It is important to know the difference between a nightmare and a night terror as they are completely different things and more importantly require a different response from you as the parent.
Nightmares are fairly common. They are simply put, scary dreams that usually wake your little ones up. They usually start to happen around 2 years of age and peak between the ages of 3 and 6. You are able to wake your little one up from a nightmare and comfort them, your little one will recognise you and might even call or cry out for you once they wake up from their nightmare.
Nightmares usually occur during the second half of the night during REM sleep (rapid eye movement). Younger children have trouble differentiating between what is real and what is a dream which is why nightmares can be quite upsetting for your little one.
What causes nightmares?
Dr. Ferber says that nightmares “are caused by, and reflect, emotional conflicts that arise from a child’s waking life. These conflicts are just the usual struggles children face throughout their normal development.” This is why most children will have nightmares at some points in their life. Your little one taking medication or being ill can also cause nightmares
How can you support your child suffering from nightmares?
Nightmares can cause fear at bedtime and thus cause sleep issues. If your little one is less than 2 years old, telling them that it was just a dream is not the right approach. They are too young to know the difference between dreams and reality. It is best to soothe and reassure them just as you would if they are upset during the day.
From about 3 years of age, you can explain that it was just a dream while still acknowledging their fear. Sleeping with a night light or the door left ajar might help as well at this age. When introducing a night light be sure to use a red night light as red does not interfere with the production of the sleep hormone Melatonin.
I don’t recommend pretending to look for monsters under the bed or spraying a ‘Monster Spray’ at bedtime as this can make the fear more of a reality. Lots of cuddles and reassuring words after a nightmare can help alleviate your child’s fears.
Should your child have several nightmares per month, you might have to address the cause during the day and find out what is making your little one feel anxious (potty training, daycare, divorce etc.). Talk about whatever is making your little one feel worried during the day to help them process it better.
Ensuring that your little one gets enough sleep is a good strategy in reducing the likelihood of nightmares, also keeping the routine before bedtime calm and not letting your little one read or watch anything scary will also help.
It is always best to comfort your little one in their own room to keep up healthy sleep habits and make them feel safe in their bed. Letting them come into your bed can quickly turn into a regular habit which can be hard to break.
Your little one suddenly screams or cries out, appears distressed, and confused. They are sweating and their heart is racing in their chest. They might suddenly sit up, thrash around the bed or even jump out of bed. Once the episode subsides they wake up fully and go back to sleep as if nothing has happened. Does this sound familiar? If so your little one might be suffering from night terrors.
Night terrors or sleep terrors occur during the NON-REM sleep stage when your little one is transitioning from deep sleep and entering into a new sleep cycle, which is usually within 2-4 hours of going to sleep. Most episodes last between 45-90 minutes and it is not possible to wake your little one up during an episode and they will also not remember the episode the next morning.
Night terrors can happen in 1 - 6.5% of children aged 1 - 12 years of age and are most common in children aged 4 - 12. They are nothing to worry about if your little one starts having them before puberty.
Sleep terrors are partial arousals from very deep sleep and they are more physical in nature than mental. Your little one does not remember these events and will not be scared to go back to sleep once they are over.
Dr. Richard Ferber defines night terrors as “incomplete wakings from deep, dreamless non-REM sleep”. Sleep terrors happen when your little one comes out of deep sleep and enters a new sleep cycle. These partial wake ups can range from mild (moaning, sitting up briefly, mumbling) to severe (screaming, crying). Night terrors happen because your little one has a strong drive to sleep and to wake up at the same time.
What causes night terrors?
Different factors influence your little one’s drive to sleep and to wake and how deeply they sleep which in turn explains the occurrence of sleep terrors. These are:
Developmental: Since younger children developmentally sleep deeper than older children and adults the internal mechanisms that trigger an arousal at the end of a deep sleep cycle are sometimes not strong enough, resulting in a child that is half-awake and half-asleep.
Overtiredness: When your little one is overtired at the start of the night, the drive to sleep is stronger than usual, meaning it is more difficult for your child to wake up which can also lead to sleep terrors.
A job to do: It is normal for your little one to wake up a little bit at the end of a sleep cycle but if all is well, your child will roll over and simply go back to sleep. If your child feels like they have a job to do at night (looking for dummy), it can lead to a half-awake half-asleep state, resulting in a night terror. This is often the case with little ones that have not yet mastered the skill of self-soothing and rely on a parent to help them get back to sleep.
Sensory stimulation: Any noise, lights or other sensory stimulation towards the end of a deep sleep cycle can also strengthen the need for your little one to wake up thus resulting in a sleep terror.
Inconsistent/chaotic sleep wake schedule: An irregular sleep schedule (different bed and nap times, different nap durations) can lead to your little one’s biological rhythms to run out of sync, thus lead to an increase in the drive to be awake at a time when your child should in fact be asleep or vice versa.
Sleep disruptions, illness or medication
How can you support your little one during a night terror?
First and foremost don’t panic, night terror episodes can look quite scary but in most cases they are nothing to worry about and your little one will outgrow them sooner or later. It is best not to intervene when your child is having a night terror unless they are in danger of hurting themselves. Trying to pick up or hug your child can make the episode worse.
Your little one will eventually wake up fully and go back to sleep. It is best not to engage in any activities at this point so as not to disrupt your child’s return to sleep.
It is also best not to mention your little one’s ‘strange’ behaviour to them as this might make them feel upset or even scared as they will not remember the episode even occurring.
It is a good idea to keep your little one’s sleep environment safe to reduce the likelihood of them hurting themselves during an episode (use a baby gate for younger children, lock all doors and windows, put a bell on their door that alerts you when your child leaves the room etc.).
What can you do to reduce night terrors from happening?
It is usually not necessary to seek psychological help for these events unless other psychological factors are in play. Treatment depends on the cause of the events, it is best to first determine the factor that prevents your little one from fully waking up from a deep sleep and then eliminate or minimise those factors.
It is a good idea to keep good sleep hygiene and ensure your child gets enough sleep and keeps to a regular schedule with a calm bedtime routine and an appropriate bedtime.
It is also a good idea to eliminate night time ‘jobs’, meaning if your little one does not yet know how to self-soothe and relies on you to fall asleep, it might be time to move away from attachment-based sleep associations (rocking, patting, feeding to sleep etc.) to independent sleep associations (white noise, sleeping bag, dark room etc.).
In conclusion keeping healthy sleep habits for your little one, ensuring they get enough sleep and have a regular sleep routine is the best way to prevent and deal with both nightmares and night terrors.
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Ferber, R, 2006, Solve your child’s sleep problems, Fireside, USA
Nightmares in children
Sleep terrors: An updated review