How to Make Night Terrors Less Terrifying

Published September 9, 2019 in The New York Times

At first, it only happened every few weeks. A few hours after putting her 6-year-old daughter to bed, Melissa Cary would hear her child moaning. Then, it would escalate to screams. Cary, 38, would run to find her daughter thrashing in bed, yelling incomprehensibly. A few times, Cary said, her daughter got out of bed and ran downstairs, eyes wide open. During these episodes, Cary was unable to wake her daughter, even if she rubbed her back and called her name. The episodes, which typically lasted for about two minutes, became more frequent, eventually occurring as often as every other day.

“As a parent, you feel very helpless because there’s really nothing you can do to make them feel safe,” said Cary, a photographer and mother of five in Madison, Wis. “If it was a nightmare, you could wake them up and give them hugs and tell them everything’s O.K. and they’d realize that they’re O.K. But with a night terror you can’t do that.”

Night terrors (sometimes called sleep terrors because they can also occur during daytime napping) are a sleep disorder that researchers don’t fully understand. While anyone can experience a nightmare — an unsettling and vivid dream that typically occurs during the late-night or early-morning period — night terrors are most common in toddlers and preschoolers and tend to occur within one to three hours after they fall asleep. The classic symptoms are hard to ignore: inconsolable screaming and crying, heavy breathing, kicking and incoherent talking. While children with nightmares can be roused and will remember their dreams, it can be difficult or even impossible to awaken children experiencing night terrors because they’re sleeping so deeply. Typically, kids who experience night terrors don’t remember the episodes at all.

While night terrors can be scary for parents, they’re perfectly normal and aren’t traumatizing for — or a sign of trauma in — kids. They’re typically short, lasting just a few minutes for most children, but up to 45 for some. Because they generally resolve by age 12, parents don’t often report night terrors to pediatricians, so estimates of the number of kids who experience them can range widely — from 2 to 56 percent of all children below age 13.

Science does offer clues, however, to common triggers for these episodes and appropriate ways for parents to handle them.

What’s happening and what should I do?

About 25 minutes after falling sleep, the adult brain cycles from light sleep to deep sleep. During the deep sleep phase, heart rate and breathing slow and it’s difficult to wake up.

While children pass through this phase, they sleep more deeply than adults, which means they’re even harder to wake, and they stay in deep sleep longer, said Dr. Rafael Pelayo, M.D., a clinical professor in the Division of Sleep Medicine at Stanford University. Night terrors occur during this deep sleep stage, generally during the first half of the night. During these episodes, some parts of the brain, including the limbic system — which helps regulate the body’s sleep-wake cycle, among other functions — stay in deep sleep while the parts of the brain that operate movement and motor functions transition out, creating a situation where the child is “caught in between the awake world and sleep world,” Dr. Pelayo said.

The reasons this happens aren’t entirely clear, said Dr. Haviva Veler, M.D., director of the Pediatric Sleep and Breathing Disorders Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Night terrors are hereditary, meaning that your kids are more likely to have them if you did. Some researchers theorize that, for children who are already genetically predisposed, normal brain development may trigger these episodes.

Pediatricians generally agree, however, on how parents should handle night terrors. First, don’t try to wake your child while she’s experiencing one. Since night terrors occur when deep sleep is disrupted, trying to wake your child by shaking her or talking to her can disrupt deep sleep even more, causing “agitation and confusion” in the moment and potentially throwing off the next night’s sleep cycle, which can increase the likelihood of another episode, Dr. Veler said.

Dr. Sachin Relia, M.D., a child and adolescent psychiatrist and sleep physician at Le Bonheur Children’s Hospital in Memphis, Tenn., recommended removing any sharp or dangerous objects from your child’s room before bedtime, and quietly watching to make sure she self-soothes during an episode and returns to sleep on her own. If she gets out of bed, gently guide her back without trying to wake her up.

Stopping terrors before they start

Browse any parenting forum and you’ll find plenty of homespun strategies for preventing night terrors, such as sniffing essential oils or falling asleep to soft music. But there is no Food-and-Drug-Administration-approved medication to treat pediatric sleep terrors; and few, if any, such alternative treatments have been proven to work. There is evidence, however, that certain medications — such as antihistamines, which lower sleep quality — can trigger episodes.

A parent’s greatest weapon in the fight against night terrors is adequate and consistent sleep, according to Dr. Relia, which promotes deep sleep without disruptions. The Centers for Disease Control and Prevention recommend that toddlers aged 1 to 2 get between 11 and 14 hours per day (including naps); preschoolers aged 3 to 5 should get 10 to 13 hours; and kids between 6 and 12 should sleep nine to 12 hours daily.

Getting adequate sleep on a regular schedule resolves “a significant majority” of night terror problems, Dr. Relia said, and increasing sleep duration by just 15 minutes by making bedtime earlier or waking children later “can make a significant difference.”

The C.D.C. offers basic strategies for improving sleep hygiene, including avoiding caffeine (such as from colas or chocolate) before bed; keeping the bedroom dark, quiet and at a comfortable temperature; and developing a consistent bedtime routine. It’s also helpful to note what time your child has an episode. Research suggests that fully waking children 15 to 30 minutes before expected episodes can help ensure peaceful sleep for everyone. Dr. Relia recommended trying these scheduled wake-ups every night for one month to see if that fixes the problem, and to continue if necessary.

As all parents know, keeping a consistent schedule for sleep, or anything else, isn’t always easy. Dr. Bobbi Hopkins, M.D., medical director of the Johns Hopkins All Children’s Hospital Sleep Center, said that events that disrupt a child’s routine, like holidays or illness, can trigger episodes. So can ongoing medical conditions, such as pediatric sleep apnea, a condition that affects roughly 2 percent of children and causes a child to temporarily stop breathing while sleeping. Symptoms can include snoring, mouth breathing, waking up often, and long pauses in breathing followed by choking or gasping for air. If you suspect your child may have sleep apnea, contact your pediatrician. Solving underlying medical conditions can eliminate night terrors as well.

Dr. Hopkins added that nocturnal seizures share some symptoms with night terrors, including erratic breathing, screaming, sitting up and thrashing. If you notice your child experiencing multiple short episodes in one night, having episodes past the first few hours of sleep or repeating the same behaviors in the same order during every episode, these could be signs of nocturnal seizures and should be discussed with a pediatrician.

For most families, including Cary’s, night terrors vanish as children grow. In the meantime, it can be helpful to connect with and seek comfort from other parents who are going through the same thing, she said.

“It’s nice to know that you’re not alone and it’s happening to other children,” said Cary. “It gets better.”