Nightmares and night terrors in children: How to identify the problem, and help kids sleep more peacefully
An evidence-based guide
Â© 2008 - 2017 Gwen Dewar, Ph.D., all rights reserved
Night terrors in children--also known as "sleep terrors"--are sometimes confused with nightmares.
Both cause distress and disrupt sleep, and though terrors are less common than nightmares, they are hardly unusual--particularly among young children.
What's the difference between nightmares and night terrors, and what can be done about these conditions?
Here is an evidence-based overview of each problem, with some tips for coping.
1. Nightmares in children
Nightmares are frightening dreams associated with REM (rapid eye movement) sleep. Because most REM sleep happens later at night, nightmares are more likely to occur after your child has been sleeping for several hours.
How can you tell if your child has frequent nightmares? That's not always easy to tell, especially if your child is too young to articulate his or her anxieties, or has trouble remembering the content of dreams.
But overall, nightmares are very common. Most studies estimate that at least 70% of young children have nightmares at least sometimes, and the incidence of nightmares peaks in later childhood -- around the age of ten years (Gauchat et al 2014).
So it's likely your child will experience nightmares at some point. And when kids experience particularly disturbing or frequent nightmares, it can affect both their sleep and their daytime functioning.
In one study, Dutch children aged 7-9 rated nightmares among their worst fears (Muris et al 2000).
In another, Chinese children who reported frequent nightmares were at higher risk for insomnia (Li et al 2011). These kids also performed a bit worse on IQ tests -- which may reflect fatigue (Lui et al 2012).
What can we do about nightmares?
We need to be aware of common triggers, like stress, anxiety, traumatic events, and medications that interfere with REM sleep (Moore et al 2006). And there are a number of specific, research-based tactics parents can use to help their children cope.
For example, experimental trials on adults suggest that people with chronic nightmares can reduce their nighttime anxieties by using relaxation techniques and talking over the content of their nightmares and fears with a therapist.
This includes "rescripting" the nightmare, or re-imagining it with a safe, happy ending. The approach has reduced the severity and frequency of nightmares (Davis et al 2011). It has also reduced the distress dreamers feel during nightmares (Rhudy et al 2010).
We need more research to determine how effective these methods are for nightmares in children. The studies that do exist are of limited value because the sample sizes are small. But the results suggest that the techniques are helpful for children as well as adults (St-Onge et al 2015; Fernandez et al 2012; Lewis et al 2015).
In one small study, parents read to their children (aged 5-7 years) from a book called Uncle Lightfoot, Flip that Switch: Overcoming fear of the dark (academic version) by Mary Coffman. The families also engaged in the book's activities, which were designed to help children to confront and dispel their anxieties and rescript frightening aspects of their dreams. After a month, 8 out of 9 children showed "clinically significant reductions in anxiety severity" (Lewis et al 2015). An edition of Uncle Lightfoot, Flip That Switch: Overcoming Fear of the Dark (Second Edition) is available for purchase from Amazon.com.
For more evidence-based tips, see my article about reducing nighttime fears in children.
2. Night terrors in children
Like nightmares, night terrors in children are distressing and disruptive. But night terrors differ from nightmares in key respects:
- Night terrors tend to occur earlier in the night, when children spend more time in deep sleep. Sleep terrors are not associated with REM sleep. Instead, they occur when a child is partially aroused from deep sleep--usually 1-2 hours after sleep onset (Moore et al 2006).
- Children may appear highly distressed, and they seem to be awake. The distress is real, but the appearance of waking is an illusion. During a night terror--which may last for 5-10 minutes--your child isn't fully awake. But he will appear terrified, and he may cry, scream, or mumble. His heart might be racing; he may be perspiring. He may also move around or sleep walk. Because he isn't really awake, he will be unaware of your presence or your attempts to soothe him (Moore et al 2006; Moreno 2015).
- Children rarely remember sleep terrors. When kids do remember something about their experiences, they report memories of having to fight or flee from frightening monsters or other threats (Guilleminault et al 2003).
- Kids can hurt themselves. Because they can involve sleepwalking and other forms of movement, night terrors in children can be physically dangerous.
All of this may sound quite exotic if you haven't coped with night terrors before. But the condition is surprisingly common, especially among very young children.
In studies tracking large cohorts of children over time, the age of highest prevalence is around 18 months. More than one third (35-37%) of toddlers this age experience sleep terrors (Nguyen et al 2008; Petit et al 2015).
(Shang et al 2006; Laberge et al 2000; Petit et al 2015, Kim et al 2017).
Children tend to grow out of it, but lots of kids still have night terrors during the primary school years. Studies estimate that between 11-20% of children aged 9-10 years experience night terrors
What causes night terrors in children? We don't really know, but like sleepwalking, sleep terrors have something to do with deep sleep. The normal course of deep sleep seems to go off the rails.
Night terrors may run in the family (Hublin et al 2001; Nguyen et al 2008; Petit et al 2015). And night terrors in children are linked with overtiredness, anxiety, stress, and sleep-disordered breathing (Crisp et al 1990; Petit et al 2006; Guilleminault et al 2003; Kim et al 2017).
Night terrors in children are also linked with television. Kids who have televisions in their bedrooms are more likely to suffer from both night terrors and nightmares (Brockmann et al 2016). In part, this may reflect the fact that children with bedroom televisions get less sleep than other kids. For children prone to night terrors, running a sleep debt can be a trigger.
Coping with night terrors in children
If you suspect your child suffers from night terrors, consult your doctor. It's important to rule out other conditions that could be causing your child’s symptoms--conditions like nocturnal seizures, panic attacks, or post traumatic stress disorder.
In addition, it's important to determine if your child's night terrors are associated with snoring or other forms of sleep-disordered breathing (SDB).
SDB can be dangerous, but it is treatable. And if you treat your child's breathing disorder, you might also reduce or eliminate her sleep terrors. A study tracked kids with both SBD and night terrors. Researchers found that kids who underwent surgery (removal of the tonsils and adenoids) for SBD were free of sleep-disordered breathing symptoms 3-4 months later. They were also free of night terrors (Guilleminault et al 2003).
More recently, experts have developed non-surgical treatments, including orthodontic approaches and myofunctional therapy (Huang and Guilleminault 2017; Villa et al 2017).
Y.-S Huang and Christian Guilleminault (2017) note that "pediatricians and pediatric subspecialists are often unaware of the advances and the remedies available," so when you ask your physician about treatments for SDB, you might bring along a print-out of the abstract of their paper.
And whether or not your child suffers from SDB, there are other important steps you can take to improve night terrors:
- Don't get upset or frustrated with a child who is having a sleep terror. His eyes might be open, and he might be very vocal. But he is asleep and not capable of responding to your questions or commands.
- Avoid late night exercise (Moore et al 2006).
- Make sure your child's sleep environment as safe as possible. Remove heavy and sharp objects from the bedroom.
- If your child is sleep-walking, stay calm and gently guide her back to bed (Moreno 2015).
- If your child's night terrors follow a predictable pattern each night, consider the treatment known as "scheduled awakenings." This treatment involves waking your child up about 30 minutes before you expect him to suffer a night terror episode. Let him go to the bathroom, then return him to bed. In small clinical trials, this treatment had a lasting, beneficial effect on both sleep walking and night terrors in children (e.g., Durand 2002; Frank et al 1997).