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Night terrors: causes and treatment

by Josephine Andrews
Published: Last Updated on 283 views

Night terrors (night terrors) are a form of sleep disorder in children. A few hours after falling asleep, the child can scream, thrash about, open its eyes wide, but recognize no one and cannot be awakened or comforted. You can read more about the causes of night terrors, how you should react and when you need to see a doctor here.

Quick Reference: Night Terror

  • What is night terrors? Disorder of sleep with short periods of incomplete waking accompanied by screaming, staring eyes, confusion, profuse sweating and rapid breathing
  • Who is affected? mostly toddlers and children up to preschool age
  • Cause: developmental phenomenon of the central nervous system. There is usually a family history.
  • What to do? Do not try to wake the child, wait, secure the area and protect the child from injury
  • When to the doctor? with night terrors that occur more frequently or after traumatic experiences, persist beyond the age of six or return after a longer break; with the first night terrors in old age or adulthood; mental illness or suspected epilepsy
  • Prognosis : usually overcome by school age due to normal development

Night Terror: What is this?

The scientific term for the night terror (night terror) is “pavor nocturnus”, which means nocturnal fear or night terrors. The sleep disorder usually affects toddlers and preschool children.

Night terrors occur mainly in the first one to four hours after falling asleep, i.e. in the first third of the night. A sudden fear can startle your child out of a deep sleep: It wakes up screaming, but only incompletely – it is neither asleep nor fully awake.

He sits up, his face showing great fear or anger. Your eyes are wide open, your pulse is racing and your heart is beating hard. The child is breathing rapidly and sweating profusely.

Since it is not fully awake, it appears confused. It may not speak clearly. In addition, it does not recognize you and cannot be calmed down – on the contrary, if you stroke it or hold it in your arms, the child can lash out. It is very difficult to wake up in this state.

After five to ten minutes, the nightmare is over: your child wakes up by itself, pulse and breathing are suddenly normal again. After that, it quickly falls asleep again. The next day, despite the night terrors, your child wakes up refreshed and has no memory of the incident.

How common is night terrors?

About a third of toddlers and preschoolers between the ages of two and seven experience night terrors. Three to five year olds are most commonly affected. Only rarely does a baby experience a night terror by the end of the first year of life. Girls and boys are equally affected.

The sleep of most affected children is disturbed only sporadically, i.e. once or a few times, by night terrors. Some children get night terrors every few months for a year or two. Only in a few cases is every night interrupted by it.

The episodes of night terrors are usually over by school age. Pavor nocturnus occurs very rarely in adults and adolescents.

Differences to other sleep disorders

Night terrors are one of the so-called parasomnias. These are disturbances in sleep in which the affected person wakes up incompletely. The result is involuntary and undesirable behavior. They can occur both in the REM phase and in the non-REM sleep phases.

Night terrors are assigned to the parasomnias of the non-REM sleep phase . It is one of the so-called wake-up or arousal disorders , as well as intoxication and sleepwalking. It can therefore happen that children affected by pavor nocturnus also sleepwalk from time to time or that the night terrors turn into sleepwalking.

In contrast to night terrors and other parasomnias of the non-REM sleep phase , the parasomnias of the REM sleep phase usually appear in the second half of the night. This includes, for example, nightmares. They resemble night terrors. In the table below you can read how to distinguish nightmares and night terrors:

Pavor nocturnus (night terror) nightmare
time One to four hours after falling asleep, in the first third of the night in the second half of the night
behavior of the sleeper
  • Eyes wide open, child sitting in bed looking confused or scared
  • It sweats, breathes fast
  • It cannot be awakened
  • It cannot be calmed down, screams and lashes out when touched
  • Behavior normalizes by itself, child then quickly falls asleep again
  • The sleeper can be awakened or wake up completely from the nightmare
  • awake child cries or calls for its parents, is frightened, recognizes parents and wants to be comforted
  • Falling asleep again is difficult
memory none yes, also the following day

Night terrors: causes

Toddler and preschool brains are immature, and the intricate architecture of sleep has yet to form. In the course of a night, different sleep phases of different depth and activity alternate regularly with each other:

  • REM sleep phase : superficial sleep phase with rapid, involuntary eye movements (“rapid eye movements” = REM) and increased brain activity.
  • Non-REM sleep phases : different deep sleep phases without the typical eye movements of REM sleep and with reduced brain activity.

In between, the person concerned can wake up briefly – so briefly that he does not even remember it the next day.

On average, five times a night there is a cyclic change between the different stages of sleep and the brief awakening. This sleep pattern and the length of sleep cycles develop with age: a sleep cycle in infants lasts 30 to 70 minutes and increases to 90 to 120 minutes in adulthood.

You can read more about the different sleep phases in the article “Sleep phases – how sleep works “.

Night terrors – a developmental phenomenon

The change between the sleep phases does not always work smoothly for some small children. A kind of overexcitation of the still developing brain can then trigger a night terror from the deep sleep phase.

So, night terrors in children is a developmental phenomenon of the central nervous system and is not related to any mental disorder or other illness. Incidentally, this also applies to sleepwalking (somnambulism). Both – night terrors and sleepwalking in children – are not dangerous and not harmful. As the nervous system matures, these forms of insomnia disappear.

If night terrors occur in adults, mental illnesses such as anxiety disorders, depression or schizophrenia are often involved.

Night terrors run in the family

Night terrors and sleepwalking are often linked. Genetic factors are involved in both sleep disorders. If your child experiences such nocturnal episodes, there is usually at least one relative who also experienced night terrors or sleepwalking in his childhood. Parents or grandparents were often affected.

Night terrors: trigger

Some factors favor night terrors in children:

  • fatigue, lack of sleep
  • emotional stress
  • febrile illnesses
  • medication
  • an eventful day, many impressions
  • Stay overnight in a strange environment

Night terrors: When do you have to go to the doctor?

Night terrors are related to the development of the nervous system and usually go away on their own over time. However, you should see a doctor if:

  • Night terrors are common.
  • The first episodes only appear in older children (e.g. twelve-year-olds) or in adulthood.
  • The night terror persists beyond the age of six.
  • The night terrors reappear after a long break.
  • Night terror occurs after traumatic experiences.
  • The person has a diagnosed mental illness.
  • The person concerned is suspected of having epilepsy.

Tip: If you are unsure whether your child is suffering from night terrors, you can use your cell phone to record a nocturnal episode and show it to the pediatrician. If possible, also tell him when the child fell asleep and when he then experienced the night terrors.

Night terrors: What’s the doctor doing?

First, the doctor will clarify whether it is actually night terrors or another sleep disorder. After that, he can start treatment if necessary.

Night Terror: Investigations

First, the doctor collects important information about the medical history (anamnesis). To do this, he talks to the person concerned (if they are old enough) or to the parents or other adults who have observed the sleep disorder. Questions to be answered include:

  • What about evening activities and eating habits?
  • How do you prepare for going to bed (e.g. bedtime story, brushing your teeth, etc.)?
  • When is the usual bedtime? Do you have problems falling asleep or staying asleep?
  • How exactly does a night terror episode proceed (symptoms, frequency, duration)?
  • When did night terrors first appear? Are there possible triggers (e.g. traumatic experiences, physical illness, etc.)?
  • What is your other sleeping behavior like (e.g. restless sleep, snoring, bedwetting)?
  • On average, how much does the person sleep per night?
  • When is the usual wake up time? Does the person concerned wake up or does he wake up on his own?
  • How is the condition after waking up? Does the person concerned remember the disturbed night’s sleep?
  • How is the behavior during the day (e.g. unusual tiredness, sleepiness)?
  • How much does the sleep disorder affect the sufferer or the family?
  • How high is the media consumption of the person concerned (e.g. daily television time, usage time of the mobile phone, etc.)?
  • Is the person concerned often anxious or emotionally very sensitive?
  • Is or was the sufferer taking any medication or drugs?
  • Have parents or other relatives known (from childhood) episodes of night terrors or sleepwalking?

To clarify such questions, the doctor can also use special sleep questionnaires such as the questionnaire from the Munich Parasomnia Screening.

Sleep diary and actigraphy

The doctor will also likely ask you to keep a sleep diary (sleep log) for a week. Among other things, the bedtime, total sleep duration, possible waking phases, episodes of night terrors, nightmares, etc. are noted therein for each night. These precise records help the doctor to clarify the sleep disorder.

In some cases, actigraphy can also help. The affected person wears a wristwatch-like device for several days, which continuously records the phases of activity and rest. The evaluation of the data can reveal disturbances in the sleep-wake cycle.

Diagnostics in the sleep laboratory: polysomnography

The movement patterns in sleep disorders such as night terrors can be very similar to those seen in nocturnal seizures. A so-called polysomnography in a sleep laboratory can therefore be useful for clarification:

The person concerned spends the night in the sleep laboratory. During sleep, it is connected to measuring devices that measure parameters such as brain activity, heart rate, respiration, as well as oxygen saturation and carbon dioxide concentration in the blood. Eye movements and other movements during sleep are also recorded by video surveillance.

The data provide information about important bodily functions during sleep (such as brain and heart activity) as well as the personal sleep profile of the person concerned.

If the examination reveals signs of nocturnal epileptic seizures, the person concerned is referred to an epilepsy center.

Night terrors: treatment

Night terrors in children are a developmental phenomenon and therefore usually do not require treatment. To prevent night terrors, the child’s stress level should be reduced and sleep hygiene optimized (see “Preventing night terrors” below).

Other measures that can be useful for night terrors:

Scheduled wake up

If the sleep log shows that your child always experiences pavor nocturnus at the same time, you can use planned “anticipatory awakenings” under the doctor’s guidance: For a week, fully wake your child about 15 minutes before the usual time the night terrors occur. After five minutes, it can go back to sleep. If the night terrors come back, repeat the awakenings for another week.


In some research, self-hypnosis and professional hypnosis have been shown to be effective in night terrors. If you want to know more about it, ask the doctor treating you.


Night terrors can only be treated with medication if everyday activities are impaired by the sleep disorder, if subsequent psychosocial disorders occur, or if the suffering of the affected child or family is very high.

However, there are no clear recommendations for drug therapy for night terrors. Only experience with individuals affected or a group of several affected people (case series) show that some active ingredients can be helpful. These include, for example, benzodiazepines (such as diazepam ) with their calming and anxiolytic effects. Tricyclic antidepressants (such as imipramine ), which are usually given for depression, may also be prescribed for night terrors.

Night Terror: You can do that yourself

Attempts to wake a child from night terrors or to comfort it are unfortunately in vain. You might even upset the child even more. But what then helps with night terrors?

Night terrors: How to react correctly

The best things to try when your child experiences a pavor nocturnus are:

  • wait and don’t wake the child, don’t stroke it or hug it – even if it’s difficult
  • Speak softly and reassuringly, reassuring your child that you are there and that they are safe
  • Secure sleeping environment to protect the child from injury

After five to ten minutes, your child will suddenly calm down and quickly fall asleep again.

prevent night terrors

To prevent night terrors, you should first and foremost ensure that your child has good sleep hygiene . It includes:

  • regular bedtimes adapted to the needs of the child
  • regular daytime sleep in smaller children
  • low-stimulus environment before bedtime (e.g. no television or use of screens such as cell phones or tablets about an hour before)
  • no exciting or strenuous activities before going to sleep
  • quiet, darkened, pleasantly tempered sleeping environment
  • comfortable place to sleep unassociated with other activities such as gaming, watching TV, doing homework, or being punished
  • regular bedtime ritual, e.g. a bedtime story
  • leave on dim night light if desired

In addition to these measures, the following additional tips can prevent night terrors:

  • avoid overtiredness
  • compensate for lack of sleep at night with daytime sleep (e.g. afternoon nap).
  • Reduce stress, eg schedule fewer appointments per week or day
  • Try out relaxation methods such as age-appropriate progressive muscle relaxation or autogenic training
  • lots of exercise in the fresh air
  • regular daily rhythm

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