Night terrors in children: "He screams like someone's set him on fire."

Each night, roughly two hours after Natalie Nugent would put her son, Wilkie, to bed, she’d brace herself, one ear trained towards the little boy’s bedroom for signs of another night terror. Between the ages of six and seven, they’d happen three or four times a week and last for several minutes – sometimes as long as ten. And there was almost nothing she or her husband could do to stop them.

“He’s always been a restless sleeper and he frequently slept walked. He still does,” the Sydney-based mother told Mamamia. “But this was different. He would sit up in bed, start screaming, eyes wide open, looking like he was possessed or something. Sweating profusely… There were instances where he’d run the length of our hallway, screaming, thrashing his arms around.

“It was really frightening at first.”

Trying to wake Wilkie was fruitless. Restraining him seemed to make him more distressed.

“We just eventually learnt it was better to not worry about whether he was awake or asleep, just to sort of be with him in the moment, and make sure he’s actually safe,” she said. “Like with the worst one. That was the night where he actually got into his wardrobe and started pulling clothing out and thrashing his arms and legs around, screaming. That was scary, but we just calmly directed him out of the wardrobe and then sort of put him back into bed.”

Wilkie is now ten, and his night terrors appear to be a thing of the past. But for those two years, it affected their whole family; “We hardly went out because you’re concerned that a babysitter might not know what to do. So it does restrict you,” she said. “It was hard.”

It’s an experience thousands of parents have endured. Most sound similar. “He screams like someone’s set him on fire.” “It’s like they’re possessed.” “He’s screaming in fear.” “He’ll jump up and down on his bed, screaming.”

What are night terrors? And how common are they?

Night terrors, also known as sleep terrors, are strong feelings of terror or panic experienced during sleep. They typically present in children under the age of ten, last several minutes and can occur in varying frequency – in some cases, up to several times a week.

Specialist sleep physician Dr David Cunnington, of the Sleep Health Foundation, explained that night terrors occur when two parts of the brain fight against each other during deep sleep, usually a few hours in.

“You get this hybrid state where the cortex – the part of the brain that says ‘It’s OK, this is where we are, it’s not a big deal’ – remains asleep, but the brain stem – the part of the brain that drives the fight-or-flight response – is fully awake,” he said. “So there’s this escalation of adrenaline drive.”

This process also underpins nightmares, but Dr Cunnington notes that night terrors are typically shorter, far more intense and often the child won’t remember them in the morning.

“The stereotypical events a nightmare is where someone who’s got that visual imagery, dreamlike imagery. And so when they wake up the recollection of that imagery is distressing,” he said. “Whereas with a night terror, the kids can’t necessarily describe what happened beforehand, or what the dream was about. But there’s just this abrupt awakening with an absolute sense of terror; screaming, fast heart rate, high levels of distress. They’re almost inconsolable.”

Figures suggest between one to five per cent of children and one per cent of adults experience night terrors. But Dr Cunnington expects that the prevalence among children, in particular, is likely to be much higher: “It’s pretty common as an occasional thing for kids – in fact, it’s almost universal as an occasional thing. So that ‘one to five per cent’ is maybe where it’s occurring more nights than not, is causing major household issues and the patient ends up in their doctor’s office.”

What causes night terrors?

Age is the biggest factor for night terrors, Dr Cunnington said, and most children will simply outgrow them by puberty.

Why? It’s back to that fight between the different parts of the brain. In children, the cortex is more difficult to rouse, allowing the fight-or-flight part to run into overdrive. “As we get older sleep gets lighter and that’s a gradual sort of process,” Dr Cunnington said. “So these things happen at the stage of life when sleep at its most deep.”

(Of course, adults can also be affected by night terrors – roughly one per cent – and typically these will happen when something triggers that same hard-to-rouse response in the cortex. Alcohol, for example.)

Sleep whisperer Elizabeth Sloane shares how to establish an infant’s bedtime routine. (Post continues below.)

Among children, there are factors that can make night terrors more likely or perhaps worse. Number one is sleep deprivation, but also social issues and mental health concerns, such as anxiety, can play a role. And less commonly, sleep apnoea or an obstructed airway. All of these things can increase the child’s adrenaline drive: “The more alert that fight-or-flight response is, the more likely sleep terrors are going to happen.”

While mental health can impact the likelihood of night terrors, Dr Cunnington stresses that it’s important debunk the myth that they occur as a result of psychological trauma: “There’s a misconception it’s a sign of deep-seated psychiatric problems. That’s not the case. In fact, almost all of the time, it’s just a normal developmental thing that’s occurring, and sometimes there are the situational factors like sleep deprivation or stress on top of it.”

What should parents do when their child has a night terror?

“It’s tough. But try to comfort the child as best as possible. Not necessarily try and wake them, or shake them out of it, because that can also be somewhat disorientating,” Dr Cunnington said. “In some respects, standing back making sure they’re safe and that they’re in a safe situation is all you can do.

“It’s hard to watch, as a parent. But it will settle. It will pass.”

What are the treatments for night terrors?

Occasional night terrors are normal and not major cause for concern. But if they’re happening often enough to distress the child or other members of the household, then it’s time to chat to a doctor.

“If it’s occurring frequently, so multiple nights per week, week after week, and there’s not identifiable factors where parents go, ‘That’s what’s happened. We’ve had a pretty tough term and everyone’s just completely tired,’ then yes, that’s when they should be talking to their GP about it.”

A GP will look at the child’s sleep pattern and make sure they’re not sleep deprived, as well as potential sources of stress or anxiety, in order to determine possible treatment options. This may involve a referral to a psychologist or sleep specialist.

Dr Cunnington’s key message to parents in the depths of that awful night terror phase: “They don’t have to it solve it themselves. This stuff fits within the realm of health problems. So go and see their health care professional for advice.”

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