Polyphasic Sleep

Taking Control of Night Terrors

Experiencing or witnessing a night terror can leave you feeling helpless, but managing triggers can put you back in control.

By Jennifer Walker-Journey

If you’ve ever witnessed a night terror, you know how frightening they can be. When someone is under the throes of a night terror they appear terrorized. They thrash about and scream or cry as if they’re fighting an invisible monster. Their eyes may be wide open but they are otherwise asleep. It’s impossible to wake or console them. After about 10-45 minutes, the episodes end and the dreamer quickly lies back down and resumes peaceful sleep. In the morning, they usually have no recollection that anything happened. 

As unsettling as night terrors are, they’re not that uncommon — at least among children. About a third of children ages 3-12 suffer from night terrors, according to Stat Pearls, the library resource of medical content for healthcare professionals. It’s far less common in adults. 

Night terrors, also called sleep terrors, are a parasomnia, a sleep disorder that causes abnormal behavior. Other parasomnias include sleepwalking and sleeptalking. Like other parasomnias, night terrors are also not considered dangerous, though in rare circumstances injury to oneself or others can occur. And while night terrors may seem like vivid nightmares, the two are different in a number of ways:

Characteristics of a nightmare:

  • Scary dreams that awaken the dreamer.
  • The dreamer often remembers the nightmare upon awakening.
  • The dreamer may be afraid to fall back asleep.
  • Usually occurs during REM sleep.

Characteristics of a night terror:

  • The dreamer appears terrified but cannot be comforted or awakened.
  • After a night terror episode, the dreamer usually falls back into a peaceful sleep.
  • The dreamer usually doesn’t remember having a night terror or what frightened them.
  • Usually occurs during the transition from the deepest stage of non-REM sleep to light REM sleep. 

Dreamers may not remember they experienced a sleep terror or even realize they have one unless someone sees it and tells them. But the sleep disorder can have an adverse effect on those who suffer from them. Some complications associated with night terrors include:

  • Excessive daytime sleepiness due to disrupted sleep.
  • Embarrassment or worry about having an attack while sleeping with others.
  • Injury to oneself or, rarely, to others nearby.

How to Manage Night Terrors

Witnessing a night terror can leave you feeling unsettled and helpless, especially since you cannot stop the attack or console the dreamer. However, there are some strategies that you can use to manage them.

Should I wake them?

The best thing you can do while your child or bed partner is having a sleep terror is to stay calm, clear their space of any objects that could cause them harm, and if they try to get out of bed, gently restrain them if you are able. Most episodes last 10-20 minutes, but some can continue on for up to 45 minutes. Afterwards, most people fall back into a peaceful sleep. 

What you shouldn’t do is attempt to wake someone during a night terror. Doing so is not only futile (it’s difficult to awaken someone during an episode), it can lengthen the episode and even provoke the dreamer to respond physically. 

If your child or bed partner has frequent night terrors, make sure the room is safe by ensuring all doors and windows are closed and removing any dangerous or sharp objects that could potentially cause harm.

Keep a sleep diary

Sleep diaries allow you to keep records of your child or bed partner’s sleeping and waking habits over a week to several weeks. These sleep logs can provide you and your doctor with clues as to what may be triggering night terrors. Information to record in a sleep diary can include:

  • Bedtimes and wakeup times
  • Any naps during the day and, if so, how long and what time the nap began
  • Any sleep terrors, how long they lasted, and what kinds of behaviors were observed
  • Any other sleep disturbances during the night
  • What bedtime routines were practiced (bath, storytime, etc.)
  • What foods, beverages and medications were consumed before bed
  • Any stressors during the day
  • Any signs of illness

Improve your sleep hygiene

Sleep deprivation is a strong trigger for sleep terrors. One way to ensure your child, your bed partner and you get ample sleep is to improve your sleep hygiene. Sleep hygiene involves the behavioral and environmental practices you engage in before bedtime. According to Ngoc L. Van Horn, a researcher from Children’s Medical Center at the University of Texas SW, “To avoid night terrors, it is vital that a sleep nurse educate parents on the importance of good sleep hygiene.” Some strategies for improving sleep hygiene include:

  • Establishing a nighttime routine that includes soothing activities, such as taking a warm bath, reading a bedtime story or working a puzzle. 
  • Eliminate blue light before bedtime. Smartphones, tablets, computers and televisions emit blue light, which is stimulating. Unplugging the devices at least 30 minutes before bedtime gives your brain and your body time to unwind and relax. 
  • Avoid stimulants before bedtime, as they can prevent you from falling asleep. Don’t serve sugary desserts or sodas less than an hour before bedtime. And don’t consume caffeine at least three hours before going to bed. Be aware that nicotine is also a stimulant and can impede sleep, so be sure to put away cigarettes and e-cigarettes a good hour before you plan to fall asleep. 
  • Invest in a new mattress. You’d be surprised how much a comfortable and supportive mattress can improve sleep quality. But don’t stop there. Dress your bed with comfortable linens, such as 100 percent cotton sheets or a cozy brushed microfiber set. And be sure you are sleeping with the right pillow for your sleep position. For particularly anxious individuals, consider a weighted blanket.
  • Exercise at least 30 minutes a day. According to researchers from Johns Hopkins Center for Sleep, there is “solid evidence that exercise does, in fact, help you fall asleep more quickly and improve sleep quality.” Daily exercise can burn energy and relieve stress, which helps you sleep better. But don’t do any strenuous exercise too close to bedtime. Aerobic exercise causes the body to release endorphins, chemicals that excite the brain. Give yourself at least an hour or two before bedtime to allow the endorphins to wash out of your system and your brain time to wind down.
  • Remember, consistency is key to working a successful plan. Establish a regular bedtime and wake up time, follow your bedtime routine, and stick to it on weeknights as well as weekends.

Who Has Night Terrors?

Night terrors are relatively common in children, affecting about 30-40 percent of kids ages 3-12. Most children grow out of them by the time they reach puberty. 

But they become less common as kids move into their teenage years. A study in the Australian and New Zealand Journal of Psychiatry found children who continued to suffer sleep terrors into adolescence — and especially those who developed sleep terrors in their teenage years — often suffer from other sleep disorders, neurotic traits, and psychiatric disorders and problems as well. 

Sleep terrors are rare among adults but just how rare is hard to say. Research published in the Journal of Clinical Psychiatry surveyed nearly 5,000 adults and found  2.2 percent reported having night terrors.

Causes of Night Terrors

Sleep experts believe that night terrors are caused by an over-arousal of the central nervous system when someone transitions from one sleep stage to another. According to Elana Pearl Ben-Joseph, MD, with Nemours Children’s Health System, 80 percent of children who experience night terrors also have a family member who has sleep terrors or sleepwalks.  

Other factors that may trigger night terrors include:

  • Sleep deprivation, being overtired
  • Fever
  • Separation anxiety 
  • Stimulants/depressants (alcohol, caffeine, etc.)
  • Migraines
  • Head injury
  • Stress
  • Sleeping in a new environment away from home

Sleep terrors are also more common in individuals who have other sleep disorders including:

  • Obstructive sleep apnea
  • Nocturnal asthma
  • Restless leg syndrome
  • Gastroesophageal reflux

Signs and Symptoms of Night Terrors

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the manual published by the American Psychiatric Association that provides information or guidelines for assessing, diagnosing and treating mental disorders, lists the following criteria for night terrors:

  • Recurrent episodes.
  • Sudden arousal from sleep.
  • The individual may be unresponsive during the attack.
  • Often there is no recall of the nightmare.
  • When fully awake, the dreamer does not remember the episode.
  • Causes the individual significant distress in interpersonal life, academics, work and social interaction.
  • The dreamer may scream or be distressed during the attack.
  • Autonomic symptoms are common, such as tachycardia (racing heart rate), diaphoresis (excessive sweating).
  • Symptoms are not explained by any other condition.

Symptoms often include:

  • Sitting up in bed and appearing frightened.
  • Staring wide-eyed.
  • Other autonomic symptoms such as heavy breathing, flushed face, dilated pupils.
  • Kicking and thrashing.
  • Difficulty arousing the individual, and being confused if awakened.

Night terrors are generally not dangerous or cause for concern. But you may want to consult with a doctor if your child or bed partner experiences any of the following symptoms or situations:

  • Seizure activity such as drooling, jerking or stiffening during an attack. 
  • Frequent terrors are regularly interrupting sleep.  
  • Terrors that last longer than 30 minutes.
  • The individual does something dangerous during an episode.
  • You think stress is a factor.
  • You have questions or concerns about the episodes. 
  • Late-onset of night terrors that begin during adolescence or adulthood.

Night terrors don’t generally require treatment beyond adopting a good sleep hygiene. But in serious cases, or in adolescents and adults, a doctor might recommend treatments such as antidepressants called selective serotonin reuptake inhibitors (SSRIs), or schedule awakenings during the night either with an alarm or a vibrating device.

Final Thoughts

Night terrors are a frightening thing to witness and can leave you feeling helpless as you watch your loved one struggle. Remember to stay calm. Don’t attempt to wake the dreamer, but do make sure there are no dangerous objects around where they could hurt themselves. Keep a safe distance and take comfort in knowing that the terror will pass in time. You can take charge by improving your loved one’s sleep hygiene and reducing any triggers. And, as always, if you have questions or concerns, contact your doctor.