Dear Dr. Respler,
I am very worried about my son who recently turned seven years old. My son often gets up at night screaming, sweating and wildly flapping his arms. These incidents can occur anywhere from 1-4 times a week and usually occurs around an hour after he falls asleep. When he wakes up screaming it is difficult to control him. He seems very incoherent and does not respond to my (or anyone else’s) loving care. When anyone asks him if he remembers his previous night’s behavior, he claims to remember nothing. Besides for this problem, my son is a very loving, well adjusted child. He is an excellent student, very sweet to his siblings and a wonderful son. Am I doing something wrong? Does he need therapy? Is there something bothering him that we are not aware of?
Concerned Mother
Dear Concerned Mother:
Thank you for writing your informative and important letter. It is possible that your son has ‘Sleep Terror Disorder.’ I am not certain that this is his diagnosis as I never evaluated him, but I will explain the difference to you between ‘Sleep Terror Disorder’ and ‘Nightmare Disorder,’ so that you can understands more about these disorders and see if you need further help.
Sleep terrors generally occur early in the night, in the first third of the night, during stage 3 or 4 NREM sleep. They occur in ‘delta sleep’ not REM sleep. Delta sleep is the deepest sleep of the night. It is usually during the first hour or so after falling asleep. It is quite difficult to wake up from delta sleep. If a child is disturbed during delta sleep, the brain becomes half asleep and half awake and during that confused state the sleep terror occurs. Children experience more delta sleep than do adults and therefore are more prone to sleep terror.
Sleep terror often starts with a blood-curdling scream, and resembles a person’s reaction to fear: wide open eyes, rapid beating heart, trembling, rapid breathing, and sweating. In some cases the child may leave his bed and run around screaming and yelling. It is very frightening to watch. After a while, the victim curls up and falls asleep again and almost always has forgotten the entire scene if it is discussed the next morning. You must make sure your child is safe and try to put him back to bed, but do not awaken him or try to calm him, since he is probably sleeping. It is important to watch over your son during these episodes, as he will have no idea where he is walking and can hurt himself if left on his own.
The average sleep terror episode lasts less than 15 minutes. Generally, only one episode occurs per night, but in some cases terror episodes occur in clusters. Some researchers note that sleep terrors are caused by a delay in the maturation of the child’s central nervous system. For most children, sleep terrors begin between the ages of four and twelve and it usually disappears during adolescence. Sleep terror disorder is reported to be more common in boys than in girls and some studies have found that sleep terror is most prevalent in preadolescent boys.
Nightmares, on the other hand, occur during REM sleep. People who suffer from nightmares generally awaken from the dream with a rapid return to full awareness and a lingering sense of anxiety or fear. Nightmares typically occur later on in the night during REM sleep and produce vivid dream imagery, complete awakenings, and mild body reaction or none at all. The person generally does not get out of bed and does not have the same level of physical reactions that come with night terror.
You can usually distinguish sleep terrors from nightmares. Sleep terrors occur early in the night, nightmares happen much later in the night. Sleep terror show much body agitation, nightmares do not. Children generally don’t remember having the sleep terrors, but do remember long and frightening dreams from the nightmares. When a child suffers from sleep terror, he will go right back to sleep after the episode is over. When a child is suffering from a nightmare, he will likely have difficulty going back to sleep as he wakes up from the nightmare and continues to feel fearful.
In children, it is imperative to make the distinction, since a child with frequent nightmares might need psychotherapy, but a child with sleep terror usually does not. Sleep terrors in adults are more serious. They often indicate excessive anxiety, agitation, and sometimes aggressive impulses. An adult who has frequent sleep terrors should consult with a psychiatrist. In serious situations of sleep terror, mild dosages of valium is prescribed to lessen the delta sleep.
It may help to attempt to decrease your child’s delta sleep by increasing the hours of his sleep. The longer one sleeps the more shallow the sleep becomes. So, first try to increase your son’s hours of sleep. Sleep terror is generally a stage which passes. If your son awakens screaming, do not wake him up for this will break his sleep cycle and cause him more anxiety and bewilderment. If he is screaming in his sleep, gently put him back to bed and allow him to go back to sleep. Try to wait by your son’s side until you see that his breathing has slowed and he returned to a deep sleep. If this is happening very frequently or you are frightened that something else may be going on, you can speak to your pediatrician about your son’s symptoms and see if there are any other possible medical treatments.
Sleep terror is generally not a sign of emotional problems. Many children have this problem and it is nothing to get overly apprehensive about. Be aware, frequent nightmares may be an indication of a more serious concern or problem and a child that has frequent nightmares should be treated. One should note that occasional nightmares are normal – we all have nightmares sometimes!
I hope that you found this information helpful. Again I do not want to diagnose a child that I never met. So please use this information to ascertain how to best proceed with your son. If the night terror does not pass after a few months even if you increase his sleep, please seek professional help! Hatzlocha!
[Information taken from DSM-V Sleep Disorders and No More Sleepless Nights by Peter Hauri PhD and Shirley Linde, PhD pgs 204-205]