Nightmares, Night Terrors, Confusional Awakenings & Sleep Walking
Disclaimer: Please note that I am not a doctor or medical professional. This post is provided for you to use on an information basis only. It is not meant to diagnose your child or confirm occurrences of one of the following sleep disturbances. If you suspect that your child is experiencing any of the events we are discussing please talk to your doctor or health professional. I have provided generic information about the situations but none of it is in complete detail. Thank you!
Once your child is in his/her toddler years a new set of sleep disturbances can begin. Nightmares, night terrors, confusional arousals and sleep walking are occurrences that are often asked about. It is important to be able to know which of the following your child is experiencing. Once you can identify some characteristics about what your child is going through you can discuss this with your doctor.
Nightmares – Nightmares occur in all individuals throughout their lifespan and is a part of normal development. Even as adults we will have a dream that frightens us therefore it can be classified as a nightmare. Typically nightmares begin and peak between the ages of 2 & 5 when children are beginning to develop intense imaginations. These imaginary situations and play that they come up with are often hard for them to differentiate from real life. Children may have a higher chance of having nightmares following difficult events in their life where they are experiencing change or stress, following a trauma that has happened to them or even something they may have seen such as a house fire, if they are overtired or if they have been thrown off their routine due to illness, vacation, etc. Sometimes nightmares happen for no apparent reason as well and so they really are hard to find the root cause.
Nightmares occur during REM (rapid eye movement) sleep which is also known as light sleep or “dream” sleep. This is an active phase of sleep where the brain is quite busy which is why it is the stage of sleep where dreams occur. A nightmare is more often going to happen at the end of a sleep period during the early morning hours where more REM sleep is occurring. One important aspect of REM sleep is that the body is in a state of paralysis which means there is no physical movement. This means that there will be no movements, walking, sitting up, etc like there is during non-REM sleep.
When a child wakes from a nightmare they will feel afraid and anxious but will recognize their parents when they enter the room and the child will seek comfort in them. A child will be able to recall the dream after it occurs. This is a major factor that makes it different from a night terror. It may also take the child a little while before they can get that scary thought out of her head and this can make it difficult for them to fall back asleep. One major factor that makes nightmares distinguishable from night terrors and confusional arousals is that the child will call for you following the nightmare… not during! When you go in the event will already be over and they will be afraid and possibly wanting to tell you about it or be comforted.
Since there is no exact cause of a nightmare they unfortunately cannot be prevented. They will happen time to time and so instead we want to try and minimize them and work with them appropriately when they do occur.
Tips on how to minimize nightmares:
Avoid scary videos, books, games, and stories prior to bed or throughout the day if you notice the subject of the dream is linked to something specific. Children pick up a lot more than we realize. They may hear you talking about a family’s house burning down or about a car crash and this can be enough to spark worry. Always keep your radar on about what they may be seeing or hearing that may cause any fears or anxieties.
Use that awesome imagination to create stories or build a “dream agenda” for what they want to dream about. During the bedtime routine you can get them to tell you what they do want to dream about such as “Tonight I will dream about going swimming” or “Tonight I will dream about playing at the park.
If your child is scared of monsters create a “monster scaring spray” that scares off all monsters and spray it before you tuck your child in. If you are working on teaching your child that monsters are not real and that those are just bad thoughts then you can make a “bad thought spray” as well.
Allow a pet to sleep in the room. This allows for a sleep partner. This can also be accomplished by using a lovey to sleep with such as a favorite teddy bear or soft toy. They are sleeping partners that are safe together.
Tips to use when a nightmare occurs:
Respond to your child quickly and tell them that they are o.k.
Stay in the room with them for a while if they need it by sitting beside their bed until they are able to calm down and fall back asleep.
“Chase away” the bad dream before you leave the room if your child is still awake. Tell them you are taking the bad dream with you and putting it in the garbage. You can come back a few seconds later and ask them if they feel better now that the bad dream is gone just to reinforce a better sleep.
Hold your child, hug them, pick them up, etc. to help them calm down before lying them back down.
** Dreams appear to be every real when children wake up from them. Respond as needed to help your child return back to sleep feeling safe and secure.
Partial-Arousal Parasomnia Disorders
Nightmares differ than other common night disturbances known as parasomnias or behaviors that occur during sleep. Night terrors, confusional arousals, and sleep walking all fit into these categories and are similar to each other except for the severity. These disturbances occur during a mixed state when the child is both awake and in a deepened (non-REM) sleep. The child will be awake enough to display frantic and complex behaviors but asleep enough that they will not recall these events when they wake up. They are essentially stuck between being awake and being asleep. In a non-REM state of sleep your body is able to physically move around which is why you may notice large motor movements, walking, running, or other erratic behavior.
With nightmares your child will call out for you following the episode when they wake up but with partial arousal parasomnias your child will call out or be displaying the behaviors while they are in the middle of the confused state. They will most often not be comforted by your presence or even be aware that you are there.
Features that differentiate these experiences to nightmares is that they typically happen at the beginning of the night and often around similar times, children do not remember the experiences like they do after having a nightmare, they fall back asleep quite easily following the episode and it is best to leave the child when they are experiencing an episode by staying close by not having a lot of physical contact.
Research has been done that has stated that there is a family history involved in partial-arousal parasomnia disorders which suggest strong genetic influences. If you are wondering if your child is experiencing any of the below parasomnias maybe ask your parents if you had them as a child or even if they may have.
Let’s go through these 3 common partial arousal parasomnias starting with sleep walking which is the least severe.
Sleep Walking – Sleep walking is a mild type of partial arousal parasomnia. Sleep walking is often seen in older children but is known to peak between the ages of 4 and 8. Sleep walking episodes can last several minutes and they are often hard to tell apart from drowsy wakefulness. Often you may notice that the child is doing semi-purposeful activities such as they get up to use the washroom but then pee beside the toilet or in another room. One little boy in particular that I know about would get out of bed, turn on the bathroom light, walk into the family room where he would pee on the floor, turn off the bathroom light and then crawl back into bed. Many children get out of bed and wonder around their room but others may sleep walk for longer lengths of time and go to other areas of the house, into the garage, or even outside.
When your child is sleep walking they will often have their eyes open and may even look right at you. It will feel as though they are looking through you and if you asked them to go back to their room they may go or you may be able to guide them back. Often they stay calm or if they do get frantic, upset, or confused they zdo not appear to be terrified like that of sleep terrors. Sometimes children will carry on a conversation with you while sleep walking but most of what they say will be mumbled and it will not make sense.
Typically the biggest concern with sleep walking is safety! Your child will be quite mobile during these states and so it is best to make safety a priority. Installing baby gates by stairs, locking doors, putting alarms on the door if you’re worried about your child going outside, putting away sharp objects or anything they could injure themselves with, etc. They are not fully aware of what they are doing and so it is best to make sure there is no harm in their way.
Confusional Arousals – Confusional arousals are often mistaken for night terrors because they are similar. These are commonly seen in toddlers and early school-aged children but can happen in infants as well. In most cases confusional arousals occur shortly after falling asleep at the beginning of the night but can happen any time during the first third of the night. They are events that tend to happen gradually. The child may begin with crying or calling out to the parents followed by confusion or inconsolable agitation that can last 30 minutes or more or they may not have any agitation at all and will appear to be calm. When you respond to them calling they may try and push you away or resist you trying to console them. In toddlers these events can look similar to the tantrums that they may throw during the day. They may stomp their feet, yell, or even ask for something. If you retrieve the item they want they will just throw it away. During this arousal, like night terrors, sweating and heart rate may be increased but they will not appear to be terrified like in a night terror but instead just angry and tantrum like.
As the arousal comes to an end the child will sometimes yawn, stretch, and lie down in their bed again. They may even like for you to tuck them in. There are cases when the child will wake up a little bit at the end of the episode but it is best if you just put them back to bed versus trying to wake them up fully to talk about it. These are occurring in those deep sleep cycles and so the child will not remember them.
Confusional Arousals may be milder as well where the child sits up in bed with their eyes open but are still sleeping, they may moan or grumble, move around restlessly for several minutes, or sleep talk.
Night Terrors – Night terrors are less common than nightmares and other parasomnias as they occur in roughly 5 percent of children. These terrors are the most extreme and dramatic form of partial-arousal parasomnia disorders. They are more common in boys than girls and typically occur in older children and early adolescents. During adolescents the majority of children will outgrow night terrors.
Like confusional arousals terrors will occur during the first third of the night and more specifically within a couple hours of falling asleep. Night terrors are characterized by an immediate and sudden onset of screaming and extreme agitation that commonly lasts 5 to 15 minutes. There is no gradual buildup of crying but instead often begins with a bloodcurdling scream and your child bolting into a sitting position. They are often paired with thrashing movements, running, or other dangerous activity. When an individual is having a night terror they can show physical signs of distress such as sweating, dilated pupils, increased breathing, increased heart rate and they really will appear to look completely terrified. Following the episode the child may wake briefly and quickly return to sleep.
During night terrors your child will appear to be awake as their eyes will be wide open but they will not recognize you. They may even try and push you away while calling out for you at the same time. It will be very unlikely that you will be able to alert or awaken your child during this state and it is an event that they will not remember.
One of the biggest risk factors of night terrors is being overtired which may be caused by too late bedtimes, not enough night sleep, sleep apnea, stress such as changes in your child’s schedule that reduces sleep, illness & fever, medications or any developmental milestones that may affect sleep. Research has shown that night terrors are not caused by scary or bad “thoughts” like that of nightmares. An interesting fact about night terrors is they will often occur the next night after a poor sleep. For example, if you keep your child up late due to a family function on Tuesday night then it may be on Wednesday that they experience the night terror. It occurs due to lack of sleep and during that deepened sleep state which is why on the following “catch up” night when their body is trying to make up for the lost sleep the night before they experience the terror.