We’ve all felt the grips of a really scary dream. Waking with a gasp, face flushed, heart racing, unable to recognize what’s real and what’s not. It’s a completely unnerving feeling and one you may agree you could do without.
It’s unpleasant enough to experience this unconscious terror yourself – it’s a whole other level of helplessness watching your child experience it.
One of the best ways to tackle discomfort is to understand its roots. And so my mission here is to:
- detail the nocturnal events that send your child into a fearful tizzy
- explain the difference between the most common types of what we call “parasomnias” – night terrors and nightmares
- outfit you with some tools that may help ease you and your child through these distressing events
First, a piece of reassurance. These sleep disruptions are common and, in most cases, are completely benign. Meaning, from a healthy sleep standpoint, they do not have to be high on your radar. But that doesn’t make them any less disruptive. And it can be difficult knowing what is actually happening – the terms night terror and nightmare get thrown around a lot. So let’s explore what’s going on here.
Parasomnias of NREM sleep – Night Terrors and Confusional Arousals
As the name suggests, these disruptions occur while your little one is in the restorative stages of deep NREM sleep. During this sleep stage, breathing is slow and steady and the body is restful, everything is completely relaxed. The body and the brain are heavily cut off from the outside world while in this deep slumber and it is very difficult to rouse a sleeping child from.
You may not be surprised to learn then that the better portion of the first part of the night is spent in NREM sleep. This is why you may be able to transfer your child from one bed to another with relative ease if he fell asleep snuggled up in your bed at the beginning of the night. This is also why you tend to hear very little from him in those first restful hours – from about 8pm to 12am. That is, of course, unless they experience parasomnias of NREM Sleep.
What is a night terror? A night terror is a partial arousal from NREM sleep. They generally occur when your child is shifting from the deep stages of NREM sleep into light stages and just before entering a REM sleep cycle. They are very much like getting “stuck” in between sleep and wakefulness. And while the body may seem alert and active, the brain is not fully conscious to the outside world. Night terrors are most common within the first two to three hours of going to sleep at night, as this is when deep NREM sleep dominates.
What does a night terror look like? If your child is experiencing a night terror, they will probably bolt upright, scream out dramatically and uncontrollably, breath rapidly, and appear extremely fearful. They may speak incoherently about things that they are afraid of, or must do, or must move away from (this may involve physically acting this out). Often no amount of verbal or physical reassurance is enough to jolt your child out of this “in between state”. Following the episode, your child will likely return to a restful state of sleep with ease.
What is a confusional arousal? A confusional arousal is somewhat of a toned down version of a night terror. They occur mainly in infants and young toddlers and may involve agitated vocalizations (crying out) and moving or thrashing around. Eyes may be open or remain closed. There is generally no sweating or flushing of the face. The key identifying feature is that your child may appear confused by your presence and be very resistant to consolation. In fact, efforts to help calm them down may only increase the agitation. As with night terrors, sleep should come easily following the event.
What causes night terrors and confusional arousals? The biggest contributing factor to these nocturnal disruptions is age. They are most common in infants/toddlers (more so with confusional arousals) through preschoolers (more so with night terrors). And they may persist into middle school, but typically phase out on their own with time.
Other factors that may contribute to increased frequency of night terrors include:
- illness (this may contribute to difficulties transitioning between sleep cycles)
- sleep deprivation (from travel, regular sleep struggles, or intermittent stress)
- a sleep-disruptive environment (noisy, bright, or hot)
- another underlying sleep condition (such as restless leg syndrome or obstructive sleep apnea).
- There also appears to be a genetic effect with these parasomnias. Children whose parents had night terrors when they were young may be up to 10 times more likely to exhibit these arousals themselves.
What do I do to help? Remember that during these events, your child is, in fact, still sleeping. They will be very difficult to impossible to wake and may resist your efforts to reassure. These events can last anywhere from just a few to 30 minutes (and sometimes longer). Though they can be incredibly distressing to witness, it’s important to know that they are generally benign. As long as your child remains in a safe environment, there is no reason to be concerned about long term effects. Studies examining the impacts of NREM sleep parasomnias show little impact on overall sleep quality (for your child) or on daily function. Your child also will not remember the event, so no psychological impact is recognized.
In other words, you are doing everything you can do by just being with your child. Do not try to restrain or prohibit their agitation. Ensuring that your child is getting as much daytime sleep as is needed (based on their age) and an early bedtime can help curtail any sleep further sleep disruptions. A few extra long naps may be in store, particularly during periods of change (i.e., potty training, starting school, introducing a new sibling, travel etc.).
If the arousal happens at a predictable time each night, anticipatory waking has been shown a helpful technique with measured success. In this technique, you would sneak into your child’s room about 15-20 minutes before the usual episode and gently jostle/rouse your little one. This doesn’t have to be to full waking, but rather just enough to cause stirring. This can help to reset the sleep cycle and bypass the regular disruption. This is only helpful when episodes are frequent and predictable.
Additionally, helping the body to relax before bed can help to alleviate agitation/anxiety. I like to recommend:
- a magnesium supplement to make sure levels are up (required for muscle relaxation)
- using massage (for younger children) and deep breathing (for older children)
- diffusing relaxing scents (think lavender, rose, or chamomile) to bring calm before sleep.
Parasomnias of REM sleep – Nightmares
These parasomnias occur while your little one is experiencing dream, or REM, sleep. The telltale sign that someone is experiencing REM sleep is, as the name suggests, the quick, intermittent movements of the eyes back and forth behind closed lids. In addition, breathing becomes rapid and irregular, body temperature rises, and heart rate and blood pressure increase. BUT muscle tone is inhibited, placing you in a state of near paralysis.
Counter to NREM sleep, REM sleep dominates that later portion of the night, or really the early morning hours. This is the period of the sleep cycle when vivid, memorable dreams are most likely to occur. And it’s often why, for better or for worse, you remember dreaming right before you wake up.
What is a nightmare? Nightmares are vivid dreams with underlying feelings/imagery of dread or terror. Negative emotions such as anxiety, fear, anger, embarrassment, or disgust usually accompany the content. The intense emotional content is enough to cause the dreamer to fully wake up. Though they can occur throughout the night, they are most common in the final hours of sleep, as this is when REM sleep dominates.
What does a nightmare look like? It may be very difficult to tell that your child is having a nightmare while it is happening, since muscle tone and activity are inhibited during REM sleep. They also do not experience sweating or flushing of the face, and only mild increases in heart rate. However, generally a child that has experienced a nightmare will wake up maintaining the fearful feelings of the dream and so may exhibit behaviours related to hiding, burrowing, or other fear responses. They are able to recount, with some amount of detail, the imagery and events of the dream and will commonly struggle to get back to sleep because of the disruptive content. They will also very likely remember the storyline to some extent in the morning.
What causes nightmares? Nightmares are particularly common between the ages of 3 and 6 years. This corresponds to a rapid development of the imagination, making imagery more salient and much more real for your child. Unlike night terrors, nightmares may not subside with age and may instead persist through adolescence and adulthood.
The frequency with which your child experiences nightmares may have both a genetic component and an environmental component. Exposure to television can heavily influence dream content, as well as other distressing stimuli (think scary halloween decorations), or traumatic experiences (violence, a death in the family, or separation from close family members).
What do I do to help? For mild events, reassurance and physical comfort may be enough to calm your child down following a nightmare. Staying with him while he falls back to sleep will provide additional security.
For more severe and frequent cases, techniques such as rescripting (help your child finish the storyline with a happy spin to it), desensitization (drawing pictures of the dream the next day, confronting the fears with creativity and imagination, or simply discussing the content can help to make it less scary), or cognitive-behavioural therapy (with the help of a clinician).
For some additional ideas for fear management, check out Sleep Monster Ike.
The biggest take home from all of this information is that these episodes are common in young children, and though completely distressing to witness, they are NOT usually harmful to your child. Sleep quality is impacted very little, if at all, and in many cases children simply grow out of these stages. Helping create a highly sleep-promoting environment, calming the body and the mind, and prioritizing healthy, age-appropriate sleep are some of the best tools to minimize these nocturnal disruptions. In the moment, being with your child and comforting them in any way that you know how, but without expectation of a particular response can help to ease your own anxiety surrounding parasomnia episodes.