Nightmares and Night Terrors

Nightmares refer to bad/scary dreams. Nightmares can occur in children of any age and are most likely to happen during the later part of the sleep such as in the early morning. This is when Rapid Eye Movement (REM) or Dream Sleep usually occurs. Nightmares can reflect worries that your child might be having during the day and it might be useful to talk to about this with them. It is not abnormal for the content to involve major threats to the child’s well-being.  Children often wake during or immediately following a nightmare and have a good memory for what occurred. It may be challenging to reassure/comfort them and they be fearful about falling back asleep.  Recurrent nightmares often occur after there has been a trauma and frequent nightmares may indicate emotional difficulties.  For some children the nightmares cause anxiety, are frequent, or interfere with restful sleep.

Night terrors occur when children are partially aroused from deep (Stage 4) sleep. They are not quite awake yet and not completely asleep. Throughout the night terror your child’s “mind” remains asleep, whereas the “body” looks somehow awake and facial expressions are very emotional. A child may scream and appear very frightened, while at the same time not recognize you or respond to your attempts to comfort.  They may try to run away or push away those trying to console.  Usually a child does not remember having the night terror the next morning. Night terrors are more likely to occur during stress, illness, and sleep deprivation and typically occur between the ages of 4 to 12.  Children usually outgrow night terrors by adolescence. They are also different to nightmares because they usually take place in the early part of the night, usually one or two hours after the child falls asleep. Like nightmares, there are usually no long-term psychological effects.

If your child experiences nightmares or night terrors, you may want to seek help if:

When to seek help:

  • If your child is afraid to fall asleep because of fear of having bad dream
  • If nightmares or night terrors are frequent, severe, disruptive, dangerous, happen at an unusual age or seem to affect your child’s performance during the day by causing sleepiness.

It is important to rule out an underlying medical disorder related to sleep such as sleep apnoea (snoring, stopping breathing and working hard to breathe), heartburn, epilepsy (very stereotyped and repetitive features) and periodic limb movements (the child complains about pains in the limbs and seems to be restless in sleep). These can cause a partial arousal, which might lead to a night terror. Treating the underlying cause often “cures” the night terrors. Most recently hypnotherapy has been shown to be effective. In rare instances, medication might be needed, especially if the events are extremely distressing for all, frequent or seem to impact negatively on the child’s daytime behavior and performance.