Night Terrors

by T. Berry Brazelton, M.D., author of Sleep: The Brazelton Way

A frightening shriek calls you to your young child's bedroom. He may appear to be awake, yet he won't respond to your attempts to comfort him. Should you keep trying to wake him? Even if you try, he is likely to look off in the distance as if you weren't there, or he may become agitated. In fact, waking him may not be necessary or even wise. He is much more likely to settle down if you don't rouse him. After the screams subside, he is calm and has no memory of the frightening event. He'll have no leftover fears, unless his parents' fears lead him to make some up. Because night terrors are so upsetting to parents, I have tried to answer the most common questions parents ask.

Is it a bad dream?

Night terrors are not bad dreams. Dreaming occurs only during light sleep, also called REM sleep. Night terrors, however, usually occur about 2 hours after a child falls asleep, when the first cycle of deep sleep has suddenly come to an end and light waking has not fully occurred. At these times, there is no dreaming, and the brain does not form memories. During a night terror a child's heart is racing, his breathing is rapid, and he may be drenched in sweat. But he will have no dream to tell you about and no memory of his "terror."

Is it a seizure?

Night terrors are not seizures, though many parents worry that they might be. Seizures that occur during sleep are more likely to occur toward the morning, and children will sometimes wake up to feel them coming on, or remember the moments before they began. When a seizure is over, a child is likely to wake and can be soothed by a parent's comforting. Each seizure is more likely to closely resemble other seizures, whereas the behavior that goes with night terrors may be more variable: a scream, crying, babbling, scrabbling around in bed. Don't hesitate to consult your physician, though, to help you sort these out.

Is a child with night terrors possessed?

Night terrors are so surprising and upsetting that some cultures have traditionally explained these as caused by spirits or some other supernatural power. In families where such views are held, it is important for the child to know that his night "terrors" do not mean that he is "bad."

Why not wake the child?

Night terrors are not really terrors at all for the child, although they are bound to terrify parents. Any parent will want to comfort a screaming child, and will be frightened when he fails to respond. If you hear him stir or scream out, but if he appears neither fully awake nor fully asleep and looks at you blankly, stay back. He is far more likely to head straight back down to sleep if you don't talk or touch him. Your efforts to comfort him may only keep him in this strange part of his sleep, coming out of deep sleep, not fully awake, and yet unable to move on into a new phase of deep sleep. Let him return to sleep without waking him and he'll have a better night's sleep. The best protection against night terrors may actually be adequate sleep at naptime and at night.

Are night terrors dangerous?

Night terrors are common in children under 6. Because their deep sleep is often deeper than that of older children and adults, they are more likely to come up to this odd, incomplete state of waking when a deep sleep cycle ends. Night terrors are normal in this age group and are not dangerous unless a child is moving around so violently that he might hurt himself. This is rare in children under age 6 and is more likely to occur when children are older, especially during adolescence. You may need to restrain the child gently, although this may make him more agitated. It is best simply to clear away any objects that he could hurt himself with and to block his way if he heads for a window or door.

Are night terrors the same as nightmares?

Nightmares are altogether different because they occur during light sleep (REM sleep).

Can night terrors lead to other problems?

Night terrors do not usually lead to other sleep disturbances—such as recurrent sleepwalking, talking, or nightmares. Sleepwalking and talking are similar to night terrors because they also occur at the end of a deep sleep phase, before a child has completely awakened or entered the next sleep phase. But they are not caused by night terrors. Making too much of night terrors with the child, at any age, may embarrass him and feel like more pressure.

At what age do night terrors occur? Will my child outgrow them?

Night terrors seem to be most common in children between the ages of about 18 months and 6 years old. But between the ages of 6 and 18 months, some infants may come up from deep sleep to a state of incomplete waking and cry out. This is not the same as those times when infants these ages wake up and cry out for feeding, a diaper change, or soothing. When infants wake up with a specific need, they usually respond to a parent's efforts. But in the mixed sleep-wake state during which night terrors can occur, infants are unresponsive to a parent's efforts to comfort. If left undisturbed, they will eventually settle into a light sleep. Whether a child coming up from deep sleep into an incomplete wake state ends up rolling around in bed, screaming, talking, or walking will partly depend on his age. Toddlers are more likely to roll around in bed, or babble, until they are old enough to speak. From 2 years on screams and cries are more likely, and sometimes a child may even get out of bed to sleepwalk. After age 6, night terrors are less common, as most children no longer sleep so deeply. After 6, this mixed deep sleep-waking state is more likely to lead to sleepwalking, and emotional factors have often begun to play a role.

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