Thursday, September 4, 2014

The Terrible Night Terrors

Just getting through a normal night of sleep is a challenge when you have kids doing the normal kid things.  I first wrote 10 tips for good-normal sleep (click here), but every now and again you get a child who is stuck in a rut.  In our sleep-depriaved state it can be hard to take a moment to step back and strategize a solution.

One of the most common sleep problems is Nightmares.  About a quarter to a third of children between ages 5 and 12 are affected by nightmares (reference). A less common but more dramatic problem are Night Terrors.

There is no general consensus in the field about why we have dreams, but the brain continues to process while we are sleeping.   Neither frequent nightmares nor night terrors are a sign of some psychopathological problem with a child.  But that doesn't mean they aren't extremely unpleasant and something parents want to help do away with.

The first thing is to differential between Night Terrors and Nightmares. They are two different events, occur at different points in the sleep cycle, and should be handled differently.

Nightmares occur at any of the 4 stages of the sleep cycle.  The first two stages (sleep onset and light sleep) are characterized with rapid eye moment (REM), increased brain activity, and suppressed voluntary motor activity.  If someone wakes up during REM sleep *he* is very likely (80%)  to report having been dreaming.  Only 40% of people report having been dreaming when they wake up during non REM sleep (deep sleep - stage 3 & 4).

When a children have a nightmare, they will often call you after the dream has occurred.  They can describe the dream, they express their fears, they are awake and can generally tell you that they are scared.   If your child has nightmares, no fear, just click here and the link will take you to an earlier post all about nightmares and what to do.  

Night terrors are different. They are episodes of "extreme terror and panic that usually occur early in the sleep period" (reference).  The child will scream (often emitting a terrifying scream), seem confused,  his heart will be racing and he may even be combative.  These episodes occur in deep sleep and the child is very hard to awake even though he may have his eyes open.  If he does awaken he will be disoriented and confused.  

Night terror occur less frequently, in only about 1 - 4% of the population, and are most common in children between 4 and 12 years of age.  Before you start worrying that your child is 'weird' recognize that nearly 90% of all kids suffer from some parasomnia (includes nightmares, night terrors and lots of other sleep issues) at some point between ages 2.5 and 6 years of age.  Night terrors may have a genetic link and they may be triggered by things like anxiety, fever, or being overtired.

If your child suffer from night terrors there are some things that you can do to protect them and maybe even get the terrors to stop.

First of all, realize that your child is not aware of the terrors.  He will not remember the episode and he will not be able to explain it to you.  That is good!  For those of us with a child who suffered a night terror - the fact that the child doesn't remember it is a great consolation.  Therefore, do not talk to your child about the subject of their terrors.  In the morning, you can let him know he had a night terror, but otherwise talking about will only cause anxiety as he falls asleep.

Secondly, keep him (and you) safe during the night terror.  Do not try to man-handle your child too much unless you deem if safe.  Gently guide him and be quick to duck if he becomes combative.  If you are a heavy sleeper or sleep far away from your child you may want to put a wind chime or bell of some sort on the child's door so that you are awakened if he gets out of bed.  Often the children are screaming so loudly that everyone in the house is already awake!

Reassure him verbally.  Don't argue with him but reassure him that he is safe, nothing can get him, he is being protected etc.  We say special prayers with him/over him, we ask for extra-angels to come surround us and take away his fear.  I will say a Hail Mary or three as I wrap him in a warm hug. 

Take him to the bathroom if you can. I know it sounds crazy, but sometime physical discomfort can trigger the episode.  You have to talk him through the process and tell him he is in the bathroom etc, but if you can get him to "go", then that may help shorten the episode. I also turn the lights on and talk to him about reality - "You are with me now, you are sitting on the couch with me, I am here to help you, you can wake up whenever you want to…"

Prevent them from happening.  Why didn't I lead with this you ask?  Because you probably wouldn't have read the other tips and it may take you a few days to get your timing down right.  Night terrors seem to happen as the child transitions out of deep sleep and into wakefulness or stage 1 sleep.   So to prevent them from happening, wake-up your child before it happens.  

Yup. That is it.  

If you child usually has them 1-2 hours after falling asleep, then wake him up about 45 minutes after falling asleep.  Just gently rouse him.  

This is a new area of research, but it was recommended to us by our pediatrician and it WORKED!     This past summer, JR started having night terrors - every night for about 2 weeks.  It was horrible.  They occurred at about 10:00 or 10:30 every night…just as we were falling asleep or course. So we began waking him up at 9:45 - BEFORE the episode.We started walking him to the bathroom.  We would wake him up just enough, and he would head right back to bed.  You could go in and mess with his hair, maybe take of the covers and then re-tuck him in… what ever.  Just enough to rouse him a little.   The second night we did this it he did NOT have a night terror.  We did this for about a week and have been free of the night terrors since!

There has been some great success reported in the lay literature (that means among us regular parents), but little research on this approach.  That is part of what made it so exciting to write about.  Sleep labs across the country are currently testing out this method so you should too!  Many thanks for Becky Purinton, CPNP, AE-C for her advice in handling JR's night terrors.  

For more on general sleep recommendations and nap info click here.  
For more on general sleep problems click here.

Thanks for stopping by and good night!

Rather than using "s/he" or "they" in referring to "the child", I find it much easier to use either the masculine or feminine.  In writing I draw from both research and my experiences as a mother. Sometimes those experiences are with my sons, others concern my daughters, and the use of personal pronouns reflects those experiences.   

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