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Mental Health Corner
THE BALTIMORE JEWISH HOME
MAY 6, 2021
Night Terrors and the Stages of Sleep By Rabbi Azriel Hauptman
A night terror, also known as a sleep terror, describes someone who partially awakens during his or her sleep in an intense state of fear. This mid-sleep activation of the fight-orflight system can result in screaming, thrashing of the arms and legs, and a look of terror in the eyes. Since the person is partially sleeping, they usually have no recollection of it in the morning. In this article, we will offer a brief overview of the physiology of night terrors, how they are different from nightmares, and how one should deal with it. Night terrors and nightmares occur during one’s sleep. Therefore, before
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we try to understand these sleep-related phenomena, we must first learn a little bit about sleep itself. Sleep is not a uniform state. During a night’s sleep, we go through sleep cycles, with each cycle lasting approximately ninety minutes. Each cycle contains several stages of sleep. These stages can be broken down into non-REM sleep and REM sleep. REM stands for rapid-eye movement and consequently REM sleep refers to the part of our sleep cycle when our eyes make rapid movements. Non-REM sleep has three stages and precedes REM sleep in the sleep cycle. Here is a brief breakdown of the
sleep stages. Stage 1: This is the very beginning of sleep when one is in a light sleep, can be easily awoken, and breathing occurs at a regular rate. Stage 2: The body temperature begins to drop, the heart rate slows, and the body prepares for deep sleep. Stage 3: This stage is known as deep sleep. In this stage, the entire body is relaxed, rate of breathing is reduced, blood pressure and body temperature are lower, and it can be very difficult to wake someone up. After stage 3, you go back into stage 2 before going into the final stage, which is REM sleep. REM sleep: During REM sleep, the brain waves behave as if the individual is awake and the eyes experience rapid lateral movements. During this stage, one experiences dreams. It is fascinating to note, that during this stage the body experiences an almost complete paralysis of the voluntary muscles. For this reason, even if someone is experiencing a very vivid dream, they will not physically act it out. Now let us return to night terrors and nightmares. The fundamental difference between them is that night terrors occur during stage 3 of the non-REM sleep and nightmares occur during REM sleep. Therefore, during a night terror the individual will act out his dream since there is no muscle paralysis during this stage. Additionally, it is almost futile to try to wake them up as they are in a very deep sleep. On the other hand, because it occurs during deep sleep there will typically be no memory of it whatsoever in the morning. Nightmares, on the other hand, occur during REM sleep. For this reason, the individual will not act out the dream since the voluntary muscles are paralyzed during this sleep stage, but the individual might vividly remember the
frightening dream in the morning. Night terrors in adults are beyond the scope of this article (as they often co-occur with a psychiatric diagnosis), but here are a few pointers about night terrors in children. The most common age of onset is between three and five years old and will usually stop by adolescence. The frequency of night terrors varies greatly. The best way to handle a night terror is to wait it out and monitor your child to make sure that your child does not hurt himself. It will usually subside on its own after a few minutes, although it can last longer. Since night terrors occur when the child is in a deep sleep but also in a certain sense awake, therefore he or she will be more prone to sleepwalking. We do not know what causes night terrors, but overtired children tend to be more prone to it. Proper sleep hygiene can greatly diminish night terrors. If your child has a set time at night for the night terrors, briefly waking him or her 15-30 minutes beforehand tends to interrupt the pattern. Doctors will only prescribe medication for night terrors in extreme cases. Perhaps it is called a night terror since it is terrifying for the parents! Nevertheless, most of the time it is just a passing phase in the child’s development. However, prudence would dictate consulting with your pediatrician who will help you determine if the night terrors are cause for concern or not. This is a service of Relief Resources. Relief is an organization that provides mental health referrals, education, and support to the frum community. Rabbi Yisrael Slansky is director of the Baltimore branch of Relief. He can be contacted at 410-448-8356 or at yslansky@reliefhelp.org
