If you are still trying to figure out whether your child is experiencing sleep terrors, see: Sleep Terrors: How Can You Tell?
Once parents have identified that their child is visibly upset due to a sleep terror, they are in a better position to implement some strategies to prevent, manage, and treat these behaviours.
This article describes the common risk factors for sleep terrors as well as suggestions for management strategies.
Risk factors and management strategies
Family history. Sleep terrors (as well as sleep-walking) often run in families. There is a strong genetic predisposition to partial arousal parasomnias, with 80-90% of children who present with them, having a first-degree relative who had/or currently has them.
Sleep deprivation. As sleep terrors occur during deep sleep, anything that results in a rebound (increase) of deep sleep can increase the likelihood of a sleep terror occurring. Since both sleep disruption and sleep deprivation often result in an increase in deep sleep, they increase the likelihood of the occurrence of sleep terrors in vulnerable individuals (those who have a genetic predisposition). In fact, sleep deprivation is often cited as the most common cause of sleep terrors.
Therefore, ensuring that your child is getting adequate sleep is important. Establishing a regular sleep schedule can be helpful in preventing sleep deprivation and ensuring adequate sleep. In some cases, it may be necessary to address sleep problems such as bedtime problems, night wakings, or poor day sleep that are causing disrupted or insufficient sleep.
Some medications, including those that are used to prevent sleep terrors, suppress deep sleep. However, when these medications are weaned there is a rebound in deep sleep increasing the risk of a child having a sleep terror.
Being disturbed during deep sleep. Sleep terrors can be triggered by environmental factors, such as noise, that cause a child to partially wake during deep sleep. White noise (a constant and even sound) in a child’s room at a very low-level and/or in the hallway may be helpful to block external and household noise.
Decreased arousal threshold: Several things can cause an individual to be more easily awoken during the night (including during periods of deep sleep). Examples include: not feeling well, sleeping with a full bladder, stress, and sleeping in a different environment. While we unfortunately cannot control whether our child gets sick or not some of these other risk factors can be addressed.
-Limit fluid intake. Limiting your child’s fluid intake in the few hours before bed (and offering her more earlier in the day) may be helpful.
-Address stress & anxiety. Working to address and decrease the stress in your child’s life may be necessary.
Sleep terrors: Other management strategies
Parental reassurance. While many parents worry that sleep terrors are indicative of, or may cause, psychological problems, there is no scientific evidence to support this. In fact, following a sleep terror, parents are often more upset than their children, who are unaware of their own behaviour.
Parents should be educated regarding the common risk factors for sleep terrors (described above) and encouraged to speak with their child’s physician or another health care professional with training in this area if they have concerns.
Safety precautions. While displacement from bed is less common during sleep terrors than sleepwalking, concerned parents may want to consider taking some safety precautions including: clearing the floor (in case the child gets out of bed), hanging a bell over the child’s door to be alerted if she leaves the room, installing safety gates at doorway and/or stairwells, and safety locking windows.
Using bedrails and protecting your child if she ‘thrashes’ around and could hit herself on a headboard or wall are important (e.g., moving bed away from wall). If your child is sleeping away from home, informing an adult in charge of your child about the potential for these behaviours is recommended.
Do not intervene during a sleep terror. While a natural reaction may be to try and wake your child by picking him up and turning on the light, intervening during the course of a sleep terror can worsen and/or prolong the terror. Parents are encouraged to sit by their child’s side, if they wish to be present, and to let the terror run its course. Remember that once the episode is over there is a rapid return to a calmer sleep. Also, parents are encouraged to avoid talking to their child about the sleep terror the next day as this can result in fears around going to sleep.
Other treatment options. In most cases, no specific treatment is needed. However, in more severe cases where sleep terrors are very frequent, cause significant family disruption, and/or involve high risk of injury to the child, other treatment options may include scheduled wakings and medication.
Scheduled awakenings are best suited for children who experience sleep terrors that occur nightly at highly predictable times. Children are woken on a nightly basis approximately 15-30 minutes before the terror typically occurs to the point that the child is slightly roused (e.g., may mumble, or turn over). This should be continued for 2-4 weeks and restarted if the sleep terrors return. Medication options should be discussed with a physician.
As disturbing and frightening as sleep terrors may appear and be distressing for parents to watch, children having them are unaware that they are experiencing them and are deeply asleep. Thus, they are worse to watch than experience.
Also, as sleep terrors are not nightmares and do not involve dreaming, a sleep terror is actually much less upsetting for a child than a typical nightmare or bad dream. Lastly, parents need to be reassured that sleep terrors are not a sign of a psychological problem nor do they cause any psychological harm to a child.
The information provided by Dr. Cohen is not intended to be a substitute for professional advice. Individuals are encouraged to speak with a physician or other health care provider if they have concerns regarding their child’s sleep and before starting any treatment plan. The information provided by Dr. Cohen is provided with the understanding that Dr. Cohen is not rendering clinical, counselling, or other professional services or advice. Such information is intended solely as a general educational aid and not for any individual problem. It is also not intended as a substitute for professional advice and services from a qualified healthcare provider familiar with your unique facts.