What are night terrors? Symptoms and Treatment

Definition of nocturnal terrors

It is a sleep disorder in the child who stands up, starts screaming to sob during the night. So it’s very worrying for parents. It is a parasomnia (para: beside, and somnie: sleep), motor or psychomotor behavior occurring during sleep, falling asleep or waking,

And where the person is not conscious or not fully aware of what she is doing.
Nocturnal terrors are frequent before 6 years of age and are related to the maturation of sleep, the implementation of sleep phases and the installation of sleep / wake rhythms in children.

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Symptoms of nocturnal terrors

Night terror is manifested at the beginning of the night, during sleep, and during slow and deep sleep.
Suddenly (the beginning is brutal), the child
– Stands up,
– Opens the eyes.
– He starts screaming, crying, sobbing, screaming (Hitchcockian howl!)
– He seems to see things terrifying.
– He is not awake in reality and we cannot wake him up. If his parents seek to comfort them, he does not seem to hear them; it can instead increase his terror and trigger an escape reflex. He seems inconsolable.
– He is sweaty,
– He is red,
– His heartbeat is accelerated,
– His breathing is accelerated,
– He can pronounce words incomprehensible,
– He can struggle or adopt a posture of defense.
– It presents manifestations of fear, terror.
Then, after 1 to 20 minutes,
– The crisis stops quickly and abruptly.
– He does not remember anything the next day (amnesia).

Most children who have night terrors have multiple episodes, for example one episode every month for one to two years. Night terrors taking place every night are rare.

People at risk and risk factors of night terrors

– Those at risk are children aged 3 to 6, at which time about 40% of children have night terrors, with a slightly higher frequency for boys. They can begin at 18 months, and the peak frequency is between 3 and 6 years.

– There is a genetic predisposition factor   to nocturnal terrors. It corresponds to a genetic predisposition to partial awakenings in deep slow sleep. This explains that other parasomnia can coexist, such as sleepwalking, or sleep-talking (talking during sleep).

Risk factors of night terrors:

Some external factors may accentuate or cause night terrors in predisposed children:
– Fatigue,
– Sleep deprivation,
– Irregular sleep,
– Noisy environment during sleep,
– Fever,
– The unusual physical exertion (late night sport)
– Certain drugs acting on the central nervous system.
– Sleep apnea.

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Prevention of night terrors

Preventing night terrors is not necessarily possible since a genetic predisposition exists and is most often a normal stage of sleep maturation.

– However, we can act on risk factors especially lack of sleep. Here are the sleep needs of children according to their age:

– 0 to 3 months: 16 to 20 h / 24 h.
– 3 to 12 months: 13 to 14 h / 24 h
– 1 to 3 years: 12 to 13 h / 24h
– 4 to 7 years: 10 to 11 h / 24 h
– 8 to 11 years: 9 to 10 h / 24 h
– 12 to 15 years: 8 to 10 h / 24h
In case of sleep duration to the limit, it is possible to offer the child to take naps which can have a beneficial impact.

– Limit the time in front of the screens.
Television screens, computers, tablets, video games, telephones, are major providers of sleep deprivation in children. It therefore seems important to limit their use considerably and, in particular, to ban them in the evenings to allow children to have adequate and restful sleep.

Medical treatments of nocturnal terrors

Most often, nocturnal terrors appear in a benign and transient way in children predisposed genetically. They are transient and disappear on their own, at the latest in adolescence, often more quickly.

Be careful; do not try to console the child, it is better not to intervene, under penalty of trigger reflex defense of the child. Do not try to wake him, as this may prolong or amplify his terror.

Parents can still act by ensuring that the environment of the child does not pose a risk of injury (night table with a sharp corner, wooden headboard, glass bottle next …).

Suggesting a nap to the child during the day (if it is possible) can have a beneficial effect.
It is best not to talk to the child just because he has no memory of it. Not to worry, knowing that night terrors are part of a process of maturing sleep. If you want to talk about it, talk to parents!

In the vast majority of cases, nocturnal terrors require no treatment, no intervention. You just have to be reassured. But it’s easy to say because as parents, you can feel anxious about these sometimes impressive events in his little child!

– Interventions in case of night terrors
In a few rarer cases, there are some problems, and it is only in these cases that we can consider an intervention:
– the night terrors disrupt the sleep of the child because they are frequent and long-lasting,
– The sleep of the whole family is disturbed,
– The child is injured or is likely to be injured because night terrors are intense.
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Intervention against night terrors is “programmed awakening”. To put it in place, there is a protocol:
– Observe for 2 to 3 weeks the hours at which the night terrors occur and note them carefully.
– Then, every night, wake the child 15 to 30 minutes before the usual time of night terrors.
– Leave him awake for 5 minutes, then let him go back to sleep. You can take the opportunity to take him to the toilet or drink a glass of water in the kitchen.
– Continue this strategy for a month.
– Then let the child sleep without waking him up.
In general, after the month of programmed awakenings, episodes of night terror do not resume.
Note that this method is also used for cases of sleepwalking.

– Medications:
No drugs have marketing authorization against night terrors. It is strongly discouraged to use them because of their risks on the health of the children and the benignity of the problem, even when it can be impressive.

When the adult continues to have night terrors, paroxetine (an antidepressant) has been proposed as a treatment.
Also used at night: melatonin (3 mg) or carbamazepine (200 to 400 mg).
Both medications should be taken at least 30 to 45 minutes before bedtime, as nocturnal terror occurs quickly after falling asleep, approximately 10 to 30 minutes later.

Night terrors and anxiety

A priori, the psychological profiles of children suffering from night terrors do not differ from those of other children. They simply present a genetic predisposition and not a manifestation of anxiety or related to inappropriate education!
However, when nocturnal terrors (or other parasomnias such as sleepwalking or bruxism) persist for years, or are daily, they may be associated with anxiety or separation anxiety or a condition post traumatic stress disorder (related to a past traumatic event). In this case, psychotherapy of the child may be indicated.

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