No more night fright

As Simon was brushing his teeth before bed, a heart-stopping, blood-curdling scream pierced the night. It was coming from the direction of his four-year-old son Mitchell’s bedroom. Simon sprinted off to investigate and found him lying on his bed wild-eyed and screaming. Simon hugged Mitchell tightly, trying to calm him, but Mitchell seemed unaware of what was happening and it only upset him further. Then, as abruptly as it began, the episode was over. Mitchell sighed, rolled over and started snoring softly. The following morning, he woke bright-eyed and bushy-tailed, unaware of the previous night’s ordeal. His dad, on the other hand, had barely closed his eyes.

What Mitchell had experienced was a night terror, a frightening sleep-related phenomenon that affects very young children right up to pre-teens. Night terrors are a type of parasomnia, belonging to the same “family” as sleepwalking and sleep talking, according to Dr Sarah Blunden, Sleep Psychologist and Research Fellow at the University of South Australia. “Most kids will experience one of these at least once in their lives, and 2–5 per cent will have frequent episodes,” she says.

When young children have a night terror, they scream, cry and shout. They’re also likely to be breathing rapidly and have an elevated heart rate. Some can also get out of bed and run around the room, says Dr Margot Davey, Director of Melbourne Children’s Sleep Unit, Monash Medical Centre, Clayton. “Parents often say their child looks like they are possessed, screaming and running around terrified,” she says.

Has your child ever had a temper tantrum when they wake at night, and you can’t seem to settle them? Chances are they were experiencing another related sleep phenomenon called confusional arousal. “It can start with the child moaning and groaning and then build up to the child thrashing, arching their back and yelling — it almost appears like a temper tantrum,” says Dr Davey. “Confusional arousals usually start off slowly and then build in momentum until the child seems inconsolable, then they’ll settle back down again.”

Night terrors or nightmares?

Night terrors and confusional arousal (also called sudden partial wakings) are often mistaken for nightmares, but they are very different. For starters, they both occur at different stages of sleep. Night terrors are related to deep sleep and this typically occurs in the first few hours of sleep. Nightmares are related to dream sleep and this tends to happen in the early hours of the morning, says Sheyne Rowley, Australian Baby Whisperer and author of Sheyne Rowley’s Dream Baby Guide.

“If your child is having a nightmare, they can be comforted and should settle back to sleep,” says Ms Rowley. But if your child is in the middle of a night terror or sudden partial waking, it has been shown that trying to wake the child can prolong the episode, she adds.

Dr Davey agrees, suggesting the best approach is hands off. Night terrors create an adrenalin-fuelled fight-or-flight response in a child, so it’s important not to touch them. If you do try to reach out and comfort or touch your child, you could be putting your own safety at risk. “Parents have been injured when they have tried to intervene. I’ve seen a dad with broken ribs and a mother with a black eye because they tried to restrain their kids during an episode,” she says.

Parents should only get involved if the child is at risk of injuring themselves. “Otherwise it’s hands off, then gently redirect the child back to bed when it’s over,” she says.

Children usually remember fragments of nightmares if not the whole episode, but if your child has had a night terror or sudden partial waking, they’ll remain blissfully ignorant of what has happened — unlike their parents. The first time a child has a night terror can be both confusing and confronting for parents, not knowing what to do or how to help their child, says Ms Rowley.

“It can be comforting for parents to know they are much more upsetting to watch than they are to experience. Your child won’t even remember,” she says.

Safety zone

One of the symptoms of night terrors can be violent thrashing. So parents need to make sure their child’s room is safe and that there are no hard or pointed objects around or near their bed that could injure the child if they fell over them. And if your child sleeps on a bunk bed, make sure they opt for the bottom bunk.

What causes night terrors?

As to why they occur, it seems no one really knows, but it’s believed to be linked to the brain moving between sleep stages. “Children have more deep sleep and ‘deeper’ deep sleep than adults,” explains Dr Davey. “These events occur when children change from deep sleep to another sleep state and the child gets “stuck” so their brain is in two states — half-asleep and half-awake.” This explains why children show characteristics of being both asleep and awake during a night terror. It also accounts for why children have no memory of the event in the morning.

But the good news is children will eventually outgrow them. Night terrors occur during deep sleep — usually between stage three and four of non-rapid-eye-movement sleep, according to Dr Blunden. “As a child reaches puberty, they have less deep sleep. With less deep sleep the incidence of night terrors drops dramatically,” she says. Night terrors can occur in adults, but it is extremely rare, according to Dr Blunden.

Genetic link

It seems there is a strong genetic predisposition towards night terrors, so if you or your spouse suffered from night terrors as a child, chances are your offspring will follow suit. A Canadian study of 390 twins supports the theory that there is a dominant genetic link. The research of Dr Birch Hong Nguyen, from the Sleep Disorders Centre in Montreal’s Sacre–Coeur Hospital, showed that 37 per cent of the twins involved in the study had night terrors, far higher than the known 3-5 per cent population average.

Stressors and illness

Elevated temperatures and fevers, or if your child is coming down with a cold, can also increase the incidence of night terrors. “Night terrors can also worsen if the child is undergoing stressful life events such as moving house or starting school,” says Dr Blunden. “Any number of factors within a child’s life can impact on their stress levels, and can lead to increasing incidence of night terrors.”

Think about what is happening in your child’s life. Is your child having problems at school, have they recently lost a pet or is there a new sibling in the family? If you can pinpoint the stressors in your child’s life and work through them with your child, the incidence of night terrors may begin to wane.

Scheduled awakening

There are some things you can do that may help prevent night terrors. Some experts advocate a technique called scheduled awakening. This involves waking the child 45 minutes before a night terror is likely to occur. Because night terrors tend to happen roughly at around the same time, it’s possible to see a pattern emerging. Parents need to keep a sleep diary for their child, noting when the night terrors occurred over a period of several weeks. Not all experts agree that the technique is beneficial. According to Dr Davey, it has met with limited success. “I haven’t found that technique very useful. The timing of the events isn’t always as regular as you’d like — and, perhaps more importantly, by trying to wake the child you do run the risk of precipitating an attack,” she says.

Getting enough sleep

It’s important to establish and maintain a regular bedtime routine for your child. Insufficient sleep can also be a catalyst for night terrors. “When children are over-tired, their bodies surge with hormones and adrenalin to sustain them — and it makes it difficult for them to drop down into deep prolonged sleep patterns, creating frequent wakings in 40-minute cycles,” says Ms Rowley.

Don’t over-stimulate your children in the afternoon. Active mornings and calm afternoons are best, according to Ms Rowley. “The problem is everybody wants to do the opposite. They want to wear their children out late afternoon so they sleep really well, but it can make the child over-tired and they won’t sleep as soundly,” she says.

Nutrition is also important. “Make sure your child is eating the right balance of foods during the day. Too much sugar or carbohydrate-based food creates too much fuel in their systems and it makes it difficult for their bodies to wind down and drop off into a good deep sleep,” says Ms Rowley.

How much sleep should your child get?

According to the American National Sleep Foundation, there is no magic number. Certain age groups need more than others and some individuals will also need more or less shut-eye than someone of the same age group. Experts estimate that preschoolers (three- to five-year-olds) need 11–13 hours of sleep, while school-aged children up to age 12 need about 10–11 hours of sleep.

The American National Sleep Foundation Guide encourages the following: newborns (1–2 months) 10.5–18 hours; infants (3–11 months) 9–12 hours during the night and 30-minute to two-hour naps 1–4 times a day; toddlers (1–3 years) 12–14 hours; preschoolers (3–5 years) 11–13 hours; school-aged (5–12 years) 10–11 hours; teens (11–17 years) 8.5–9.5 hours; adults 7–9 hours.

Monsters and dragons

Seven-year-old Georgia is convinced there’s a giant brown bear that gobbles up young children living in her wardrobe. She started having nightmares about it after watching an animated cartoon about a bad-tempered bear. Like most kids who have nightmares, Georgia usually wakes up alert, orientated and very frightened.

So what causes childhood nightmares? Turn on the television these days and you are likely to see a plethora of violent and frightening images on TV news broadcasts, movies and television programs. These are blamed, but it’s often innocent cartoons that are the culprits, according to Ms Rowley.

“Parents let their child watch animated movies and cartoons because they believe they’re harmless, but some can give a child nightmares,” she says. “Very young children are egocentric, so when they see something happen on a cartoon they think it will happen to them. Sadly, a common formula in most animation involves abandonment or rejection, the loss of a parent or getting lost or being alone,” she says.

When your child wakes from a nightmare, help them settle back to sleep and then discuss the nightmare with them the next day. It can help the child to draw or write down what happened. “Parents need to work with the child to explore if there is a recurrent theme and help the child to rationalise and understand their fears,” says Ms Rowley.

Taking a walk on the wild side

Ten-year-old Taylah loves setting the table for dinner. The problem is she usually does it in the middle of the night while she is asleep. Taylah is not alone. According to Dr Davey, sleepwalking occurs at least once in 15–45 per cent of healthy children and around 3–5 per cent will have regular monthly episodes.

“When kids sleepwalk, the younger ones tend to gravitate towards a parent or a light source,” says Dr Davey. Older children, on the other hand, usually have their own agendas; some will get clothes out of the cupboard and try to dress themselves, rearrange furniture or, just like Taylah, set the table for dinner. A not-so-surprising fact is that nearly half the children who experience night terrors will also sleepwalk, says Dr Davey.

Bedtime dilemmas

Imagine sitting at the breakfast table and having all your family members animatedly discuss at length your wild night of antics. But you don’t remember any of it. It’s no wonder young children can become anxious and upset at hearing about their actions and behaviour while having a night terror or sleepwalking. If your child has night terrors, it’s important not to make a big deal of it, according to Dr Blunden.

“If parents and siblings overplay it, children can get anxious about going to bed. This delays the onset of sleep and so increases sleep deprivation. So you end up with a vicious cycle of insufficient sleep and more frequent events,” she says.

“Be honest about what happened, but there’s no need to go into detail and, most importantly, reassure your child that it’s normal — many children have night terrors.”

When to seek help

If your child’s nocturnal activities are affecting your child and your family, it’s a good idea to chat with your doctor. A medical check can also rule out any other concerns that could aggravate the problem. Snoring, epilepsy or obstructive sleep apnoea (a blockage of the airway when the child sleeps) can all lead to disruptive sleep and low oxygen. This interferes with the quality of sleep, which in turn can create more sleep disturbance. “Correct the underlying problem and the night terrors may disappear,” says Dr Blunden.

Sleep phases

  • Sleep is divided into two states that are very different from each other. These are called non-rapid eye movement (NREM) and rapid eye movement (REM).
  • Rapid eye movement is often known as dream sleep and in children this usually occurs in the second half of the night, which is when they are more likely to experience nightmares.
  • Non-rapid eye movement (NREM) is further divided into another four stages: NREM stages 1 & 2 are light sleep, and NREM stages 3 & 4 are deep sleep.
  • In children, this NREM deep sleep occurs during the first third of the night and this is when they are more likely to have a night terror, confusional arousal or sleep walk.

Courtesy Dr Margot Davey Director Melbourne Children’s Sleep Unit, Monash Medical Centre Clayton

Carrol Baker

Carrol Baker

Carrol Baker is an award-winning freelance journalist who is a passionate advocate of natural health and wellness. She writes for lifestyle and healthy-living magazines across Australia and internationally.

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