Nightmares and Night Terrors
Barry Zuckerman
I. Description of the problem.
A. Night terrors. Children with night terrors bolt upright from their sleep to cry inconsolably for 5-20 minutes (in rare cases, even longer). They usually occur 15-60 minutes after going to sleep. Night terrors are associated with autonomic signs including a rapid pulse, increased respiratory rate, and sweating. The child has a glassy-eyed stare, which is due to the fact that the child is in rapid-eye-movement (REM) sleep and not actually awake. Following resolution, children easily return to sleep and have amnesia for the event in the morning.
1. Pathophysiology. Night terrors are a disorder of arousal, occurring during an abrupt (rather than the usual slow) transition from stage 4 non-REM sleep to REM sleep.
2. Epidemiology. Occurs in approximately 3-6% of children.
B. Nightmares. Nightmares are upsetting dreams that occur during REM sleep. Nightmares and night terrors are compared in Table 58-1. Nightmares are a universal occurrence in childhood and usually not due to a significant problem.
II. Management.
A. Night terrors. Because of the inconsolable crying and glassy-eyed stare, parents are usually terrified that something is wrong with their child. After the child returns to sleep, the parents may remain awake with their own terrors.
1. The primary goal in management is to reassure the parents of the benign nature of these episodes. Management involves demystifying night terrors by explaining the physiologic basis of the behavior. Using an analogy like a myoclonic jerk during light sleep can help parents understand the physical nature of the night terrors. Most important, parents need to be assured that night terrors are not due to psychopathology or horrible life events. When parents know that there is nothing wrong with their child, they can usually tolerate periodic episodes.
2. When the episodes are frequent and/or disrupt the sleep of others (especially siblings), the child can be awakened prior to the time the episode usually occurs. This is thought to alter the sleep cycling and prevent a night terror from occurring.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
