Nightmares and Night Terrors
“We really didn’t know what to do! Mathew would wake up screaming at the top of his lungs. We would rush to his room to find him hysterically crying and terrified. No matter what we said or did, it was like he was frozen in place and didn’t even know we were there. We tried throwing water on him, shaking him, and getting in his face to make eye contact to snap him out of it. He’d come to and not remember a thing. He’d get frustrated with us. We were all so exhausted, and we always knew these episodes weren’t over. More times than not, he’d start back up again within an hour. It took years for him to work through it. I really wish I understood then what I know now.”
This is the testimony of Melissa, mom to three boys ages 15, 9, and 7. Mathew is her oldest son who was clearly experiencing night terrors when he was around 4 years old. However, Melissa had no idea what they were, or how to deal with them. She truly thought it was just bad dreams and there was nothing they could do.
So many families struggle with their toddlers, preschoolers, and school-aged children having nightmares and/or night terrors. Oftentimes, parents tend to believe they are basically the same thing and these terms are synonymous. However, they identify different situations and should be treated as such.
So, what is a nightmare and how does it differ from a night terror? Let’s dig into that.
Nightmares
Most people will experience nightmares at some point in their life and describe them as “bad dreams.” When a child has a nightmare, it will generally occur in the second half of the night. Parents may be awakened by cries or screams. When they go to their child, they may be scared, anxious, crying, and will typically remember the details of the nightmare.
So, what should you do if you believe your child has experienced a nightmare? As you would when they’re hurt or scared during the day, you should comfort your child and assure them that they are safe and okay. If they want to talk about the details of the dream, let them and listen. Remind them that the dreams are not real, and assure them that you will keep them safe.
Always, always, always validate that they are afraid, but avoid validating that the dream was reality or the need to be afraid exists. You can do this by saying something like
“I know the bad dream scared you. I understand that you were so afraid. That is ok! I’m afraid sometimes, too. I am here, and it is my job to protect you and keep you safe, and you are.”
Notice the need to be afraid is not addressed. However, there is a reminder that your child is safe. Once they are ready to go back to sleep, you can remove items from the room that may be scaring them and leave a light (a red lamp preferably) on if they want it.
When children experience nightmares, they often lose sleep. So, consider an earlier bedtime for your child when they experience nightmares the night before. If nightmares become a regular occurrence, think about making these few changes.
Bedtime should be moved back to an earlier time until the nightmares decrease.
Consider what your child is exposed to during the day. Nightmares can occur based on a child’s brain processing images or videos they saw the day before, it can even come from their imagination based on a book they read. If you notice your child is having a lot of nightmares after watching a scary show or reading a particular book, it may be a trigger for them.
Provide your child with some comfort items ahead of time. This may be in the form of a blanket or stuffy they are attached to that they can talk or sing to, or in the form of mantras that they can repeat to themselves if they are scared. “I am safe in my room, I am safe in my bed, I am safe in my mind.”
Night Terrors
Unlike nightmares, night terrors will often occur during the first few hours of sleep. Night terrors are considered hereditary as they will commonly run in the family, and they occur more in boys than girls. In most cases, night terrors occur between 3 and 8 years old, but they have been known to exist in children as young as 15 months old. Common triggers for night terrors include overtiredness, stress, excitement, and life-changing events (positive or negative).
Night terrors will look and feel very different than nightmares. You may wake up to blood-curdling screams coming from your child. When you go to them, you will notice that they are
•uncontrollably crying
•sweating
•shaking
•breathing fast and heavy
•thrashing
•kicking
•staring motionless
•appearing awake yet unresponsive
•unable to recognize you
•combative towards you
(Not all of these must occur to signal a night terror, only one or two may appear.)
A noticeable difference between nightmares and night terrors is that after a nightmare your child will typically have a positive reaction to your presence. However, with a night terror, your child may seem to look straight through anyone who tries to talk to them. They will seem incoherent and unresponsive, kind of like Melissa’s son Mathew. When they experience night terrors, they do not generally remember them. This makes the experience of a night terror much more difficult for you as a parent than your child having them.
So, what should you do if your child is experiencing a night terror?
Remain calm.
Avoid trying to wake your child or snap them out of it.
Allow the night terror to completely work itself out while providing a safe environment for your child. If you wake them, they could enter back into the terror once they fall back asleep. Allowing the terror to play out will significantly decrease the chances of it returning.
To help ward off night terrors
implement early bedtimes, especially if your child had a night terror the previous night
Keep a daily log to help catch trends or associations. Be sure you include details such as:
bedtimes
night wakings
wake times
nap times
general daily activities
food consumption (not just that they ate, but what they ate)
any non-regular activities
stressful or exciting events
specific details of the suspected night terror
time
length
what your child was saying or doing
did you wake them or did you let the terror play out
any other details that could help narrow down a possible trigger
Once you’ve kept a log for about 2 weeks, speak with your pediatrician to rule out any underlying causes or triggers.
Confusional Arousals
Since we are discussing nightmares and night terrors, it is only fitting that we also discuss confusional arousals. Confusional arousals are characterized by an incident where a child wakes up out of sleep and is confused. The child may sit up, look around, and seem, well, confused. There is generally no emotion, no crying, no screaming, etc. The child simply wakes up, looks around confused, and goes back to sleep with little to no interaction with those around them. These incidents do not last very long, some will be as short as a few seconds while others may last a few minutes.
Confusional arousals are common in children and are considered harmless. However, if you notice that your child is having quite a bit of them, start using a sleep log and speak with your pediatrician and a pediatric sleep consultant (like me). An earlier bedtime should also be considered.
Nightmare, Night Terror, Confusional Arousal
Nightmares, night terrors, and confusional arousals are identified as parasomnias (sounds scarier than it is) and they can be quite common in children. Nightmares are easily identifiable as most children are able to remember them and may even identify them as a “bad dream”. Night terrors, however, are more complex and children will not remember them because they were actually asleep during the incident. Confusional arousals are mild wakings that should not raise red flags or concerns unless they occur often.
Talk to a Pediatric Sleep Consultant
If you are concerned with your child’s nightmares, night terrors, or confusional arousals and want to get a professional’s opinion on your child’s sleep schedule. Please, book an Evaluation Call with me and let’s take a look!
