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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Night Terrors

Night_TerrorsNight terrors also known as Sleep Terrors, Sleep Terror Disorder or Pavor Nocturnus, tend to run in families and are classified as one of the Parasomnia disorders. Night terrors usually occur during deep non-REM sleep or stage 4 sleep, which happens approximately an hour into the sleep cycle. They can happen at any age but tend to occur in children between 1 and 8 years old. Boys are more frequently affected than girls.

Research has shown that night terrors occur due to increased activity in the brain. During a night terror, the person is asleep even if their eyes are open. Sleep terrors can last anywhere between 5 and 45 minutes. Night terrors commonly occur in cycles. They may happen every night for several weeks, then disappear for months.

Most children have no recollection of the event when they wake up but may experience a sense of fear. Other children may remember portions of or their entire night terror. Night terrors are generally harmless and each episode will end on its own accord. Most children with night terrors outgrow them before the age of 12.

Causes:
Night terrors tend to be an inherited problem, occurring in 2% of all children. There is generally a history of some type of nighttime activity in the family. In most cases, there is a first-degree relative who suffered from a parasomnia (including sleep walking, sleep talking, head banging, teeth grinding and body rocking) in childhood.

Night terrors are not caused by psychological stress but seem to be exacerbated by overtiredness. It is commonly believed that night terrors are the result of a chemical trigger in the brain, which causes the brain to "misfire". These electrical currents disrupt the normal sleep cycle and are strong enough to arouse the child from deep sleep, without fully awakening him or her. As a result, it appears as if the child is having a bad dream and cannot wake up.

Symptoms:
  • Gasping
  • Moaning
  • Crying
  • Screaming
  • Kicking
  • Sweating
  • Confusion
  • Rapid heart rate
  • Dilated pupils
  • Senseless talking
  • Staring in wide eyed terror
  • Your child may sit up in bed or walk around the room
  • Your child appears to be frightened but cannot be awakened or consoled
  • Some children act "weirdly", are unresponsive or appear to be "out of it"
  • Your child does not acknowledge your presence but rather seems to stare straight through you, even if their eyes are open
  • An inability to explain what happened or to recall the event
  • It is common to see snakes, spiders, animals or people in the room
  • Seeing dark, shadowy people is frequently reported

Diagnosis:
Night terrors are usually diagnosed on the basis of a child's sleep history. Sleep terrors are sometimes confused with another fright reaction that occurs during sleep, namely nightmares. Night terrors occur during deep, slow wave sleep, generally during the first third of the night. In contrast, children tend to experience nightmares during the middle or latter part of the night, during REM sleep.

During a night terror, children are intensely aroused (rapid heart rate, dilated pupils), may appear agitated or confused, are difficult or impossible to arouse, are unresponsive to the environment, and have little or no memory of the episode. On the other hand, nightmares are frequently remembered, rarely involve verbalizations or motor agitation, and the child is easily aroused.

Although some seizures may appear to be similar to night terrors, parents should bear in mind that these are brief (usually lasting between 30 seconds and a few minutes) and are more common in older children and adults. In contrast, night terrors are more frequent in younger children and longer in duration.

Treatment:
Night terrors are often more difficult, upsetting and tiring for parents than children. Sleep experts consider 2 approaches to be the most effective when addressing the behaviour, namely the hands-off-approach and the waking program.

Although it may go against your parental intuition, touching, waking or trying to console your child during a night terror, will not only be ineffective but may make it worse. These actions will only make your child sleep deprived and this may fuel the frequency and severity of their terrors. Instead of running in to the room and grabbing your child, when they scream and thrash about, walk into the room and stand in the background. If you talk to your child during an episode they are unlikely to hear you. Try to remain calm and keep your tone soft and neutral if you feel the need to talk. For the hands-off-approach to be effective, it is essential not to touch or pick up your child. In most cases, the night terrors will stop within 1 month of implementing this technique.

If this is ineffective and your child's night terrors tend to occur regularly around the same time each night, wake them 20 minutes before the predicted episode. By initiating a waking program, you are disrupting the electrical trigger during the sleep cycle that prevents your child from reaching the final stage of sleep. If this technique is applied for 10 consecutive nights, the night terrors tend to stop in two thirds of all cases. Make sure your child is fully awake; give them a sip of water and if necessary - get them out of bed.

If neither of these management tools is effective, medication may be prescribed. Benzodiazepine has shown to be effective in severe cases. Some doctors report that the recommended dose of Benadryl, given 1 hour before bedtime, reduces the occurrence of sleep terrors.

If the night terrors are severe, persistent, or cause injuries, psychotherapy may be suggested.

Remember that a person who is having a night terror does not know what they are doing. Make sure that all objects that they could injure themselves with are out of the way. Do not force physical contact. Do not shout and tell them that they are only dreaming, as this may agitate them further. It may be helpful to turn on your child's bedroom light, so that he or she is not confused by shadows.

Prevention:
It is essential that children have a regular sleep routine and get enough sleep during the day. Although sleep deprivation does not cause night terrors, it can make them worse, if they are already occurring. A regular sleep routine can have a positive impact on children with sleep disorders. If possible, ensure that your child sleeps in the same room every night, tucked into the same bed. Keep disruptions, such as TV, music, toys or any other loud noises to a minimum. Having a warm bath before bed may have a soothing, sleep-inducing effect on your child. Limit physical activity, heavy meals or sugary snacks an hour before bedtime. Read your child a story or sing them a soothing song. Avoid scary tales. Make sure that the lighting in their room is dim and conducive to comfortable sleep.

Try alleviating stress by addressing any problems your child may have at school or home.

Prognosis:
Night terrors can be very traumatic for parents and caregivers. In most cases children outgrow these nocturnal activities. Parents can also find solace in knowing that their child is not in any pain, is not frightened, is still asleep, and are not aware of their actions. However, if they remain repetitious and disruptive, they should not be ignored.

60% of chronic cases are indicative of an underlying sleep disorder, such as Sleep Disordered Breathing (SDB) or Periodic Sleep Movement Disorder (PLMD). Snoring and sleep apnea form part of SDB. Monitor if your child is snoring most nights of the week, if they have lengthy pauses in their breathing or if they are struggling to breathe. PLMD is characterized by extreme restlessness during sleep and sometimes during the day too, uncontrollable kicking of the legs and writhing in their sleep.

If your child experiences persistent night terrors, in addition to these behaviours, contact your health care provider for further advice.

References:
  • About.com. Night Terrors - Pediatric basics. About.com Pediatrics. http://www.pediatrics.about.com. Updated May 18, 2011. Accessed October 17, 2012.
  • Ask Dr Sears. Night Terrors. AskDrSearscom. http://www.askdrsears.com/. Accessed October10, 2012.
  • Circle City Communities. Night Terrors & Nightmares. Circle City Communities. Http://www.circlecity.co.uk/. Accessed October 10, 2012.
  • Demand Media. Night Terrors and Children. Essortment. http://www.ga.essortment.com. Reviewed 2011. Accessed October 17, 2012.
  • Night Terrors Resource Centre. Night Terrors. NightTerrors.org. http://www.nightterrors.org/. Accessed October 10, 2012.
  • The Bub Hub. How to stop night terrors. My Child magazine. http://www.mychildmagazine.com.au. Accessed October 10, 2012.