Night terrors in children and adults: what they are and what to do

What is a night terror?

A night terror is a partial arousal out of deep sleep. The person looks awake: their eyes are open, they scream or cry, sometimes they leap out of bed, and their body shows every sign of fear, with a pounding heart, fast breathing, sweating and wide pupils. But part of the brain is still asleep. They don't answer when you speak, they may not recognize you, and trying to comfort them can make them more agitated.

Episodes usually happen in the first few hours of the night and last anywhere from a few seconds to several minutes; the UK's National Health Service says they can go on for up to about fifteen. Afterward the person almost always drifts back to sleep on their own. The next day they recall nothing, or, in adults, perhaps a single fleeting image.

Sleep specialists group night terrors with the non-REM parasomnias, the same family as sleepwalking and confusional arousals. That's why it's common for all three to turn up in the same family, or even in the same person.

Night terror or nightmare: how to tell them apart

A night terror is not a nightmare, even though people often use the words interchangeably. A nightmare is a dream: it happens in REM sleep and is more common in the second half of the night. A night terror comes out of deep non-REM sleep, when there's little or no storylike dreaming. These differences help you work out which one you're seeing:

• Timing: night terrors come early, often within the first few hours; nightmares tend to come toward morning.
• Contact: during a night terror the person doesn't know you're there and can't be soothed; after a nightmare they wake up, look for you and calm down with you.
• Memory: little or nothing remains of a night terror; a nightmare can be retold, sometimes in vivid detail.
• Afterward: after a night terror they fall back asleep right away; after a nightmare, fear can keep them up.

Who gets night terrors: children, and adults too

Night terrors are most common in childhood, especially between ages three and eight, according to the NHS. Most children grow out of them on their own, with no treatment. They're more likely when night terrors or sleepwalking run in the family, which points to an inherited component.

They're less common in adults, but they do happen. In a telephone survey of 1,000 adults in Norway, about one in ten said they'd had a night terror at some point and nearly three percent in the previous three months; the authors themselves caution that the figures rest on simple questions and should be read carefully. In adults, episodes often show up during stretches of stress, short sleep or drinking, and sometimes they point to another sleep problem worth looking into.

What can trigger an episode

Night terrors tend to appear when something makes early-night sleep deeper or less stable. Knowing the usual triggers helps you get ahead of them:

• Built-up tiredness, a skipped nap in a child who still needs one, or a short night.
• A fever or a recent illness.
• An irregular schedule, travel or sleeping somewhere new.
• A sudden noise, or a full bladder in the night.
• Stress, anxiety or worries carried over from the day.
• In adults, alcohol and some medications, and other conditions such as sleep apnea or restless legs syndrome.

During an episode: what to do, step by step

When you're facing a night terror, your job is mostly to keep watch and wait. The episode ends by itself, and what helps most is that you stay calm, even though it's hard to watch.

• Take a breath and remember they aren't suffering the way it looks: what you're seeing is the body on high alert, not a horrifying dream they'll carry with them.
• Stay close, quiet or speaking in a low, steady voice, and don't ask questions.
• Move anything they could hit out of the way, and if they get up, gently steer them back to bed.
• Wait until they settle and fall back asleep, which usually takes just a few minutes.
• The next day, jot down the time and anything notable about that day. The record helps you spot patterns and is useful for a doctor if you need one.

What not to do

Some natural reactions make an episode worse or longer. The NHS advises against trying to wake the person, because they may not recognize you and could become more upset.

• Don't shake them or shout to wake them up.
• Don't hold them down, unless they're in danger or could hurt someone.
• Don't question them or try to reason with them mid-episode.
• Don't recount the night dramatically the next morning; it can make a child afraid to go to sleep. If they ask, explain simply that sometimes the body wakes up only halfway.
• Don't treat it as misbehavior or as a sign that something is wrong with your parenting.

Keeping the home safe

Most night terrors pass without harm, but some people jump out of bed or run. A few simple changes at home lower the risk of bumps and falls:

• Lock outside doors and windows at night, and put a safety gate at the top of the stairs if there are young children.
• Keep the floor clear of toys, cords and low furniture.
• Don't let a child who has night terrors sleep on the top bunk.
• Move anything sharp or made of glass away from the bed.
• If the person is an adult and the episodes are rough, talk with your partner about more room in bed, or separate beds for a while.

Prevention: good sleep and scheduled awakenings

Prevention starts with enough regular sleep: a set bedtime, a calm wind-down routine and, for little ones, keeping the nap if they still need it. A sleep diary kept for two or three weeks shows whether episodes line up with tired days, fevers or tension.

If episodes happen at about the same time each night, the NHS describes a simple technique: gently wake the person about fifteen minutes before that time, every night for two weeks, then let them go back to sleep. It's called scheduled awakening. The evidence comes from small studies, so it doesn't work for everyone, but it's harmless and worth a try, ideally with your pediatrician's guidance.

When to see a doctor

A single night terror is no cause for alarm. Still, it's a good idea to talk with your child's pediatrician or your own doctor in these situations, which the NHS and sleep-medicine references flag:

• A child still having night terrors after age twelve, or starting them after age five.
• Very frequent episodes, several times a week, or episodes that disrupt the whole family's sleep.
• Injuries or risky behavior, such as trying to leave the house.
• Loud snoring, pauses in breathing or heavy daytime sleepiness.
• Episodes that look the same every time, happen many times in one night, or come with stiffening or jerking: a doctor will want to rule out nighttime seizures.
• An adult who starts having them for the first time, or who notices they began with a new medication.