Nightmares, Night Terrors, or Nighttime Tantrums: What’s the Difference?

Dear Parents,

Has your child been waking and screaming at night? Are you wondering if your child is having nightmares or night terrors. Or, perhaps your child is having nighttime tantrums? Please check out the article below to find out the difference between the three and what to do.

Nightmares

All children have nightmares at some point, and if children are dreaming they may also have nightmares. Interestingly, even infants dream and according to one landmark study, newborns dream more than any other time in a young person's life. Nightmares are bad dreams and can happen at any point in a child's life, especially if a child has just had a traumatic event or situation. Several different studies have shown that children may have nightmares following surgery, tooth extraction, and motor vehicle accidents. Nightmares can also begin during periods of developmental change such as the period between 18 to 21 months and again right before a child's third and fourth birthdays. These are periods of individuation, when a child may become more sensitive or emotional as they become more independent.

Nightmares occur during REM (Rapid Eye Movement) sleep cycles and typically occur in the final stages of sleep, later in the night. This makes nightmares different from night terrors, which typically occur in the first few hours of sleep (more below). Nightmares are thought to be most common between the ages of 3 to 5 years old, but can begin as early as the first year of life. They can be an important way that young children express their fears, anxieties, feelings, and their day-to-day experiences. They are typically not a sign of emotional or psychological problems. Some children may become so fearful that they may protest going to sleep or sleeping in their beds at night.

What to do to help your child:

• In the morning, invite your child to draw a picture of what they dreamed about the previous night

• Comfort and reassure your child when they wake at night and try to leave before they are asleep

• Write a sleep book with your child and read at bedtime (e-mail
  me angelique@angeliquemillette.com if you would like a handout for writing a sleep book)

• Leave the hallway light on and the door open at bedtime

• Use a night light in your child’s room

• Be sure to avoid talking about scary thing before bedtime

• Be sure your child doesn't see or hear scary movies or kids shows

• Try to keep stress to a minimum

• Walk your child back to their bed and provide comfort in their bed/room

• Make sure your child is getting enough sleep, try an earlier bedtime

• During the bedtime routine, tell a story about your child being safe and loved

• Don’t use "monster spray" or pretend to get rid of the monsters in your child's room, that just reinforces that there are monsters in their room!

• Play in your child's room during the day

• Provide your child with a snuggly item

• One-on-one time with parents and caregivers helps children self-regulate so add in a little 5-10 min of extra cuddles and pillow talk at bedtime

When to call your child's doctor:

• The nightmares become worse or happen more often

• Your child's fears begin to interfere with day to day activities or their ability to feel relaxed and fall to sleep at bedtime

Night Terrors

Night terrors, also called “confusional arousals,” commonly begin around ages 2 to 4 years old. They are considered normal until age 6 and are seen in approximately 5% of children. There is often a family history of confusional arousals and night terrors, and they are most common in boys. They are often triggered by sleep deprivation or by a sudden change in the child's schedule in the days preceding such as vacations, end of school year, or visiting relatives and do not have a psychological basis. They can also be triggered by fever and illness, and research shows they may be triggered by allergies. They are very different from nightmares in that during a night terror, a child is not dreaming and typically will have no memory of the event afterwards. Once it is over, the child will usually go back to sleep without much problem.

Night terrors occur in the transition period between deep non-REM sleep and a lighter sleep stage, whereby the child becomes stuck and is unable to completely emerge from slow wave sleep. Night terrors typically occur within 2-3 hours of going to sleep. Although night terrors are harmless for children they can be very upsetting for parents who may be concerned that their child may hurt themselves. Your child may jolt awake, thrash their body, scream, or moan but they will be unable to answer you or hear you. Your child's eyes may be open or closed, and your child may look confused and may not recognize you. The duration of a night terror may be 1 to 30 minutes, with an average time of 5 to 10 minutes. During the night terror, you can prevent your child from injury but do not try to wake them. Make soothing comments, stay in proximity but do not shake or shout at your child to attempt to wake them up. Understand that if they hit, kick, thrash, or head butt you, they are not awake and simply stuck in between sleep stages. The night terror will pass and they will fall right back to sleep.

What to do to help your child:

• Stay close (but within a safe distance if they are thrashing or kicking) and do not wake them up (keep them in their room)

• Try for an earlier bedtime especially if dropping their nap or starting a new school program

• Reduce stress in your child's life

• If traveling, stick to your child's schedule and bedtime making sure to reduce sleep deprivation

• Prepare other caregivers (e.g. babysitters, grandparents) for these episodes

• Try a "scheduled awakening":

1. For several nights, observe how many minutes it is from the time your child falls asleep until the start of the night terror

2. Wake your child for a full 5 minutes, 15 minutes before the expected time of the night terror

3. Do this for seven nights in a row to fade night terrors

4. If the night terrors return, you can repeat the scheduled awakening as needed

When to call your child's doctor:

• Terrors lasting longer than 30 minutes

• Your child has stiffening, jerking, or drooling

• Terrors are happening during the second half of the night

• Terrors happen after seven nights and continue

• If family stress may be a factor

Nighttime Tantrums

In my sleep consulting practice, most of the children (not babies) who are struggling with waking and screaming off and on at night are waking from nighttime tantrums. Nighttime tantrums are a behavioral sleep issue and can start at several time points in your child’s development and may continue well into childhood. At the basis of the nighttime tantrum is your child’s difficulty with separating from you at sleep time. Sometimes the trouble with separation starts at bedtime. Other times, your child may be fine separating at bedtime and going to sleep without your presence but may need your presence when waking at night. A few scenarios that I commonly see in my practice that can lead to issues with separation at sleep time and nighttime tantrums:

• Fear of the dark or scary things at bedtime leading to big tantrums, crying, and/or refusal to sleep. You stay with your child to help them to sleep and now they begin to insist you stay with them at bedtime and begin to wake up at night screaming for you. Rinse and repeat this cycle of waking/screaming through the night, needing your presence to get back to sleep.

• Your child recently transitioned out of the crib and is now getting out of bed at bedtime or during the night. To help them to stay in bed, you stay with them at bedtime. Or you stay with them if they get out of bed at night. Your child begins to wake more at night, now screaming and having tantrums and needing your presence to get back to sleep.

What to do to help your child:

• Use my two-phase approach for toddlers to help your child feel safe to separate from you at bedtime/night. Phase 1, you will implement play and language based activities to do with your child to get them ready to separate from you. Phase 2 is a parent presence fading method called the Chair/Mattress Method.

• Notice if their nap time is keeping them more awake at bedtime

• Notice if new potty learning is waking them at night/early morning

• Notice if a full diaper/pull up is waking them at night—>ready to start potty learning

• Notice if your child suddenly develops separation anxiety at bedtime and/or during the night. This can be caused by any number of variables including recent weaning, developmental changes, new baby in the family, or a recent move to a new home to name a few. Giving your child a few weeks to adjust to the changes can reduce their separation anxiety and then make it easier for them to feel safe to separate from you at sleep time.

Are you still having issues with unexplained night time waking in your young child? Is your child screaming in the middle of the night and not sure why? Please contact me Dr. Millette to schedule a free 15-20 min informational intake call to find out about how my two-phase sleep method that solves this issue.