A scream in the night.
It was 11 p.m. The screaming was coming from my 5-year old daughter's room. I knew, as I went to her room, that she was sound asleep. No amount of talking to or shaking would wake her up or calm her down. She would not be comforted or consoled. All I could do was ensure that she could not hurt herself. She would calm down in 15 minutes or so. Kara was having another night terror.
Night terrors occur, in some degree, in 15% of children. They are one of the most frightening of sleep disorders, but only to the parents. Night terrors (pavor nocturnus) are a partial arousal from a very deep (Stage 3-4) non-dreaming sleep. Parents and doctors alike think the child is suffering from extreme nightmares, or even having seizures. The episodes occur from one to four hours after falling asleep, generally just as Mom and Dad are heading for bed. The child seems to have difficulty making the transition from NREM (Non Rapid Eye Movement) to wakefulness. It is as if the child is both waking and in a deep sleep. He will moan, speak (or mumble), lift his head, grind his teeth, and thrash about. In fact, while he may seem awake, he is still in a sleep state. The child will be sweaty, tremulous, and uncontrollable. His pulse will be high. He will not recognize you. The duration is usually 15 to 30 minutes. As the night terror ends, he will make a deep sigh, roll over and go immediately back to sleep. In the morning, he will have no recollection of anything. If an older child does wake up following an episode, he will experience a deep feeling of anxiety and/or fear that he will not be able to describe.
It can be difficult to tell the difference between nightmares and night terrors because the child may be too young to explain a nightmare. If you struggle to wake him, he will seem confused and disoriented. You may assume he is still "half-asleep" and upset from a nightmare. While both are parasomniac events, they do differ. A night terror is a much more dramatic situation. Nightmares occur towards the end of the night, during REM (Rapid Eye Movement) sleep. They are followed by a complete awakening. The child can remember a nightmare and give you a complete description. They will follow a story line or plot. He will recognize you and come to you for comfort. Afterwards he will remain frightened, even refusing to go back to sleep.
Night terrors are very hard for the parent, mainly because there is little they can do. Kara was 2-years-old when she had her first episode. I decided to rush her to the hospital because she had squirmed out of my arms and was thrashing around on the floor. As she was still in a sleep state, I was afraid of seizures. Halfway to the hospital, the episode ended. Kara woke up and thought the night time trip was great fun. We returned home and she slept quietly the rest of the night. After many trials and efforts and a lot of research, I finally found some answers. The parent of a child experiencing night terrors should leave him alone. You can stay with him to make sure he does not hurt himself. If he is in a top bunk, move him down. Any furniture should be removed, placing his mattress on the floor, if he thrashes about severely. Do not wake him up or attempt to console him. Any interference seems to make the child fight, causing the episode to become stronger and longer. If he does wake up after an episode the deep feeling of fear or anxiety will cause him to start to cry all over again. At this point, and only at this point, will your child allow you to comfort him. As the child will not remember anything the next morning, don't embarrass or upset him by asking questions.
Dr. Jeffrey Elmer of the Spokane Sleep Center in Spokane, WA advises parents to recognize that this is not a sign of psychotic behavior or abuse. It can be caused by life stresses. Although many studies have been conducted, the main cause of night terrors cannot be pinned down. Several studies have suggested that children with night terrors or parasomniacs have a positive family history for such behavior. They affect boys about 4 times more than girls. It has also been noted as a developmental problem, and can be associated with the nervous system. However, stress has been known to trigger episodes.
If a child's night terrors become so severe as to cause injury to herself, or so frequent that the parents need help, Dr. Ralph Pascualy of the Seattle Sleep Disorder Center, advises the use of medication such as diazepam (Valium - an anti-anxiety drug) or trazodone (Deseryl - an anti-depressant medicine). However, both Dr. Pascualy and Dr. Elmer do not recommend it unless it is a severe problem. If a child takes drugs like these he may have difficulty waking up in the morning and remain groggy and slow for the first few hours. Often, physicians try to avoid the use of drugs if possible. The episodes can be misdiagnosed as a seizure disorder. Children should be checked for the differences. Medication could be used for the older child on occasions such as a overnight stay or camp.
In general, a child will outgrow the problem. As her sleep patterns and nervous systems become more mature the episodes will become less frequent and less severe. When Kara began experiencing night terrors, some weeks she would have 1 to 3 a week; some weeks 1 to 3 a night. they would last from 15 minutes to one hour or more (possibly because I interfered). She is now 5-years-old and has an episode approximately once a month, that lasts no more than 15 minutes. If she is fighting a cold or extremely tired, she is more likely to have an episode.
Night terrors can be extremely frightening for the parent who doesn't understand. It is frustrating to be unable to help a child who is experiencing a night terror. However, Kara's episodes have improved greatly since I left her alone. If you suspect your child is having night terrors, discuss it with your family physicians. If you feel the episodes are severe, check for additional information. There are Sleep Centers throughout the U.S. that could be of help.
I know it is frustrating to be told that your child will outgrow it. Dr. Pascualy emphasizes that the child rarely remembers these spells and is not suffering. Remember that your child is a happy, healthy individual in every other aspect of life.
Kerry Wiltzius is a free-lance writer, mother of three, and has struggled with a child with night terrors for three years.
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|Publication:||Pediatrics for Parents|
|Date:||Oct 1, 1989|
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