Nightmares versus Night Terrors – what’s the difference and how to help your child

Most parents have found themselves woken during the night by their children having nightmares or night terrors, but do you know the difference between these two sleep issues and do you know how to manage them when they occur?

Sleep is made up of two types – non-rapid eye movement sleep (NREM) consisting of four distinct stages of sleep representing increasing depth of sleep and difficulty of arousal (levels 1-4), and rapid eye movement sleep (REM) characterised by dreaming. Adults and children have several sleep cycles throughout the night where we drift between the four NREM stages of sleep and periods of REM sleep.

Nightmares

Nightmares are unpleasant dreams that usually occur in the later part of the night during REM sleep (Haupt et al, 2013). The incidence of nightmares in children aged 3 to 6 years is 25-50%, but the prevalence of nightmares is highest between the ages of 5 and 10 years (Davis, Parker & Montgomery, 2004b; Schredl, et al., 2009). The incidence of nightmares drops off significantly in adolescence. Children having nightmares awaken from their dream and show emotional distress. They are able to be calmed by an adult and can recall most, if not all, details of the offending dream. Many children find it difficult to get back to sleep after having a nightmare. While infrequent nightmares are relatively common, frequent nightmares may be indicative of other stressors that a child is experiencing when they are awake – if this a problem it can be helpful to seek some support from a psychologist to help you with this.

Night Terrors

Night terrors, in contrast, usually occur during the first part of the night when the child is shifting from deeper (non-REM) sleep to lighter (non-REM) sleep. It is also important to note that they can also occur during day sleeps as well. They are characterised by sudden screaming or crying out in terror. The child may jump out of bed, be sweating, and wide-eyed (with dilated pupils). The child is often unresponsive to attempts to calm and may even fight against restraint. The child appears disorientated and confused if woken (yes they are actually asleep!) however, after around 5-15 minutes, the child will calm, and have no recollection of the event in the morning. If the child does awaken, s/he is typically able to get back to sleep without difficulty.

Despite looking very scary to observers (usually the parent), night terrors are not a cause for concern. They are a normal part of development for children between 18 months and 4 years old that reduce in frequency as children mature (Davis, Parker & Montgomery, 2004b). They occur in 1-6% of children (2-6yrs) and 2-3% of adolescence, with a strong genetic predisposition and can therefore run in families (Davis, Parker & Montgomery, 2004b; Jones, 2014).

Strategies to help most sleep related issues including Nightmares and Night Terrors

• CONSISTENT ROUTINE – The most important way to help any sleep related issue is to establish and maintain a consistent bedtime routine, that starts 1-2 hours before you would like the child to be asleep. This allows enough time for the child’s body and brain to slow down in preparation for sleep and is referred to as good ‘sleep hygiene’
• ENVIRONMENT – In addition to completing tasks such as bath, teeth brushing, story reading before bed, consider conditions such as room temperature (keep the room cool), lighting (low, dull lights are best) and noise levels (turn off loud noises in the house such as TVs);
• REDUCE STIMULATION – It is also important to restrict electronics and/or high physical activity levels in the hour or so before bedtime. The light emitted from screens interferes with our body’s natural sleep cycle
• TALK TO YOUR CHILD EARLIER IN THE EVENING rather than right before you want them to go to sleep, so the child can go to bed with less on their mind (Moore, Allison & Rosen, 2006). Straight after dinner is a better time to do this.

Specific strategies for managing nightmares

• Talk about daytime stressors or traumatic events your child has experienced and help them come up with a plan to deal with those issues. Daytime stressors are often a major contributing factor to nightmares. If these are things you and/or your child are unable to work through on your own contact a psychologist to help you with this.
• Make yourself available to listen and talk with your child – If your child wants to talk about the nightmare during the day, provide them with your complete attention
• Be aware of what your child is watching, eg Tv, Youtube, or games they may be playing as these images can sometimes contribute to nightmares, even when they don’t seem scared at the time of viewing them
• Provide reassurance for your child when s/he wakes from a nightmare. It can take some children a while to go back to sleep following a nightmare so reassure them that the dream is over, that your child is safe and it is ok to go back to sleep.
• Try to avoid letting your child sleep with you after a nightmare – this will likely reinforce the frightening nature of the nightmare and create sleeping habits that become challenging and stressful to reverse
• Help children develop calming strategies such as calm breathing, or taking charge of a scary dream and making it funny (e.g. a T-Rex is much less scary when wearing a pair of polka dot undies).
• Exclude possible medical causes – If nightmares are frequent, persistent over time, or impact on daytime behaviors, it can be helpful to talk to your GP to see if there could be a medical issue contributing to the nightmares

Specific strategies for managing sleep terrors

• Parents need to remain calm – Reassure yourself that your child is ok and doesn’t need to be woken. Use some calming and relaxation strategies such as slow breathing, or singing to yourself to manage your own reactions to the sleep terror, both during and after.
• DO NOT try to wake the child and only move or touch the child if you feel they are at risk of injuring themselves – Sleep terrors usually occur in the first few hours of sleep and the child is not aware of the event despite acting in terror.
• Ensure your child gets enough sleep when required. Being overtired can also lead to an increase in night terrors
• Manage possible physical factors such as fevers, reflux, and a full bladder.
• Talk to your GP or Paediatrician to rule out possible underlying medical causes, such as sleep apnoea, if sleep terrors continue to occur frequently

Nightmares and sleep terrors are both common and developmentally appropriate events in childhood and can be quite frightening for both child and parent. However, knowing a little about them can help in their management and ensure everyone in the household gets the sleep they need. As every child and household is different, many families find it helpful to talk with a psychologist about how to individualise and apply the strategies we have mentioned above in their situation. So please feel free to give us a call if you need any support or guidance.

Many thanks to Bianca Eastman of Changes Psychology for this article.