For children, sweet dreams are often interrupted by unpleasant sleep events. such as night terrors, sleep walking, REM behavior disorders, and nightmares. Parents who understand the nature of these unpleasant events can learn to manage their own fears and support their child.
Pattern of Normal Sleep
When a child falls asleep normally they begin a cycle of sleep that takes them from drowsiness to deep sleep to dreaming [REM] sleep. This cycle is repeated throughout the night, and after 8 hours leads to the child feeling rested and ready to start a new day. However, the sleep cycle can be disrupted by genetic factors, worries, and environmental factors, such as noise or conflict. Surprisingly, when children are awakened from sleep, they may or may not remember of what caused them to awake.
Night Terrors and Sleepwalking
These two disorders are usually far more upsetting to the witness than to the child. The yelling and panic of the night terror, and the rambling speech and walks are usually not remembered when the child awakens. Why is this?
These two disorders occur at the deepest levels of sleep, so children are not recording in their minds what is happening. There is usually a genetic element, so that there is often a history of someone in the family having these disorders as a child. Both of these conditions usually occur early in the night; IE: before midnight in children who are going to sleep at 8PM or 9 PM, during the first sleep cycle.
Facts about Night Terrors and Sleepwalking
- Usually initiated with a scream. Intense arousal and fear, rapid heart rate, widened pupils, sweating, rapid breathing
- More frightening to observers than the patient
- May progress to sleepwalking
- Possibly increase in response to stressful life events
- Family history
- Often MADE WORSE BY THE USE OF SLEEP MEDICATIONS and some other psychiatric medications
What should a parent do, if a night terror is suspected?
It is most helpful to be supportive to the child. This can usually be accomplished without waking up the child, simply by making sure that the bed coverings are comfortably arranged for sleep. If the child awakens, then use whatever comforting measures have worked in the past to help the child go back to sleep.
What should a parent do if a child is found sleepwalking?
It is most helpful to let the child continue in the sleepwalking until returning to bed, unless, something dangerous is happening, such as walking out of the front door of the house. In these case, it is necessary to try to guide the child back to bed. If the child awakens during an episode of sleeping walking, it may trigger a period of anxiety and confusion. This should be managed by providing calm and supportive actions, that end with the child returning to bed to sleep. In many cases an explanation to the child that this a common sleep experience for children, or that some relative had this experience may provide additional support. The idea that sleepwalking betrays a guilty act, such as with Lady Macbeth, is not a cause of sleepwalking.
REM Sleep Disorders and Nightmare Disorder
These disorders occur when the child is in an episode of REM sleep, and occur frequently in the second part of the night, usually after midnight. Both of these disorders can be triggered by the use of sleep medications. They can also be triggered by the lack of sleep.
The REM behavior disorder can either be purposeful behavior, like opening a door, or just muscle movements, like movements of arms or legs. If the movements appear to be part of repeated muscle jerking, then the presence of a seizure disorder needs to be considered as a possible explanation of what is happening. A child with a REM behavior disorder would likely remember his/her actions and their purpose, and if it was harmful or dangerous, be worried or might apologize for it. A history of trauma or recent frightening experiences, may be a partial explanation of the actions the child was trying to carry out.
Nightmare Disorder can awaken children from sleep. It is often accompanied by anxiety and distress, and the dreams are usually remembered. About 2%-4% of preschool children have nightmares, and in adolescence the same percentage of boys have them, but they occur twice as often in teenage girls. A history of trauma or recent frightening experiences, may be a partial explanation for the content of the dreams.
Good sleep hygiene can be helpful in decreasing both of these conditions.
Fact About Good Sleep Hygiene
- Put to sleep at the same time each night
- Provide adequate nutrition before bedtime (Don’t send children to bed hungry.)
- Have a quiet place and comfortable bed to sleep in
- Keep room temperature around 70 F degrees
- Avoid drinking caffeinated beverages or medications with stimulants
- Avoid watching scary movies, video games or being read scary stories just before bedtime
- Have one or two familiar items to sleep with, if desired.
- Have a night light, if the child wishes
- Avoid going to sleep angry or in distress.
- Offer a hug, etc. and comforting words before sleep
Finally, if the disturbance continues. it is probably worth consulting your child’s physician, because medical conditions often coexist with chronic sleep difficulties.