Q&A: night terrors

Bernalgirl writes:

"Last night our 16-mos old daughter woke up screaming just 1.5 hours after she went to sleep. She was inconsolable for 20 minutes. No thrashing, and it wasn't entirely clear she was awake, but she's pretty verbal, and was able to tell us that nothing hurt. As she calmed down she just said "Hug, hug, hug" over and over again. She didn't want to go back to her crib (where she normally prefers to sleep) so for the first time in a while we had a family bed. It was scary, and then heartbreaking.

She had a HUGE day yesterday, I had her in one more activity than was prudent (and realized it part-way through the day) and last night she walked on her own more than she ever has in her life (possibly cumulatively).

Does this sound like night terrors? And what should I do about it? Sears says nothing at all on this in his Baby Book; What to Expect said to leave them alone to self-soothe (no way, not when she's muttering Hug, Hug, Hug); and Brazelton described the lead-up perfectly, although by his account she's a little young yet. Then he scared me to death by stating that night terrors show up as small seizures when measured on an electroencephalogram.

Other than simplifying her schedule and holding her as long as she needs to, I'm at a bit of a loss on diagnosis and response. Is this a totally normal developmental phase or can I do something more to prevent this from recurring?"

I don't know if it's "night terrors" specifically, but it's definitely terror in the night. Poor thing. She reminds me of the monkey in the Jez Alborough book Hug.

I don't have much experience with this, myself. There have been a couple of nights when my older son woke up screaming in the middle of the night. We did what you did--went and comforted him, tried to figure out if there was anything physically wrong with him, and then brought him in with us to sleep the rest of the night. For us it seemed like isolated incidents that were, just like they were for you, a result of overstimulation the day before.

I hate to have to say "I've got nothing" to people who write in to me, so I went looking to the "experts" for the thoroughly-researched theory behind and treatment for night terrors. I didn't find anything helpful. Basically, the party line (that crosses sleep-theory party lines) is "Sometimes kids have night terrors. It'll pass." Gee, thanks. All of you people and your collective pontification couldn't come up with anything better than that?

So all of what I'm going to say is just a shot in the dark, but at least you didn't spend $14.95 for it on Amazon.

It seems to me that night terrors (aka "waking up in the middle of the night screaming") could be caused by any or all of the following things (or, of course, something we don't know about or understand):

* Too much activity or intensity the day before, or a few days before. Kids can seem fine with all the stuff that's happening around and to them, but then it'll come out in their subconsciouses while they're sleeping.

* Movement, or new skills in general. The brain gets ahead of the body or the body gets ahead of the brain, and something's got to give, so it vents off in the middle of the night.

* Food they've eaten that gives them bad dreams. I always thought the food-dreams connection was kind of bogus, but my husband swears that when he eats certain foods too close to bedtime he'll have nightmares. If it happens to adults, why couldn't it happen to kids?

* Scary sounds or images. Little kids are sponges for things they hear and see, even when they don't understand them. If they overhear scary (or even just intense) things on TV or movies or catch glimpses of images they don't understand, those things can ricochet around in their little brains and turn into something really frightening in the middle of the night. At our house it's a constant battle to mute the TV or change the channel when a scary trailer or commercial comes on because the baby sleeps on the other side of the wall the TV's against.

* Things that go bump in the night. There could be noises she's hearing as she sleeps that wake her up, but she's incorporating them into dreams that scare her. You know what I'm talking about--your alarm's going off but your mind makes it the sound of a fire alarm ringing in the dream you're in the middle of. If there are noises in your child's room at night, they could be morphing into whatever dreams she's having and making the dreams more intense.

* Fake panic attacks. She could be having blips in her nervous system. (Stay with me here.) During both of my pregnancies, I've gone through phases in which my hormones were raging so much that they stimulated my nervous system to produce all the symptoms of panic attacks. (Despite what I say about him otherwise, I will always be thankful to Dr. Sears for mentioning this as a possibility in The Pregnancy Book. I haven't read about it anywhere else, and I thought I was actually having real panic attacks for awhile.) It really feels exactly like a panic attack--racing pulse, confusion, sweating, closed-in feeling, desire to scream, fear--except that the only thing causing it is hormones, not feelings. It makes complete sense to me that a growing child (hormones!) could experience the same thing in the middle of the night. How could you not wake up screaming from that feeling?

I guess the upshot is that if you try to calm down her activity level, bland down her before-bedtime foods, and keep the noise pollution out of her hearing, there's not much else you can do to prevent night terrors. And they obviously do pass eventually. You're absolutely handling them the right way by comforting her. If she's fine going back to sleep where she usually sleeps, that's great, but if she needs to come in with you, a few nights in with you for the rest of the night isn't going to have much long-term effect on your sleeping arrangements. But knowing that her parents will come help her when she needs it will stay with her forever.

The "good news" is that once they're older and potty-trained, overstimulation results in wetting the bed instead of night terrors. That may not be good news for everyone, but I'd much rather have sheets to wash than have my sweetheart screaming in fear in the middle of the night.

Comments

[Kate]

Did she remember it in the morning? (Hard
to tell, probably, at 16 mos.) Did she get sick within a day or so?

She doesn't seem to have a textbook case of night terrors, but the timing (relatively soon after going to sleep) and the description seem to be night terrorish to me. They don't remember them--was she confused about waking up in your bed?

My daughter has had episodic sleep terrors--sometimes during naps!--(she's almost two), starting at about 10 months. She doesn't thrash either, just screams and cries inconsolably with her eyes closed. Either doesn't acknowledge us or pushes us away and has to calm herself down. It takes up to an HOUR for this to happen. It is horrible.

FWIW Ferber (in Solve Your Child's Sleep Problems) discusses sleep terrors and nightmares in detail. I don't use his sleep training at all, but his book was reassuring when it came to this. He says sleep terrors can happen as early as six months--an incomplete waking from non-dreaming sleep.

The reason I asked about her getting sick is that my little brother (and the son of one of his preschool teachers, which is how my mom figured it out) would get them has a prelude to running a fever. He got them from ages 2.5 to 11 (fewer as time went on). They were awful to watch too; he wandered the house half awake and terrified.

Sorry so long-winded and disjointed (nak), but I think it's worth taking Ferber out of the library.

[Sara]

My son has had night terrors on and off since he was about that age. They really are upsetting.

For him, it really is all about the developmental stage thing. If he's working on a new skill, either linguistic or motor, its way more likely that he'll have one.

What I found is that trying to completely rouse him from it made it far worse and took much onger to get over. They're not really awake during them, and if you *make* them come to full consciousness, it seems to bring the whole thing into working memory and then they have to process how upset they are in the "real world." They find themselves in a different place with an actual *memory* of being upset, and that would (for us) spin into a long and awful crying fit.

So we would stay with him, touch him, hold his hands, hug him (once he was in a twin bed where we could lie down next to him) but never pick him up, move him from room to room or anyplace well-lit. What worked as a baby would be a firm hand on his chest,gently rubbing, and soft, simple, very repetetive words. And slowly he'll subside back into real sleep.

Once he was potty trained, they did involve wetting the bed. Except he'll still half-rouse, and we'll find him sleepwalking towards the bathroom, entirely unaware of his surroundings, and then he'd get really upset. A full bladder can actually trigger night terrors/sleepwalking.

[Moxie]

Crap, Kate. You mean I really have to take Ferber out of the library again? I just gave him back.

It's probably worth spending the money for a used copy at this point (for me, I mean--not for you guys).

:)

[K.]

Probably not worth the effort for one night, but if night terrors become a consistent problem, homeopathy has excellent track record on this problem. There are some remedies that are perfectly suited for children's night terrors.

[Kate]

I inherited my mom's copy of Ferber. It must have been hanging around her house for years--my brother's 19 now! He has a very good breakdown of various sleep disturbances (from infant through teenagers).

We were never able to tie Miss M's sleep terrors to anything in particular, unfortunately. She often cries out in her sleep--not a full blown terror, but a minute or two jag. Enough that one of us goes to check on her and returns shrugging to say that she isn't awake. The brain is a mysterious thing...

[Paula]

Good Morning America did a story on this a few years ago. They recommended keeping a sleep diary to see if there is a pattern to the terrors, and then waking the child 15 or 20 minutes before the terror was likely to start to short circuit the cycle.

http://abcnews.go.com/GMA/TurningPoints/
story?id=127864&page=1

Just one more idea....

[shayneegray]

I have often wondered if "bad dreams" or the infant equivalent could be behind our sleep situation. My 16-month-old daughter wakes every one to two hours throughout the night, crying woefully. She begins to cry while still asleep (I have watched her do this on numerous nights) and actually wakes herself with her own cries.

Sometimes while I'm holding her and comforting her, she has these "episodes" in which she jerks, breathes erratically, and wimpers, as if trying to flee something; she often cries out as well. During these times, I cannot rouse her with my voice or a gentle touch as I can during restful sleep. Instead, I just hold her until she settles more peacefully, usually after about 10 minutes.

I have begun to think of these episodes as bad or vivid dreams--both my mom and I have very vivid dreams and sometimes experience partial/incomplete waking from a dream, where we're aware of what's going on around us but cannot move or speak. If something like that were happening to her, it would make sense that it would frighten her and lead to crying out. (I realize that she's not experiencing this every time she wakes through the night, but I think it happens often enough that she associates waking with being unhappy/frightened, so she always cries in her sleep or as she's waking up.) It's reassuring to hear about the Ferber notion that such dreams can begin at a young age. Sorry for the length of this!

[Carla]

My son had these for a while and my Ped recommended the sleep diary and waking him up because true "night terrors" typically occur around the same time at night.

My son's were short lived and we just brought him to bed with us and sort of comforted him without smothering him (he would thrash around crying without waking up).

I hope it is short lived because it is hard to see your baby crying and scared but not awake.

[Kate]

Just to note that Ferber (and from personal experience from dealing with my brother) recommends AGAINST trying to wake a kid having a sleep terror. They are in a very deep sleep stage and will be difficult to rouse; plus if you DO manage to wake them, they will be very confused/scared and it will be extremely difficult to resettle them.

Comfort them if they allow it; if not, keep them safe and gently guide them back to bed (yours or theirs). They'll re-enter sleep at a pretty deep stage--it can take a while--and continue along with their night and won't remember things in the morning. My brother was always confused about waking up in a sleeping bag in my parents' room (until he got older and knew the drill).

[bernalgirl]

Very helpful, thank you. We made sure we had a weekend lightly filled with familiar activities and she seems fine. I think walking is really blowing her mind, as she's definitely a bit more of a fragile flower lately.

I was a bedwetter, so I suppose it's a good possibility she'll be one, too. And I agree, the prospect of wet sheets is way better than seeing her this distressed again.

[karla]

my son has night terrors and i remember calling his doctor and crying as i was telling her what he was doing, because it was so heartwrenching. he would curl himself in a tiny ball and scream like he was in terrible, horrible pain....and then run through the house with eyes wide open, terrified-looking. sometimes he would scream, and he would ALWAYS push us away if we tried to comfort him (and sometimes he would hit at us, like we were the frightening thing).
After lots of CAT scans and ultrasounds and other invasive testing, doctors came up with no reason for his "pain", (which is what i was sure it was).
Doctor then brought up night terrors and suggested we start keeping track to see if there was any pattern. There was. He woke up about 1 1/2 - 2 hours after he first fell asleep and then 2 hours after that....sometimes two or three times/night. Doc suggested giving him more naps during the day (night terrors are from lack of sleep) and gently rousing him from sleep before the night terrors would naturally occur. You don't need to get him up...just rouse him/her a little until you know he/she is no longer sleeping, and then cover them up and leave the room. This really effortless solution has helped to stop the night terrors almost 100%. Sometimes, if my son is sick, and is not getting much sleep (due to cough/fever), he will slip back into the same night terror pattern.

[honey]

wow, I'm glad I came to read "Ask Moxie".

Our experience w/ our 23mo has been very similar to shaneegray's. He started with the wretched crying/screaming at about six months, it was awful because it sounded like he was being stabbed to death. We cosleep, and after a few minutes he'd inch closer to me and nurse himself back to quiet sleep. When we asked the Ped, he suggested what has already been said, to wake him up just before the time he'd normally have a terror episode. But I chose not to try it because my baby's otherwise a very light sleeper and he doesn't have an episode *all* the time, whereas if he does wake up... life is NOT good. I do think hitting some developmental milestones might've been a trigger for him early on but it's been a looooong time now since he's had a night terror. He does still sleep with us and seems to do better snuggled up against one of us -- as in, he also gets those episodes where he cries out or whimpers for a minute or two when he's napping by himself but not when he's snuggled with someone. FWIW, I remember having night terrors where I'd wake myself up screaming (and my grandmother bringing me to her bed), and I've also always had very vivid dreams and nightmares. My husband and his first son also have a history of sleepwalking, so I think our baby is genetically predisposed to sleep issues...

Anyway, sorry for the long comment. My real point was to say that I totally recommend that if your daughter is saying "hug, hug, hug" you should hug her even if she's not awake. Obviously her brain will process that information and the comfort of being hugged will help her settle. If you touch her and she screams louder, then she should not be touched or moved. Just wait and be patient, don't force anything to happen. Some nights my son would cry hysterically during an episode for what seemed like an eternity before finally latching on and settling quietly. The brain *is* an amazing mystery and we don't yet have enough information to really understand what's going on. When I first started dealing with this I found very little information, just like Moxie, so I had to go with my mommy instinct. I have another son (different father), and he's slept like a log for the last 15 years, from the day he was born. My sons are total opposites.

[SZ]

My brother had night terrors for our whole childhood. He would sit up with his eyes wide open and scream bloody murder while sound asleep. Once while staying at our cousins' house, he sleepwalked into the parents' bedroom and started screaming while standing at the foot of their bed, which of course made them start screaming, too. (now it's funny. back then, not so much.)

The key thing that makes a night "terror" different from a bad dream is that the kid has total amnesia after a night terror. He scared the living daylights out of the rest of us many times, but he has no memory of any of those instances, no memory of any bad dream or scary thing. (only of waking up and going, "Wha..? Mom, how did I get in your bed??")

As he got older the screaming stopped, but he would still occasionally walk around the house or talk in his sleep (as do many other members of our family). Even in college he once locked himself out of the dorm, sleepwalking in his skivvies. It seems clear to me (though I'm not a brain expert!) that night terrors/sleep talking/ sleep walking/ bedwetting are all related, and are definitely hereditary.

My mom still talks about how the sound of his screams would make her "levitate off the mattress" from jumping up in fear so fast. But once it was established that he wasn't in any pain, he didn't remember it afterward, and he was otherwise well-adjusted, it made it much easier to deal with.

And now it's my sister-in-law's problem, anyway! :) Heh.