Just because your child has learned how to sleep through the night does not mean he always will. For many children, nightmares and night terrors can cause major disruptions in their sleep and in yours. The key to getting the best night’s sleep possible is to know the difference between these two parasomnias (otherwise known as abnormal sleep behaviors) so that you can handle them each appropriately. Stephanie Jackson, M.D., a pediatric neurologist specializing in sleep medicine at Riley Hospital for Children at IU Health, explains how to identify nightmares and night terrors in your child, and what you can do manage them.
Nightmares vs. night terrors
A nightmare is an unpleasant or scary dream that occurs during a stage of sleep called REM (rapid eye movement) sleep. It can happen to people of any age and may cause them to wake up, cry, scream, or breathe heavily. “All kids probably have nightmares at some point,” says Dr. Jackson. “It’s part of normal development that children are learning about the world, their imaginations are becoming more active, and they may develop fears that can manifest through nightmares.” Kids who are anxious or have had a trauma tend to be more prone to nightmares, but any child might have one after ruminating about a scary story or movie.
Night terrors, on the other hand, are not connected to fears or scary dreams even though a child having a night terror may look like she’s having a nightmare. In fact, night terrors happen in a completely different and deep phase of sleep called slow wave sleep, when we are likely incapable of constructing meaningful dreams. Dr. Jackson explains that during the night, we cycle through various stages of sleep in a loop. We start out with light sleep (stage 1) and move into more stable sleep (stage 2). We then delve into deep slow wave sleep (stage 3), and eventually progress to REM sleep. We then circle back around and continue the pattern as long as we’re not disrupted. With a night terror, “the brain gets sort of stuck in the sleep cycle—almost like a frozen computer screen—between a lighter arousal stage and the deepest stage of sleep,” explains Dr. Jackson. This often happens to children when they are sleep deprived, have frequent sleep disturbances (such as with sleep apnea), or the brain is trying to catch up on slow wave sleep. Night terrors are most common in the preschool set, and kids tend to outgrow them around age 8.
One simple way to differentiate a nightmare from a night terror is that a child having a nightmare is very easy to wake up because he is in REM sleep, while a child having a night terror is very difficult to wake up because he is in a deep sleep. Though a child having a night terror may have her eyes open and be thrashing around and crying, she is actually asleep and completely unaware of the outburst. “If you were to wake him, he would be disoriented and would have no recollection of the night terror the next day,” says Dr. Jackson. Another distinction: Nightmares usually occur in the second half of the night; night terrors usually happen in the first half of the night.
How to respond
“Even though night terrors seem awful for children, do not try to wake them up since this will just interfere with the brain getting back into that stage 3 sleep and will prolong the event,” says Dr. Jackson. “We tell parents to make sure the child is safe. If he’s gotten out of bed, get him back into bed. You can hold him but the best thing to do is to let a night terror run its course.” Dr. Jackson also notes that you can take comfort in the fact that your child will not remember the night terror in the morning. If your child has a nightmare, however, comforting him is much more straightforward. “He’s going to be able to tell you what was scaring him,” says Dr. Jackson. “It will be easy to wake him out of it and you can hug him and talk to him.”
Managing issues over the long term
If night terrors are disruptive and frequent, seek out a sleep specialist. “It could be the result of something else going on, like sleep apnea triggering sleep disturbances,” says Dr. Jackson. Also, note that if your child seems to be having multiple night terrors a night, those may actually be seizures. What’s more, if night terrors persist into adolescence and adulthood, there may be an underlying psychiatric condition involved. In that case, it would be important to see a specialist.
If your child seems to have a lot of nightmares, Dr. Jackson suggests guided relaxation, positive imagery, and avoiding scary shows and stories before bed. Do what you can to make your child’s bedroom feel comforting and safe. If the darkness is part of the problem, acclimate your child to the dark by playing games in the dark with flashlights, and look around the room together with the lights off and show her that everything is okay. You can also help your child rewrite her scary dream’s script. “Help your child think of an alternate dream scenario,” says Dr. Jackson. “Instead of something frightening happening, change it to something funny or silly happening to help him retrain his thought process.” And when your child finally does make it through the night without you, praise her for being brave.
-- By Rachel Rabkin Peachman