I wished I never had to write on this particular topic; because believe it or not, I myself had been (what should I say), a victim (if I may say so), of sleep terrors. This phenomenon started just as I was about to say goodbye to my sweet teenage period and step into adulthood. I continued to experience these sleep terrors almost for a period of 5 years, and I know exactly what it feels to experience these.
Sleep is divided into two categories of rapid eye movement (REM) and non-rapid eye movement (non-REM). Non–REM sleep is further divided into four stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 non-REM sleep to stage 4 non-REM sleep, beginning approximately 90 minutes after you fall asleep.
What is a Sleep Terror and Why does it Occur?
Sleep Terror is also known as night terrors or pavor nocturnes. It is basically a parasomnia disorder (something that is related to sleep and beyond). Sleep terror causes feelings of terror or dread. It typically occurs in the first few hours of your sleep. Technically speaking, this happens during stage 3 or 4 of your non-rapid eye movement NREM sleep.
Sleep terrors are caused by over-arousal of the central nervous system (CNS) during sleep. This may happen because the CNS (which regulates sleep and waking brain activity) is still maturing. Some kids may inherit a tendency for this over-arousal. About 80% who have sleep terrors have a family member who also experienced them or sleepwalking which is a similar type of sleep disturbance.
You would mostly find sleep terrors to occur to you during your periods of arousal from delta sleep. This delta sleep is also known as slow wave sleep. During the first half of your sleep cycle, delta sleep occurs most often. This indicates that if you are the one with more delta sleep activity, then you are more prone to experiencing night terrors. I think, I can say that I too belonged to this group of excess delta sleep activity.
Human beings have always known to be afflicted by sleep terrors ever since the ancient times. But, in those times as science had not progressed much in these fields, it was impossible to differentiate from nightmares until rapid eye movement was discovered.
The following reasons could be a broad classification of the reasons that are responsible for causing sleep terrors either in an adult or a child:
- Stressful life events
- Sleep deprivation
- Certain medications that affect the central nervous system (the brain)
- Recent anesthesia given for surgery
- Children sleeping in a new environment or away from home
- Children who suffer from sleep terror may also experience the following:
- Tachycardia (increased heart rate)
- Tachypnea (increased breathing rate)
- Sweating during episodes
- Are Sleep Terrors and Nightmares the Same?
No, no, no. You should not confuse sleep terrors with nightmares. Nightmares are only some bad dreams that cause feelings of horror or fear in you. While nightmares are relatively common during childhood, sleep terrors occur less frequently.
Sleep terrors are distinctly different from the common nightmares, which occur during REM sleep. Sleep/night terrors are characterized by frequent episodes of intense crying and fear during sleep, with difficulty arousing the person. Sleep terrors are frightening episodes that can even disrupt your family life.
Going by the available estimates around 1-6 percent of children and less than 1 percent of adults will experience a sleep terror episode with their lifetime. Sleep terrors can often be mistaken for the disorder of arousal from sleep in a state of confusion. Sleep terrors begin between ages 3 and 12 years and then usually dissipate during adolescence. In adults they most commonly occur between the ages of 20 to 30. Though the frequency and severity varies between individuals, the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights or multiple times in one night.
Since sleep terrors are largely unknown to most of us, we tend to harbor the false notion that any type of nocturnal attacks or nightmare is a sleep terror; and most often than not we report all such happenings as sleep terror. But never mind, it surely is a lot confusing with such things.
Characteristics of Sleep Terror
If you ever experience a bout of sleep terror, you would reportedly be described by your family members or companions as ‘holding upright’ with your eyes wide open and a look of fear and panic on your face. You will often scream. You may also sweat excessively, exhibit rapid respiration and also have a rapid heart rate. These are some of the automatic signs of experiencing a sleep terror.
Some of you might even exhibit more elaborate motor activity, like thrashing of your limbs. This could include punching, swinging, or fleeing motions. This kind of activity results due to the notion in your mind that you are trying to protect yourself and/or escape from a possible threat which can lead to some kind of physical injury to you.
If it is your child who is suffering from this condition, then it may appear to you that your child is awake during a sleep terror. The child will appear confused, be inconsolable and/or unresponsive to your attempts to communicate with him/her. During this period your child may not even recognize other family members familiar to him/her. The child may thrash around in bed and does not respond to comforting even by the parents.
You should be very careful while dealing with a situation like this because, if you try to awake your child or any other person when he/she is experiencing a sleep terror, he/she will lash out at you and this can be dangerous for both of you.
As a parent, you may have comforted your child after the occasional nightmare. But if your child has ever experienced what’s known as a sleep terror, his or her fear was likely inconsolable, no matter what you tried.
Most people who experience this disorder are amnesic or partially amnesic from the incident the next day. They usually do not remember the episode the next morning.
Most episodes of sleep terror last for about 1-2 minutes, but it may not be up to 30 minutes before the child relaxes and returns to normal sleep.
Sleepwalking is another predisposition of this disorder. Sleepwalking and sleep/night terrors are different manifestations of the same parasomnia disorder.
Who are at Risk?
Sleep terrors and other parasomnia disorders can be congenital. Sleep terrors in children are also more likely to occur in males that females. In adults, the ratio between the sexes is the same.
The disorder of sleep/night terror typically occurs in children aged 3-12 years, with a peak onset in children aged three and a half years.
The Precautions and Coping with Sleep Terrors
It may sound unfortunate, but it is a reality that no adequate treatment yet exists for curing sleep terrors. Management of sleep terrors primarily consists of educating the family about the disorder and reassuring them that the episodes are not harmful.
Sleep terrors can be very upsetting for any parent, as you might feel helpless at not being able to comfort or soothe your child.
If your child seems to be experiencing sleep terrors, an evaluation by the child’s pediatrician may be useful. During this evaluation, the pediatrician may also be able to exclude other possible disorders that might cause night terrors.
You can also try to interrupt your child’s sleep in order to prevent occurrence of sleep terror. This might sound weird, and is a bit difficult too, but it is something which you can do on your own and help your child. For this, you may follow the below given procedure:
Note how many minutes the sleep terror occurs from your child’s bedtime.
Then, awaken your child 15 minutes before the expected sleep terror, and keep her awake and out of bed for five minutes. You may want to take your child to the bathroom to see if he/she will urinate.
Continue this routine for a week.
However, you should also note that you should never awake your child while he/she is experiencing sleep terror.
Following this routine would take a toll on your sleep, but believe me that this is one of the effective ways to help your child control sleep terror. Your sleep is a very small sacrifice to be made to ensure your child’s well being.
As parents, you should also take the following precautions at your home:
- You should make the child’s room safe, so as to prevent the child from being injured during an episode of sleep terror.
- You should eliminate all sources of sleep disturbance in your child’s room.
- You should strive and maintain a consistent bedtime routine and wake-up-time.
- If your child is severely affected by sleep terrors and this is negatively interfering daily activities of your child, like school performance, and if peer or family relations are being affected, then certain tricyclic antidepressants (such as imipramine) may be used as a treatment. However, it has to be kept in mind that such treatments do not provide long-term help for your child; and these should only be used as a temporary treatment.
- Frequent follow-up care with your doctor to provide support and reassurance helps alleviate their anxieties.
Most of the time, you would find sleep terrors simply disappearing on their own as the nervous system matures. Since nearly all children outgrow sleep terrors by adolescence, it is up to you that as a parent, how well you manage the situation and provide comfort to your child.
Understanding night terrors can reduce your worry and help you get a good night’s sleep yourself. But if night terrors happen repeatedly, talk to your doctor about whether a referral to a sleep specialist in needed.