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Nightmares, Night Terrors and Sleepwalking

Nightmares

Nightmares and night terrors are different entities that are commonly confused by parents. A nightmare is a scary or disturbing dream that occurs during REM sleep. One out of every four children experiences these at least weekly. Nightmares happen frequently in preschoolers and peak between the ages of 6 and 10.   Often preschoolers, who are yet not fully able to distinguish between dreams and reality, will be anxious about these bad dreams and may resist going back to sleep. Nightmares generally occur in the second half of the night, commonly between 4 and 6 AM. Unlike with night terrors, your child will fully awaken after a nightmare and may come to you seeking comfort and reassurance. Your child will usually be able to remember at least parts the dream and may be able to tell you why it was scary. Nightmares may be precipitated by frightening or overly stimulating events that occur before bedtime. Stress or anxiety provoking events during the day are also associated with nightmares, as are some medications. It is possible your child will have the same nightmare repeatedly.

If your child wakes after a nightmare, they may require assistance from you to calm themselves and return to sleep.   If you hear your child awaken, go to her as soon as possible. Offer a hug and some quiet reassurance that she is safe and that you will not let anything harm her. You may need to remind her that dreams are not reality. Encourage your child to tell you about the dream and what was frightening about it. Asking your child to think of an alternative, happier ending to the dream is a helpful strategy. Nightlights, comfort objects and white noise may ease your child’s transition back to bed.

Night Terrors

Night terrors are very different than nightmares. These are most common in toddlers and preschoolers and occur during the deepest part of sleep. These usually happen in the first part of the night, often before parents are in bed. Often night terrors occur around the same time each night over a span of several nights. Unlike nightmares, night terrors occur infrequently. Night terrors may run in families. Eighty percent of children who have night terrors have a family history of a parent also having night terrors as a child. They may be slightly more common in boys than in girls.

If your child is having a night terror, he may not seem fully awake, but very frightened or confused. His eyes may be opened. You may find him screaming, sweating, breathing quickly or crying. He will generally not recognize you or acknowledge that you are there. You may find him flailing his arms and legs and he may push you away if you try to hold him. It may be difficult to awaken him and the episode may last several minutes. Once the episode is over, he may fall right back to sleep, unlike the child who has experienced a nightmare. He will generally not be able to recall the event.

Night terrors are much scarier for the parent than the child, as the child generally will not remember the episode in the morning. If you find your child experiencing a night terror, it is most important that you stay calm. Your role is to help keep your child safe and prevent injury until the episode passes. Don’t try to awaken your child. Stay nearby your child. Gentle restraint may be needed if your child tries to get out of bed.

As it is very difficult to interrupt a night terror in progress, preventing them may be the best strategy for dealing with them. Establish and stick to a bedtime routine. Ensure that your child gets enough rest, as night terrors are more common when children are overtired. Interrupting the deep sleep onset may be helpful if your child is having nightly episodes. To do this, note the onset of the episode and then fully awaken your child the following night 15 to 30 minutes before the usual onset time. This awakening is usually done for 2 to 4 weeks consecutively. If the episodes recur, the technique should be used again. It will be reassuring to parents to know that night terrors are usually self- limited. Their incidence declines dramatically after the onset of puberty and are very uncommon in adolescents and adults.

Sleepwalking

Sleepwalking sometimes occurs at times during this period, most commonly between ages 4 and 8 years. Again a family history of sleepwalking is commonly noted. As with night terrors, sleep deficits, illness and some medications make children more prone to sleep walking. Children who sleep walk may be found wandering or engaging in behaviors without being fully awake. If you your child is sleepwalking, gently lead them back to their room. Ensure that safety measures are in place to keep the sleepwalking child from injury. Having a room located away from stairs, using gates or placing a bell on the door to alert a parent are good safety measures. Sleepwalking also becomes less frequent toward the adolescent years.

An additional helpful strategy for parents dealing with nightmares, night terrors or sleepwalking is to keep a sleep log for your child. Helpful information would include: where the child sleeps, the number of hours of sleep each night, length and timing of naps, how long in bed before falling asleep, number of episodes of night waking per night, any changes or stressors, use of media or electronics around bedtime, comfort items needed to fall asleep, how you respond when your child wakes. Keeping this log over a period of a few weeks may help you identify triggers and solutions to these common sleep problems. This log will also be very helpful to us when discussing sleep problems with you.

Armed with this knowledge, we hope you know feel equipped to tackle all monsters, spooky shadows and things that go bump in the night. Sweet dreams!