Nightmares and Night Terrors in Children
As parents haven’t we all comforted our little ones after the occasional nightmare? But did you ever feel that what your child experienced was unlike a simple nightmare. Your child was not only agitated and frightened, but also inconsolable, no matter what you did to comfort him/her.
Your child may be experiencing another form of sleep disturbance called as night terror. While it may seem more dramatic and scary for you than a nightmare it is part of the normal development of your child and is only a reflection of your child’s struggle to cope with normal childhood fears and problems.
Normal sleep rhythm
While you sleep through the night your brain does not completely switch off. It goes through several sleep stages primarily REM (rapid eye movement) and non REM sleep. About every 90 minutes your brain switches between REM and non REM sleep. The duration of REM sleep is seen to increase with each sleep cycle through the night. During the REM sleep, your eyes move back and forth under your closed eyelids, and it is during this stage that you have dreams/nightmares that can be scary or upsetting at times. Night terrors are seen to occur during non REM sleep and are technically not described as a dream. They are said to be more of a sudden reaction of fear that happens instead of the normal smooth transition from one sleep phase to another.
A nightmare is nothing but a bad dream that can make you feel scared, anxious or upset, yet can cause you no harm. Almost everyone, an adult or a child gets a nightmare once in a while. Children between the ages of 3 and 8 years of age are seen to be affected. Nightmares are seen to occur in children often in the early morning hours between 2 am and 6 am. Your child may be suffering from nightmares if he/she is truly awake and can remember his/her dream. The child may sometimes talk about it and will seek your help, and feel comforted by your presence. However, screaming or moving is very uncommon during a nightmare.
Medical reasons for nightmares may include use of certain drugs or medications or sudden withdrawal from them, and physical conditions such as illness and fever. Children who are seen to experience nightmares in the absence of any traumatic events are likely to outgrow them. Nightmares are not seen to happen as your child grows older and may stop completely when your child is a teenager. Nightmares may seem to continue in some adults who are imaginative and creative.
Night terrors are said to be mysterious glitches in the otherwise smooth transitions we make each night between sleep stages. They are seen to occur in the first few hours of the night. Night terrors are seen to affect about 15 percent of children beginning from their toddler and preschool years, and continuing up to age 7 or until adolescence. It is seen to be a little more common in boys. It is seen in kids who are overtired, ill or stressed, are taking a new medication, or are sleeping in a new environment away from home. Your child could be suffering from night terrors if he/she suddenly bolts upright in bed, cries, screams, moans, mumbles, and thrashes about with his/her eyes wide open, but without being truly awake. The child is not aware of your presence and is not likely to respond to whatever you say or do.
An episode of night terror lasts for about two to 40 minutes, after which your child may fall back to sleep abruptly with no memory of the incident. It is seen that children with a tendency to night terrors may also sleep walk or urinate in bed. These episodes are seen to be as a result of erratic or insufficient sleep schedule or sleep deprivation. Certain medical conditions such as sleep apnea (difficulty in breathing during sleep that prompts the child to partially awaken) caused by enlarged tonsils and adenoids (normal tissue in the throat) that block airway passages during sleep may manifest as night terrors.
Cause for worry
As a routine there are no additional tests or investigations needed if your child is suffering from night terrors or nightmares. However, the child may need psychological evaluation if the night terror is severe or prolonged. You may also seek an appointment with your doctor if the night terrors or nightmares are persistent or frequent, occur often enough to regularly disrupt sleep, are associated with other symptoms, is severe enough to cause injuries, or is disturbing your child’s ability to function during the day.
You can help
It is very difficult to chalk out preventive measures for night terrors as no one knows exactly what causes them. You may get the child examined by your doctor and rule out causes such as enlarged tonsils or adenoids as the reason for sudden awakening. Try to solve any sleep problems your child may have, ensure he/she has a regular bedtime with a calming routine, and gets enough hours of sleep. If your child gets frequent night terrors then you may try to awaken your child before the time he/she usually has a terror. This can interrupt the sleep cycle and prevent night terrors from occurring.
If your child is having an acute episode of night terror, do not try to awaken him/her. Don’t try to hold the child as it can make him/her wilder. A child experiencing a night terror cannot be calmed down so don’t attempt to comfort him/her physically unless the child is in danger of getting hurt. Wait for the acute episode to subside. Just put yourself between the child and anything that can cause him/her danger (e.g. Headboard of the bed). Take care of a few things before going to bed every night. Remove toys or objects on the floor that the child could tumble on, fasten the gate on top of the stairs, ensure all doors and windows are closed. You may rarely need to use sleep medications unless your child has very frequent night terrors.
Night terrors and nightmares are common sleep problems among children. A simple differentiation between nightmare and night terror states that after a nightmare the child is more agitated with the experience; whereas after a night terror the parent who watched it is more disturbed than the child who lived it. All said and done these conditions can definitely be disturbing but rest assured they do not signify any underlying psychological problem. Your child will outgrow suffering from these conditions usually by the age of 10 or as he/she reaches adolescence. There is no need for any extensive workup or treatment for these conditions. All that is required is to ensure that you are around to make sure that your child is safe, comfort him/her as best as you can, and help him/her return to sleep once it is over. Understanding nightmares and night terrors can help reduce your worry and get you also a good night's sleep.