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How to deal with night terrors

night terror
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SLEEPING SCARED: While night terrors cannot psychologically harm your child, witnessing them experiencing a night terror can cause distress.

Dr Marguerite Dalton, a paediatrician based in south Auckland and National Coordinator of Well Child who has years of experience working with children, says night terrors are part of a group of disorders called parasomnias.

These 'undesirable' movements or behaviours occur during sleep and include sleep terrors, sleepwalking and states of confusion or arousal, all of which overlap.

"If your child has night terrors, these are likely to be characterised by facial expressions of extreme fear, associated with screaming, shouting and agitation," she explains.

"The child is seemingly awake but does not recognise or respond to the people around them. In fact, they often push their parents away or try to run from them, which is very distressing for the parent. Older children may even leap out of bed and run around blindly trying to get away from some unseen danger."

The physical symptoms of night terrors include a racing pulse, sweaty skin, dilated pupils, quivering movements and rapid breathing, all of which are associated with a marked activation of the child's autonomic (involuntary) nervous system.

While an episode of night terror is usually brief, lasting around one to five minutes, they can sometimes last up to half-an-hour which can be very distressing to parents who are unable to calm their child down.

What is the difference between a nightmare and a night terror?

Cherin Abdelaal Selim a Registered Psychologist based in Christchurch who specialises in childhood sleep disturbance says parents are often confused about the differences between nightmares and night terrors.

"Night terrors typically occur during the first part of the night (before midnight) while nightmares tend to occur later. With night terrors, children cannot be consoled and they do not have any recollection of it in the morning. With nightmares children can be consoled and typically seek comfort. They can usually recall what the nightmare was about," she explains.

Although the exact cause of sleep terrors is not known, Selim says there are a variety of factors that contribute, although these differ from child to child.

"Stress is the most common psychological issue that contributes to night terrors. Other common contributing factors include sleep deprivation or a disrupted sleep schedule, illness, sleeping with a full bladder or sleeping in a different or noisy environment," she explains.

"There is also often a family history of night terrors or other sleeping difficulties such as sleep walking."

It's not your fault

Many parents find sleep terrors extremely frightening and distressing to witness, says Selim.

However, while it is understandable to be anxious about how to respond, it is important to remember that sleep terrors are much more distressing to witness than they are to experience.

"Some parents even wonder if their child is having an epileptic seizure. Parents often report to me that they feel useless as they can't console their child, which is typically the case with night terrors."

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While there is very little that a parent can do when their child is experiencing a night terror, it is important that they ensure their child is safe during a night terror and that their sleeping environment is safe.

"Parents need to make sure their child is getting sufficient sleep and maintain a regular sleep schedule. It is also important that parents ensure their child goes to the toilet before bed," Selim advises.

"Parents should attempt to identify and minimise any stress in their child's life, although there are always going to be periods of stress in any individual's life."

If your child does experience a night terror, it is important not to interfere or try to wake them.

"Parents also need to avoid talking about it the next day. Their child will have no recollection of it and discussing it may cause undue stress."

If you are worried, see a doctor

If sleep terrors continue, it is important to keep your doctor informed and eliminate any other possible explanations.

"If parents find that the night terrors are disruptive to the whole family then they may need to seek more assistance to minimise the disruption, says Selim.

"If parents think there might be a particular factor that is contributing to the night terrors, such as a stressful event or toileting difficulties, then they can seek professional assistance for this."

A psychologist would be able to assist by helping develop a consistent bedtime routine and sleep schedule, which may help.

Could it be something else?

Your doctor will be able to determine if there might be something else going on, Dr Dalton says epileptic seizures, or cluster headaches may present as night terrors, but your doctor will know what tests to carry out to determine this:

Epileptic seizures - these can occasionally appear similar to night terrors, but they tend to be short-lived, with stereotypic movements and abnormal muscle tone.

"These seizures often occur in clusters throughout the night rather than as a single episode, and may be associated with daytime seizures or absence episodes (i.e., "phasing out", not remembering what happened) as well," says Dr Dalton.

Cluster headaches - these are more common in older children but can appear as a period of arousal followed by agitation and daytime headaches. A family history of headaches is commonly found.

"The doctor will need to ask about sleep patterns and night-time routines as well as medication use, so keeping a detailed account of the episodes and related factors would be helpful for the diagnosis," says Dr Dalton.

Physically, the doctor may look to find features that may cause sleep disruption; such as enlarged tonsils, which may cause obstructive sleep apnoea (disrupted breathing), limb pain at night or stomach acid reflux.

Practical tips for parents

It is reassuring to know that the outlook for the child with night terrors is good, most children grow out of them by late childhood or adolescence, and there are usually no long-term psychological effects.

"A good bedtime routine is important, as is the need to keep the child safe if they do tend to sleepwalk," says Dr Dalton.

"It is a good idea to lock outside doors and windows, have the child sleep in ground floor room, and perhaps put them to bed in a sleeping bag for some restraint."

Night terrors tend to happen at about the same time each night, so it may help to wake the child with a gentle nudge about 15 minutes before that time and then let them drift off to sleep again. Often, after four or five nights, this can effectively stop the terrors.

Medications are recommended by doctors in some more severe cases (e.g., some antidepressant and anticonvulsant drugs), but a doctor will only try treatments like that after a full assessment.

A child might need further assessment if: 

  • There is history or any evidence or clinical suspicion of sleep apnoea (disrupted sleep breathing) 
  • Episodes are unusual or have stereotypic features suggestive of seizures 
  • There are daytime seizure-like episodes 
  • The child is unusually sleepy the day afterwards 
  • Episodes are occurring at an unusual age (in very young or older childhood with no previous sleep disturbances) 
  • Episodes are frequent, severe, prolonged, dangerous or disruptive.

- © Fairfax NZ News

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