Night terrors, nightmares and night waking…oh my!

Waking to the sound of your child screaming or calling your name in the middle of the night can be alarming. And, unfortunately, it’s a relatively common occurrence among parents with kids under the age of 12. According to the American Academy of Sleep Medicine, about 75 percent of adults remember experiencing at least one nightmare as a child. 

When a child wakes from sleeping in fear, there may be one of two things going on. If your child is able to describe their scary dream and explain why they are feeling afraid, it’s likely they had a nightmare. However, if your child appears to be confused or afraid and is continuing to scream while you comfort them, it’s possible they may be experiencing a night terror. 

Responding to a nightmare versus a night terror looks slightly different, so understanding what your child is experiencing can best help you calm them and get them back to sleep. 

Nightmares

A nightmare is a scary dream that often occurs during the second half of the night when your child experiencing lighter REM sleep. When your child has a nightmare, they’re typically able to remember the nightmare and describe it to you. 

Why children experience nightmares

Currently, there is no medical consensus as to why nightmares occur. Some theories in sleep medicine and neuroscience suggest dreams can be the result of processing emotion or consolidating memory, which could explain why dreams often contain content children have been exposed to or experienced. However, there is no definitive evidence about why children have nightmares. 

What to do when your child has a nightmare

• If your child is calling out, go to them and assure them that you will not let anything harm them. 
  
  
• Ask your child about the dream and encourage them to tell you what happened, reminding them that dreams are not real. 
  
  
• Find ways to calm your child and return them to sleep. Extra night lights, flashlights or stuffed animals can provide comfort. 

Night terrors

Night terrors are a type of arousal disorder (parasomnia) that are caused by an over-arousal of the central nervous system (CNS) during sleep. During sleep, the body moves from the deepest stage of non-REM sleep that occurs earlier in the night (within the first 3-4 hours of sleep) to lighter REM sleep. This transition is normally a smooth one, but sometimes the transition can overload the central nervous system, which can result in a night terror. 

Night terrors are most common in toddlers and young children, but only about 3-6 percent of children experience them, making them a relatively rare occurrence. As a child’s nervous system grows, night terrors often disappear on their own.    

During a night terror, a child may appear awake and very frightened, but they are actually still asleep. The child may cry, scream, look confused or scared, sweat, and tense their muscles — thrashing, shaking or kicking. Night terrors can last as long as 45 minutes, but they’re often much shorter than this. Though it can be upsetting for you, your child will not likely even remember that the night terror occurred. 

Why children experience night terrors

There is some evidence that suggests night terrors may be linked to a family history of parasomnia conditions. If a parent or sibling experienced night terrors, it could be more likely a child would experience them, too. Night terrors may also be more likely to occur if a child is experiencing other sleep disorders — like sleep apnea, restless leg syndrome or gastroesophageal reflux.

There are also other factors that can trigger night terrors, including fever, sleep deprivation, disruption to the sleep schedule, periods of emotional distress or conflict, stress and certain medications. 

What to do when your child has a night terror

• Stay calm, and remember that the night terror is likely much more traumatic for you than it is for your child. They probably will never even remember that it happened. 
  
  
• Support your child to make sure they don’t hurt themselves. Gently restrain them to keep them in bed until they relax. 
  
  
• Try not to fully wake your child and just be patient as the episode passes. Waking your child up could cause even more confusion and make your child more upset. 

Managing sleep issues

Disruptions to sleep can be stressful for you and your child. While it may not be possible to prevent nightmares and night terrors completely, there are some things you can try to minimize them: 

• Create a safe, comforting environment for your child to sleep in. Make bedtime enjoyable and relaxed, taking time to talk through fears and angers, read favorite stories and end the day on a positive note. 
  
  
• Nightmares often contain images your child has experienced throughout their day — such as watching a story on the news, watching a movie or hearing a story from a peer. Do what you can to minimize their exposure to gruesome or stressful experiences, especially those that are particularly triggering for your child. 
  
  
• Teach your child healthy coping strategies to use when they are scared. Deep breathing, visualizing happy memories and counting can be helpful practices to teach your child to help them deescalate when they’re feeling upset or frightened. 

When to contact your pediatrician

Some night waking is normal (especially in young kids), but if you’re noticing a significant frequency in nightmares or night terrors, it may time to consult your pediatrician. You may also want to seek help if: 

• Nightmares are increasing in frequency
  
  
• Nightmares are resulting in daytime sleepiness or making it difficult for your child to function
  
  
• Night terrors are occurring more than twice per week
  
  
• Night terrors are resulting in injury to you or your child
  
  
• Night terrors are accompanied by other parasomnias like sleepwalking or sleep talking

Your pediatrician knows your child’s health history as well as anyone and they’re here to help. If you have any questions, about sleep or any other topic, please don’t hesitate to reach out. 

Mary Boren, MD Pediatrician Oak Creek Pediatrics

Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.