You’re drifting off at 10 p.m. when your 7-year-old screams bloody murder. You race to her bedside in full rescue mode — only to find it’s a nightmare.
But not just any nightmare. “During a night terror, a child may scream, talk or cry,” explains pediatric sleep disorders expert Vaishal Shah, MD, MPH. “If the light is on, you can see they’re pale or sweaty. The fight-or-flight response is fully activated.”
Night terrors may be over in a few seconds or may last several minutes. They have no pattern, striking once a week, a few times a year, or — in rare cases — several times a week.
Cousin to the night terror is another behavior disorder: sleep-walking. “Sleep-walkers can often navigate the familiar home environment,” says Dr. Shah. “But when you call them, they won’t respond or won’t remember in the morning. Or they’ll say something nonsensical because they’re not awake.”
What’s a parent to do?
Here are tips for understanding and coping with the strange sleep behaviors that occur at all ages but most often in childhood.
Prime time for problems
Night terrors, which affect 2 to 7 percent of children, peak between ages 4 and 7. Sleep-walking, which 1 to 11 percent of children develop, peaks between ages 8 and 13.
Do these worrisome behaviors signal an underlying problem? Not at all, says Dr. Shah. “Night terrors and sleep-walking occur in normally developing children,” he says. “They aren’t caused by anxiety or by psychological issues.”
Genetics may be a factor, however. Kids are more likely to have sleep terrors or to sleep-walk if their parents did.
Most children outgrow night terrors before their teens. Some of them may start sleep-walking. Sleep-walking can persist into the teen or adult years.
‘Stuck’ between stages
The two sleep disturbances share a similar underlying mechanism.
“As we sleep, we alternate between REM (rapid eye movement, or “dream”) sleep and non-REM (deep) sleep, spending 90 to 120 minutes in each cycle,” Dr. Shah explains.
Throughout the night, “we all wake up two to six times, look around, roll over and fall back asleep,” he says. “But kids who have night terrors or sleep-walk ‘get stuck’ between waking up and being in the deepest stage of non-REM sleep.”
These sleep behaviors tend to occur within the first half of the night, when non-REM sleep predominates.
2 common triggers
Anything that wakes a child up from deep, non-REM sleep can trigger a night terror or sleep-walking episode, including:
- Not enough sleep. Getting too little sleep one night makes your child sleep much deeper the next night, increasing the chance of an episode.
- Sleep apnea. If your child can’t breathe correctly during sleep, this can also trigger night terrors or sleep-walking. (Kids who are overweight are at greater risk of sleep apnea.)
While it’s a less significant trigger, illness — with a fever, for example — may make a child sleep more. Also less critical, a noisy environment may lead to sleep disturbances as well.
“We work with parents to identify triggers so they can try to prevent them,” says Dr. Shah. “This can reduce the number of episodes.”
What parents can do
It’s best to allow a sleep disturbance to run its course. Trying to awaken a child in the midst of a night terror or sleep-walking episode will make it last longer. And they’ll find it harder to wake up.
If your child is prone to night terrors, surround them with soft pillows to keep them safe if they thrash around. “Parents should interfere if the safety of the child becomes an issue,” says Dr. Shah. “For example, you can gently turn a sleep-walker around and guide them back to bed. They’ll fall asleep.”
Parents of sleep-walkers should also:
- Prevent cuts and bruises: Remove sharp objects from their room and protect them from hard edges.
- Check the windows: Close — and lock — windows. Sleep-walkers can open them.
- Don’t use bunk beds: To prevent falls, find a solution other than bunk beds. Some parents let kids sleep on a mattress on the floor.
- Lock up well: Sleep-walkers can wander from your home. Keep the main door to your home completely locked. Make sure the lock is out-of-reach. Some parents use an alarm system at the bedroom door or front door.
In rare cases, when episodes are very frequent, children may need medication, says Dr. Shah.
Finally, even if your child’s night terror or sleepy attempt to climb out a window scares you half to death, try not to share your distress.
“Kids don’t remember anything in the morning, so there’s no need for reproach,” says Dr. Shah. “Explain what happened, discuss the triggers, let things run their course, and help them be safe.