, frequency, duration)?
- When did the night terrors first occur? Are there possible triggers (e.g. traumatic experiences, physical illness, etc.)?
- What is the other sleep behavior (e.g. restless sleep, snoring, bed-wetting)?
- How much does the person sleep on average per night?
- When is the usual wake up time? Is the person concerned woken up or does he wake up on his own?
- How do you feel after waking up? Does the person remember the disturbed night sleep?
- How is the behavior during the day (e.g. unusual tiredness, sleepiness)?
- How much does the sleep disorder burden the person or the family?
- How high is the media consumption of the person concerned (e.g. daily television time, usage time of the cell phone, etc.)?
- Is the person concerned often anxious or emotionally very sensitive?
- Is the person taking or taking any medication or drugs?
- Are there any known episodes of night terrors or sleepwalking in parents or other relatives (from childhood)?
To clarify such questions, the doctor can also use special sleep questionnaires such as the questionnaire from the Munich Parasomnia Screening.
Sleep diary and actigraphy
The doctor will probably also ask you to keep a sleep diary (sleep log) for a week. Among other things, the bedtime, total sleep time, possible wake-up phases, episodes of night terrors, nightmares, etc. are noted for each night. These accurate records will help the doctor clarify the sleep disorder.
In some cases, actigraphy can also help. The affected person wears a wristwatch-like device for several days that continuously records the phases of activity and rest. The evaluation of the data can reveal disturbances in the sleep-wake cycle.
Diagnostics in the sleep laboratory: polysomnography
The movement patterns in sleep disorders such as night terrors can be very similar to that of nocturnal epileptic seizures. A so-called polysomnography in a sleep laboratory can therefore be useful for clarification:
The person concerned spends the night in the sleep laboratory. During sleep, it is connected to measuring devices that measure parameters such as brain waves, heart rate, breathing as well as oxygen saturation and carbon dioxide concentration in the blood. Eye movements and other movements during sleep are also recorded via video surveillance.
The data provide information about important body functions during sleep (such as brain and heart activity) as well as the person's personal sleep profile
If the examination reveals evidence of nocturnal epileptic seizures, the person affected is referred to an epilepsy center.
Night fright: treatment
The night terrors in children are a developmental phenomenon and therefore usually do not need any therapy. To prevent nighttime disturbances, the child's stress level should be reduced and sleep hygiene optimized (see “Preventing night terrors” below).
Further measures that can be useful for night terrors:
Planned awakening
If the sleep log shows that your child always experiences a pavor nocturnus at the same time, you can carry out planned "anticipatory wakes" under the guidance of the doctor: For one week, wake your child completely about 15 minutes before the usual time the night terrors occur. After five minutes, it can go back to sleep. If the night terrors recur, repeat the awakenings for another week.
hypnosis
In some studies, self-hypnosis and professional hypnosis have been shown to be effective in treating night terrors. If you would like to know more about this, ask your doctor.
Medication
Treatment with medication is only considered for night terrors if everyday activities are impaired by the sleep disorder, subsequent psychosocial disorders occur, or the suffering of the child or family is very high.
However, there are no clear recommendations for drug therapy for night terrors. Only experience with individual sufferers or a group of several affected persons (case series) shows that some active ingredients can be helpful. These include, for example, benzodiazepines (such as diazepam) with their calming and anti-anxiety effects. Tricyclic antidepressants (such as imipramine), which are usually used for depression, may also be prescribed for night terrors.
Nachtschreck: You can do that yourself
Attempts to wake a child out of the night terrors or to comfort them are unfortunately in vain. You might even upset the child even more. But what then helps with night terrors?
Night fright: this is how you react correctly
It's best to try the following tips if your child is experiencing a pavor nocturnus:
- Wait and don't wake the child, stroke them or hug them - even if it is difficult
- Speak softly and reassuringly, reassuring your child that you are there and safe
- Secure the sleeping area to protect the child from injury
After five to ten minutes, your child will calm down suddenly and quickly fall asleep again.
Prevent night terrors
In order to prevent the night terrors, you should first and foremost pay attention to good sleep hygiene in your child. It includes:
- regular bedtime, adapted to the needs of the child
- Regulated daytime sleep for smaller children
- low-irritation environment before going to bed (e.g. no television or no use of screens such as cell phones or tablets about an hour in advance)
- no exciting or strenuous activities before going to sleep
- quiet, darkened, comfortably tempered sleeping environment
- comfortable place to sleep that is not associated with other activities such as playing, watching TV, doing homework, or being punished
- Regular bedtime ritual, e.g. a bedtime story
- if desired, leave the weak night light on
In addition to these measures, the following tips can prevent the night terrors:
- Avoid fatigue
- Compensate for lack of sleep at night with daytime sleep (e.g. afternoon nap)
- Reduce stress, e.g. schedule fewer appointments per week or day
- Try relaxation methods such as age-appropriate progressive muscle relaxation or autogenic training
- lots of exercise in the fresh air
- regular daily rhythm
