Dear Dr. Respler:
I am very worried about my seven-year-old son. He often wakes up during the night screaming, sweating and wildly flapping his arms. These incidents can occur anywhere from once to four times a week, usually about 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. In the morning, he says he does not remember anything that happened.
Other than this issue, 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? Could there be something bothering him that we are not aware of?
Dear Concerned Mother:
Your son appears to suffer from Sleep Terror Disorder, although I am uncertain that this is his diagnosis. For clarification sake, I will explain the difference between Sleep Terror Disorder and Nightmare Disorder.
Sleep Terror Disorder generally occurs early in the sleep cycle, usually in the first third of the night during stage 3 or 4 NREM (non-rapid eye movement) sleep – during delta waves, the slowest and highest amplitude brain waves, as opposed to during REM (rapid eye movement) sleep. Delta sleep is the deepest sleep of the night, customarily taking place during the first hour or so after falling asleep. It is quite difficult to awake from delta sleep. If a child is disturbed during delta sleep, the brain becomes half-asleep and half-awake and in that confused state the sleep terror occurs. Children experience more cases of delta sleep than adults; thus they are more prone to sleep terror.
Sleep terror often starts with a blood-curling 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. After a while the victim curls up and falls asleep again, almost always having forgotten the entire episode if told about it the next morning. While you must ensure that your child is safe by putting him back to bed, do not awaken him or try to calm him since he is probably sleeping. It is important to carefully watch your son during these incidents, as he will have no idea where he is walking, and could accidentally hurt himself.
The average time span of a sleep terror episode is less than 15 minutes. Generally, only one episode occurs per night, but in some cases terror episodes happen 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, usually disappearing during adolescence. It is reported to be more common in boys than in girls, and some studies have found that it is most prevalent in pre-adolescent boys.
Nightmares, on the other hand, occur during REM sleep. Nightmare sufferers normally awaken from the dream with a rapid return to full awareness and a lingering sense of anxiety. Nightmares typically occur later in the night and produce vivid dream imagery, complete awakenings, and mild or no body reaction. The person generally does not get out of bed and does not have the same level of physical reactions that come with night terror.
One can easily distinguish between sleep terrors and nightmares. Sleep terrors demonstrate much body agitation while nightmares do not. Children normally don’t remember experiencing 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 following the episode. Conversely, when a child has a nightmare, he will likely have difficulty falling back asleep.
As it pertains to children, it is imperative to make the distinction between the two, since a child with frequent nightmares might need psychotherapy; a child with sleep terror, however, usually does not.
Sleep terrors in adults are more serious and often indicate excessive anxiety, agitation and, at times, aggressive impulses. An adult who has frequent sleep terrors should consult with a psychiatrist. In serious situations, mild dosages of Valium are prescribed to lessen the delta sleep.
It may help to increase your child’s sleep hours. The longer one sleeps, the shallower the sleep becomes. Keep in mind that sleep terror is generally a stage that passes. If your son wakes up screaming do not wake him up, for this will break his sleep cycle and cause him more anxiety and bewilderment. If he screams in his sleep, gently pat him on the back and wait by his side until you see that his breathing has slowed and that he has returned to a deep sleep. And if this is happening very frequently or you are frightened that something else may be going on, speak to your son’s pediatrician about possible medical treatments.
Sleep terror is by and large not a sign of emotional problems. Many children have this problem and it is not something to be apprehensive about. However, frequent nightmares may indicate a more serious problem and should be treated. Occasional nightmares are normal; everyone has them.
If after increasing your son’s sleep the night terror does not pass, please seek professional help. Hatzlachah!
Note: The information I’ve provided in this column was taken from DSM-V Sleep Disorders and No More Sleepless Nights by Peter Hauri, Ph.D., and Shirley Linde, Ph.D., pages 204-205.
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