Night Terrors

Dear Lisa,

Hi - I have an eight year old son, who about an hour and half after going to bed wakes up crying. He will sometimes get out of his bed crying and searching out for me but most times he sits up in bed until I get there. I talk to him but he doesn't answer and after a couple of minutes of me sitting with him he stops crying and goes back to sleep. Although I sometimes feel he is actually not awake when he cries. I ask him in the morning if he remembers crying and coming to me but he remembers nothing. What could be causing this? Is he having bad dreams? He doesn't remember so he can't tell me. He is very active, diagnosed with ADHD and takes Concerta in the morning and Ritalin (10 mg) late afternoon though by the time he goes to bed the Ritalin has worn off. I feel bad that he wakes up crying and I can't seem to help him other than just holding him.

“Crying in his sleep”

Dear “Crying in his sleep”,

It sounds like your son is having Night Terrors. Night Terrors are sleep state disturbances that typically occur 1 ½ hours after a child goes to sleep. Children experience them during the transition out of slow wave sleep. When a child has a Night Terror he wakes at night intensely anxious and agitated. The child tends to sit up in bed and cry or scream and appears to be staring at something. A child having a Night Terror typically is disoriented and does not respond to his caregiver’s soothing. After a few minutes the child tends to fall asleep on his own and usually does not remember the episode in the morning.

In order to prevent Night Terrors from occurring you need to break the sleep cycle, since Night Terrors are a sleep cycle disturbance. You can break the sleep cycle, by waking your child ½ hour before the time the episode typically begins. Once you wake your son, have him walk around the house for a few minutes and then let him go back to bed. If you do this a few nights in a row, it should break the sleep disturbance pattern and he should stop having Night Terrors. Since children tend to have Night Terrors when they are overtired or when they don't get enough sleep it is important to make sure your son is well rested in order to prevent the Night Terrors from occurring.

Sometimes what appears to be Night Terrors may really be seizure activity. Seizure activity, unlike Night Terrors commonly occurs early in the morning before arising. (1) Therefore if the symptoms occur early in the morning instead of shortly after going to sleep at night , it would be important to have an evaluation to rule out seizures. If you are not sure if your son’s symptoms are consistent with Night Terrors, you can video record the event and bring in the tape to your Pediatrician for review.

Interestingly, Obstructive Sleep Apnea, another type of sleep disorder, is associated with Attention Deficit Disorder. It is thought that Obstructive Sleep Apnea results in ADD symptoms. (2) The signs of Obstructive sleep apnea include, pauses in breathing during sleep, excessive sleepiness during the day, hyperactivity during the day, nocturnal enuresis (bedwetting), night time awakenings, restless sleep, poor school performance, mouth breathing, behavioral problems, loud snoring or stridor. Since your son has ADD it is important to look for signs of Obstructive Sleep Apnea. If your son is experiencing symptoms consistent with Obstructive Sleep Apnea, you should bring this to your doctor’s attention. There are pediatric doctors that specialize in sleep disorders and if indicated your son’s Pediatrician may refer you to one.

Children with ADD tend to have difficulty sleeping. The disorder itself is associated with sleep disruption. (2,3) Additionally, many times the medications for ADD contribute to difficulty sleeping. If your son’s symptoms started when he began or increased his ADD medication, you should tell the prescribing doctor. Sometimes medications dosages, times of medication administration or type of medication need to be adjusted in order to alleviate side effects. Other times, a child just needs to get used to a new medication or different dosage.

It can be very stressful for a parent to watch their child have a Night Terror. Especially when your child does not respond to you. The good thing is that children do not remember the event in the morning. Also it is reassuring to know that most children outgrow Night Terrors in time. If your son continues to have night time symptoms, contact his Pediatrician for further guidance.

(1)Rosen, G. General Overview of Neuroanatomy and Neurophysiology of Sleep. Presented at Pediatric Sleep Disorders Conference. JFK Medical Center, NJ; May 31, 2002.
(2)Dahl, R., Pelham, W., Wierson, M. The role of sleep disturbances in attention-deficit disorder symptoms: A case study. J Pediatr Psychol. 1991;16:229-239.
(3)Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Sleep disturbance in preschool-aged hyperactive and nonhyperactive children. Pediatrics. 1987; 80:839-844.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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