Night terror
Pavor nocturnus; Sleep terror disorder
Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state.
Causes
The cause is unknown, but night terrors may be triggered by:
- Fever
- Lack of sleep
- Periods of emotional tension, stress, or conflict
Night terrors are most common in children ages 3 through 7, and much less common after that. Night terrors may run in families. They can occur in adults, especially when there is emotional tension or alcohol use.
Night terrors. What are they and what do you do about them? I'm Dr. Alan Greene and want to discuss this common childhood issue with you called night terrors, or sometimes confusional arousals in some of the parenting books. What happens is a young child sometime shortly after bedtime will sit upright, open their eyes, start screaming, not recognize their parents, and seem extraordinarily frightened. What's going on? Well it turns out that they are not having a nightmare. They're not actually afraid of anything conscious that they can remember. And they're not awake. They're actually stuck between different stages of sleep and have this big adrenaline rush that is causing all of these behaviors that with no conscious thought going with it at all. Now the typical idea of what you should do during a night terror, confusional arousal, is perhaps hug the child. But sometimes it will make it even worse. My wife Cheryl came up with an idea for treating night terrors that I absolutely love. I've now heard from thousands of people that have tried it and it's the most effective thing I've ever come across. She reasoned that because night terrors happen at the same age where kids are learning to get this feeling of a full bladder up to their brains to wake them up, maybe it's a partial signal the bladder's full and not quite enough to wake them up. But it's enough to disrupt their sleep. So, she suggested taking a child, this happened with my youngest son, take them into the bathroom and see if they'll go to the bathroom. So, he woke up screaming. We were feeling bad about his screaming. Walked him into the bathroom. He didn't recognize us. He was screaming, eyes open, but he did for some reason recognize the toilet and went and immediately was calm again. So, we shared this with friends. We shared this with people online. Thousands of people have tried it. And for many, many children, that does indeed appear to be the cause and by far the most effective thing I've seen. You can also sometimes help by making bedtime and wake up time the same every day by keeping it very calm and the last hour before bed, maybe even a warm bath. And you can sort of do trial and error to what actually calms you child during a specific night terror.
Symptoms
Night terrors are most common during the first third of the night, often between midnight and 2 a.m.
Children often scream and are very frightened and confused. They thrash around violently and are often not aware of their surroundings.
The child may not be able to respond to being talked to, comforted, or awakened.
The child may be sweating, breathing very fast (hyperventilating), have a fast heart rate, and widened (dilated) pupils.
The spell may last 10 to 20 minutes, then the child goes back to sleep.
Most children are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.
Children with night terrors may also sleep walk.
In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream after waking up and will not be disoriented after the episode.
Exams and Tests
In many cases, no further examination or testing is needed. If night terror episodes occur often, the child should be evaluated by a health care provider. If needed, tests such as a sleep study can be done to rule out a sleep disorder.
Treatment
In many cases, a child who has a night terror only needs to be comforted.
Reducing stress or using coping mechanisms may reduce night terrors. Talk therapy or counseling may be needed in some cases.
Medicines prescribed for use at bedtime will often reduce night terrors but are rarely used to treat this disorder.
Outlook (Prognosis)
Most children outgrow night terrors. Episodes usually decrease after age 10.
When to Contact a Medical Professional
Contact your provider for an appointment if:
- Night terrors occur often.
- They disrupt sleep on a regular basis.
- Other symptoms occur with the night terror.
- The night terror causes or almost causes injuries.
Prevention
Minimizing stress or using coping mechanisms may reduce night terrors.
References
American Academy of Pediatrics website. Nightmares and night terrors in preschoolers.
Avidan AY. Disorders of arousal. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 116.
Owens JA. Sleep medicine. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 31.
Vaughn BV, Basner RC. Sleep disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 374.
Version Info
Last reviewed on: 4/28/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
