Nightmare or Night Terror?

Introduction:

Nightmares and Night Terrors. I see the two get interchanged a lot in mom groups on both the internet and in person. Like teething, I feel that nightmares and night terrors get a bad rep for being the “reason” a child (especially an infant) wakes up screaming and crying. Also like teething, even if these sleep disturbances are occurring, there is most likely more to the story. So how do you know what your child is experiencing, why they are experiencing it, and what to do about it?

This blog will teach you the difference between nightmares and night terrors along with how to combat both so everyone gets a good night sleep.

Nightmares:

What is a Nightmare?

According the Mayo Clinic a nightmare is defined as a disturbing dream associated with negative feelings, anxiety, or fear, that awaken you.

What ages do Nightmares begin?

Typically, Nightmares occur somewhere around 2.5 and 3 years of age. Nightmares stem from a child’s imagination so whenever you notice your child truly starting imaginative play (like speaking for dolls or creating scenarios to act out) is when you can expect a nightmare could occur. One Study showed that less than 15% of nursery aged school children have a bad dream at least once a week, while several studies have shown bad dreams to be more prevalent between the ages of 6-10.

As we know, even adults can have nightmares sometimes, so the threat of a nightmare never truly ends. Female teenagers were shown to have more frequent nightmares than their male counterparts and that gap continues to widen through age 16.

My belief is any waking before age 2 of hysterical crying is probably not nightmare related. It is possible that it is a night terror (see below) or a medical underlying condition, but more likely than not it’s just the result of a sleep schedule that needs adjusting.

Why do children have Nightmares?

This study  Found that children with previous waking-sleep disorders (circadian rhythm disorders) during their first year of life, were almost twice as likely to have nightmares than those of normally sleeping children.

Some other researchers have pointed to parental practices such as co-sleeping, excessive physical comfort past the age of one, and falling asleep with the presence of a parent as reasons a child might experience more frequent nightmares. Their reasoning is that these children have frequent night wakings and sleep disturbances due to the lack of ability to self-regulate. However, while studies have been done on these types of parenting practices and difficulty sleeping at night (and been proven these behaviors do in fact inhibit sleep) no studies to date have investigated the link between these choices and bad dreams.

 Truthfully, we don’t know what exactly causes nightmares to occur. What we do know is that nightmares occur more frequently in children who are experiencing stress, have experienced trauma, or are overtired.

 It’s important to note that some medications (and supplements like melatonin) have been linked to increased cases of nightmares or disturbing dreams. If your child has recently started a new supplement or medication, it would be wise to consult your pediatrician to see if there is an alternative.

What does a Nightmare look like?

Nightmares usually are very easy to recognize, especially because we as adults also have nightmares from time to time.

• Your child will either wake up crying or calling out for you. They are fully awake and alert, but probably slightly hysterical.

• Your child will be able to communicate with you. They will tell you they had a bad dream, but they may or may not remember exactly what the bad dream was about.

• They may be sweaty or have a rapid heart rate and breathing pattern that will calm down as they talk to you.

• There will most likely be a temporary fear of falling back to sleep.

• Typically occur around 2AM or later (nightmares happen during REM sleep)

How do I handle a Nightmare?

Nightmares can be hard to navigate. There is a fine line that a parent must walk of validating the child’s nightmare without giving it any credit. You don’t want to brush off the nightmare as “silly” or “dumb” or “crazy.” Whatever happened in the nightmare was very real to your child and it was very scary, no matter what it may seem like to you.

•  Validate that the nightmare was really upsetting and the content of the nightmare was unpleasant.

 Example (taken from my own child’s real nightmare):

 “oh wow, I can see why dreaming about that upset you. It would me too. Ursula is very mean to Ariel and Prince Eric; I wouldn’t like dreaming about her chasing me either.”

•  Once you’ve validated their feelings you can reassure them that the dream wasn’t real and that they are safe with nothing to worry about.

 “I know it was scary but that was just a dream. Ursula is just a character in a movie and she can’t get you. Mom and dad are always right here watching you and we would never let someone chase you.”

•  At this stage you’ve validated the fear, let them know why they don’t have to fear it anymore, and you’re ready to move on. You can offer to sit beside the bed until they fall back to sleep or offer to check in on them from time to time.

 My own daughter takes a lot of comfort from knowing the monitor is on in her room and we can see her. When she has nightmares, I offer to stay until she “feels calm” and after a few minutes she will usually tell me it’s okay for me to go.

 However, you handle it is up to you as the parent, my only advice for all parents would be to be clear on when you will leave the room. If you say “I’ll stay with you.” And then leave once they fall asleep; they will most likely wake again and realize you aren’t there. This will create a spiral of them trying to stay awake to make sure you stay in the room and lead to an even longer night of lost sleep for everyone. Always say what you mean, and mean what you say when it comes to nightmares.

 *a quick note on Valid Nightmares- If your child I experiencing reoccuring nightmares related to actual traumatic events that have occurred in their life, please contact your pediatrician for further advice and resources on therapy and other methods of help*  

Night Terrors:

What is a Night Terror?

Night terrors are defined by the American Academy of Sleep Medicine as “A cry or piercing scream accompanied by an autonomic nervous system and behavioral manifiestations of intensese fear.”

Night terrors are a Parasomnia disorder, meaning they occur during partial arousals from a deep sleep state. Because of this they typically occur earlier in the night when our bodies experience deeper sleep for longer periods of time and less REM cycles.

What age do Night Terrors begin?

A study conducted by the Journal of American Medical Association found that 1.5 was the most common age for a night terror to occur, with about 35% of children experiencing night terrors at that age. They also found that night terrors occurred at least once in about 56% of children and occur up to the age of 13.

It is very unlikely that a child under 18 months is experiencing a night terror. While it is certainly possible, a case has never been documented (to date of this blog) so if your infant is experiencing these symptoms I would urge you to reach out to your pediatrician.

Why do children have Night Terrors?

 The current cause of night terrors is largely unknown however some studies have shown that genetics can play a factor in Night terrors and other Parasomnia disorders such as sleep walking. If you suspect your child is having night terrors it would be worthwhile to ask immediate family members if they or anyone else related had night terrors as a child.

 While heredity comes into play as a predisposition to have a parasomnia disorder, environmental factors also play a significant role in Night Terrors, the most common environmental factor being that the child is overtired.

One study in 2014 has found there to be a possible link between nightmares and Parasomnia events and psychotic experiences in 12 year olds. Obviously we all have had a nightmare at one point in time and many of us experienced night terrors in our formative years and yet, here we sit with no diagnosis of psychotic experiences or behavior. Nightmares and Night Terrors are common occurrences in children and for the most part are absolutely nothing to be concerned over as a parent. The only reason I even decided to bring up psychiatric connections is because the internet is* not* your friend guys. I want to extinguish any fears you may have from the middle of the night google session, so let me say it again:

Is there a link between nightmares, night terrors, other Parasomnias and Psychosis?

Maybe, but to what end and other factors that come into play have yet to be discovered.

If your child has one of these events does that mean they have Psychosis?

Nope, not even remotely.

What does a Night Terror look like?

Night Terrors can be distinguished from nightmares by the behavior of your child.

• A child who is having a night terror will often be screaming or crying hysterically. Their eyes may remain closed or they will have a glassy-eyed look.

• They will often not respond or seem to recognize a parent or caregiver.

• Physically the child may present a rapid heart rate and sweating.

• They may also thrash their legs or arms about in a panicked like manner.

• Night terrors can last for several minutes. The child will often fall back to sleep as if nothing occurred, or if they fully wake, they will be confused and have no (or very little) recollection of the events.

• There is no “bad dream” component to night terrors.

• Typically occur earlier in the night (before 1AM)

How do I handle a Night Terror?

   Because Night terrors are a medical condition and not linked to behavior, there is sadly no way to stop night terrors from occurring. While we can’t eliminate night terrors, we can try to combat them with the following steps.

 1)    A Medical Evaluation: Your pediatrician can do an exam or write referrals for a sleep study or other medical tests to rule out any physiological reason for your child to be having nightmares. While my biggest piece of advice to any parent is to trust your gut when it comes to your child’s health, I would strongly recommend a medical evaluation if night terrors are frequent, last 30 minutes or longer every time, result in your child accidently harming themselves or others, or you notice any other oddities about sleep such as irregular breathing or they are abnormally tired during the day.

It can be helpful to videotape one of the night terror occurrences so that your pediatrician can actually see and hear what you, the parent, are seeing and hearing. Make sure to record a “typical” night terror and keep data of dates, how long the night terror lasts, and anything you find important about the event. All of this information will help your doctor to evaluate the situation and (hopefully) avoid any unnecessary tests or procedures.

2)    Prevent overtiredness by making sure your child has an age appropriate bedtime and naps according to their needs.

3)    Have a relaxing and regular bedtime routine- I recommend this for every child regardless of night terrors, but for those experiencing this it is very crucial that bedtime routines are quiet, calm, relaxing, and follow the same sequence.

4)    End screen time 2 hours before bed

5)    Talk to your child if you feel something may be bothering them- while night terrors are not caused by bad dreams or a child’s imagination, stress can be a trigger to start or increase night terrors.

6)    Make sure the child’s environment is safe to prevent injury.

7)    A Hit or Miss combative measure – anticipate the night terror and wake before it happens. This is where your data will come into play. If your child very consistently has night terrors (within a 30-minute window) then you can try to lightly arouse the child *before* the anticipated event. You want to wake them just enough to stop their current sleep cycle and start a new one. This of course always has the ability to backfire and fully wake your child, making it difficult for them to fall back to sleep. It could also flat out not work. It’s worth trying if the night terrors are consistent but if you don’t see the desired results after a few nights then I would discontinue the practice.

 What to do when a night terror occurs:

 Since Night terrors cannot really be prevented, chances are if your child has this disorder you will have to deal with a night terror from time to time despite your best efforts.

•  The best thing to do during a night terror is to be a calm and present force while the night terror plays out.

•  Sit near your child and speak in a calm and soothing voice.

•  While you might be tempted to help, it is not recommended to touch a child during a night terror unless they are harming or in significant danger of harming themselves. Touching them can cause the episode to be worse, so it’s best to let them be if you can.

•  The next morning or if your child arouses fully after a night terror it is best to not make a big deal about the events that occurred. They will have very little to no recollection of what has happened. Talking extensively about it will only cause anxiety and fear surrounding sleep and bedtime.

Conclusion:

At the end of the day, there is a 100% chance that your child will have a nightmare at some point in their life, and there’s a pretty decent chance your toddler will experience a night terror. Both of these sleep events are common and nothing for you to worry about if they occur occasionally.

It is interesting that the best way to prevent both of these sleep disturbances is to prevent your child from becoming overtired. Most sleep problems stem from the simple solution of needing more quality sleep. If you know your child is having these problems and you know they are waking frequently during the night, refusing to go to bed, or refusing naps you know they need, then it’s time to make a lifestyle change for the betterment of your family.