Nightmares vs. Night Terrors (Tips for coping with sleep disturbances)

Sleep disturbances are difficult for parents to endure, but happen fairly regularly with toddlers and preschoolers.  I know this both in theory and in practice.  Liam (my two year old) is prone to night terrors, while Riley (my four year old) is no stranger to sleepwalking and nightmares.  Although they have no trouble falling asleep, nighttime can be pretty exciting around here!

On some level, it often boils down to exhaustion. When sickness hits and the kids aren’t sleeping well, or a nap is missed for whatever reason, I can generally count on a few wake-ups.  For this reason alone, I’m a bit of a stickler for the sleep routine.  But genetics also play a role.  Nightmares, night terrors, and sleepwalking can all be imprinted into our DNA.  This doesn’t mean that we can’t prevent them, but it helps to know your own history so that you know what to expect.  I have very vivid memories of two of my frequent childhood nightmares, and Sean still walks in his sleep when under stress or exhausted.

Sleep terrors and nightmares are often confused, so it helps to know some details about each sleep disturbance so that you know how to proceed when one strikes.  I will never forget Liam’s first night terror; it was like watching a scene from a horror movie.  I’ve learned over time what soothes him during these events, but that first one had me overly concerned.

Night Terrors: Night terrors are common in 2-6 year olds.  They generally happen during the early phase of the sleep cycle, usually 1-4 hours after falling asleep.  They are characterized by: screaming, sweating, rapid breathing, and increased heart rate.  Children often have their eyes open during the event, but will be unaware of our presence.  Their pupils may appear larger than normal.  They will appear panicked and be difficult to wake. Night terrors tend to last between 5-30 minutes (although they can last longer.  Liam once endured one for 45 minutes during a cross-country flight) and then your child will return to normal sleep.  Your child will have no recall of the event, and will usually wake up chipper the next morning. Night terrors sometimes include sleep walking, and often include thrashing around the crib/bed.  Although children appear panicked during the event, night terrors are often more traumatizing for the caregiver.  Children usually outgrow night terrors by age 12, although some outgrow them much sooner and some may experience them into their teens.

Nightmares: Nightmares are very scary dreams that occur later in the sleep cycle, during REM sleep, between 4-6am.  Preschoolers are particularly prone to nightmares due to their newfound fears, but they can affect toddlers and older children as well. Young children struggle to distinguish dreams/nightmares from reality, so they often wake up very fearful and afraid to return to sleep.  Children can often recall their nightmares, causing them to process the events during the day as well.  The content of nightmares often relates to developmental stages. Toddlers are likely to have nightmares about separation, preschoolers often have nightmares about monsters and the dark, and older children often have nightmares about death and real danger.  Nightmares are often caused by exhaustion, stress (from physical or emotional events), and major life changes. Some children are prone to recurring nightmares during stressful periods (ex:  moving, divorce, long separations from a parent, sickness in the family, etc.).

Dreams: Some research has actually shown that, although young children do experience nightmares, they often don’t experience/remember pleasant dreams until around age 10.  Dreams occur during REM sleep (between 4-7am) and can be related to real or imagined events.  Dreams often relate to how you feel, what you’re thinking about, and your current worries.

Now that you have some facts, let’s move on to some solutions.  Below are some tips to help your child (and you) cope with night terrors and nightmares:

For Night Terrors:

1. Stick to routine: Whatever the nighttime routine (which hopefully consists of milk, bath, stories, lights out), follow it down to the minute.  It’s easy to say, “just this one time”, but children who are prone to night terrors don’t do well with “just this one time”.  Exhaustion is the main culprit when it comes to night terrors. When Liam skips his nap for some reason, I can count on at least one night terror two hours after he falls asleep.  Sometimes kids skip naps or go down late for their own reasons but as a rule, stick to what works.

2. Avoid waking: The natural inclination of a parent when faced with a screaming, panicked child is to want to wake them up and end it.  It is exceedingly difficult to wake a child from a night terror, and sometimes attempts to do so can actually scare the child.  If your child seems to rouse while you are there, that’s ok, but don’t go to great lengths to wake him.

3. Provide safety: Safety is the biggest concern for a child during a night terror.  If your child is prone to sleep walking during these events and your bedrooms are on a second level, make sure you have a gate at the top of the stairs.  If your child tends to thrash around in the crib, leave the bumper in or be prepared to block your child’s head from hitting the side of the crib.  Keep side rails on the bed, even if you feel your child has otherwise outgrown them.

4. Provide comfort: Turn on a low light to help decrease fears of shadows when your child starts to wake, use a calm, soothing voice and repeat, “Mommy is here to keep you safe”, and rub your child’s back.  Many children do not want to be touched or picked up during these events and will swat at you if you attempt to provide physical comfort.  I have found over time that Liam likes me to pick him up and rock him in his rocking chair.  Sometimes you have to use trial and error to find what works best.

5. Keep your voice low: Don’t ever raise your voice or shake your child during a night terror.  You might think that jolting them awake will end it, but often these tactics prolong the event.

6. Revisit naps: If your preschooler (who no longer naps) is having regular night terrors, it might be time to reintroduce a short daily nap.  Even just 45 minutes of daytime sleep can help curb the exhaustion that causes night terrors.

7. Alert Caregivers: If you won’t be home and have someone else caring for your child, make sure that your caregiver has a detailed list of what to expect and how to soothe your child should an event occur.

For Nightmares:

1. Normalize, don’t trivialize: It’s easy to quip, “monsters aren’t real” at 4am when you just want to go back to sleep.  In fact, they’re not real.  In the mind of a terrified preschooler who just woke from a scary dream, they are very real.  Normalize your child’s fears by saying, “I know you had a scary dream and you’re feeling very upset right now.  It’s hard to get back to sleep after a dream like that.  Let’s get you cozy and think of something happy to dream about next”.  Revisit the nightmare during the day. Help your child understand how fears can sometimes show up in dreams and feel very real.  Share your own childhood fears and how you learned to get yourself back to sleep at night when you had a bad dream.

2. Provide comfort: Extra hugs, kisses, and back rubs can sometimes help a scared child ease back into sleep.  Keep your voice calm and turn on a soft light to help your child see that everything is as it should be.  I know I’ve said it before, but please skip the monster/ghost spray.  We want to teach our children that these things aren’t real, not that they require vanilla spray to leave the room!

3. Open door policy: Don’t ever close the door on a child who is afraid of the dark.  Leave it open at least a crack and keep a hall light on.

4. Follow routine: As with night terrors, the best defense against exhaustion is sticking to a well defined nighttime routine.  Try to avoid nighttime TV that might cause stress.  Preview everything.  And revisit naps if nightmares are happening on a nightly basis and/or interfering with school and other normal activities.  **Always put your child back to sleep in his own bed!

5. Added security: Help your child find a security blanket or toy that helps him feel safe at night.  Liam has three giraffes in his crib (and one with him at all times), but Riley never really attached to a blanket or stuffed animal.  Instead she sleeps with one of my sweatshirts to feel close to me.  Consider hanging family pictures next to the bed for added comfort.

6. Relaxing ritual: The last thing your child hears before bed should be positive.  Even on the worst possible night!  Consider doing a nightly relaxing story, where you tell a calming story and cue your child to take deep breaths (this works wonders for Riley).  Ask your child to think of 3 great things that happened that day.  Cue your child to come up with a positive thought to end the night on. I always ask Riley, “What can you dream about tonight?” before we say “I love you”.

7. Alert Caregivers: If you won’t be home and have someone else caring for your child, make sure that your caregiver has a detailed list of what to expect and how to soothe your child should an event occur.

8. Books: When in doubt, reach for the bookshelf.  “Franklin In The Dark” by Paulette Bourgeois & Brenda Clark and “The Berenstain Bears and the Bad Dream” by Stan and Jan Berenstain are both great resources for coping with fear of the dark and nightmares.  Kids take comfort in knowing that they’re not alone in their fears.

If either night terrors or nightmares are happening more often than not and interfering with your child’s ability to attend school and other activities (and you’ve already exhausted all of these tips), it’s time to consult your pediatrician.

It’s important to remember that night terrors are more frightening for the parent than the child, and that nightmares are very scary for the child.  Do your best to soothe your child and focus on good sleep habits!

How do you handle night wakings?

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About Katie

Katie Hurley is a Child, Adolescent, and Family Psychotherapist and Parenting Expert in Los Angeles, CA. She works in private practice in the South Bay area of Los Angeles, writes for PBS Parents, Washington Post Parents, and the Huffington Post. She is the author of “The Happy Kid Handbook: How to Raise Joyful Children in a Stressful World” (Tarcher/Penguin, 2015) and the forthcoming “No More Mean Girls: The Secret to Raising Strong, Confident, and Compassionate Girls” (Penguin Random House, 2018)

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