Sleep disturbances and difficulty falling asleep are very common problems in childhood. “Parasomnias” are disorders characterized by abnormal events or behaviors associated with sleep, its specific phases or the transition periods between sleep and wakefulness.
Parasomnias include disorders such as sleepwalking, bruxism, bedwetting, nightmares, and night terrors. Although these last two modifications are often confused, the truth is that the nightmares and night terrors have as many differences as they have similarities.
What are nightmares?
A nightmare is a dream of terrifying content that gives rise to strong feelings of fear or dread. When the child wakes up from a nightmare, he stays in touch with reality and reacts appropriately to the environment. When you wake up, it is common to remember the contents of sleep.
nightmares they occur during the phases of REM sleep, Which occur to a greater extent during the second half of the night. REM sleep is characterized by high brain activity, lack of muscle tone, high respiratory rate, rapid eye movements, and rapid, irregular heartbeat. It is precisely in this phase of sleep that most dreams, including nightmares, occur.
It is one of the most common disorders of childhood and adolescence. According to studies, between 10 and 50% of children aged 3 to 6 suffer from it. Although nightmares usually do not pose a health risk to the child, they can cause some fear of going to bed, especially if they are frequent. In these cases, the sleep pattern may be altered and excessive drowsiness, irritability, anxiety, etc. may appear secondarily.
What are night terrors?
During nighttime horror episodes, it is common for the child to suddenly sit up in bed and start to sleep. scream, moan, stutter or cry with a facial expression of terror. He keeps his eyes open without being really awake and shows signs of anxiety with great autonomic activation (tachycardia, hyperventilation, sweating, etc.). In addition, night terror occurs in the deep phase of sleep, when there is no muscle tone.
The appearance of this sleep disorder in adulthood is not excluded but it is in childhood that they are most frequent. Its onset usually occurs between 4 and 12 years old and is estimated to be between 1% and 6% of children suffer from episodes night terrors.
Why are they happening?
Factors such as emotional stress, traumatic events, anxiety, fatigue, irregular hours sleep, fever or taking certain medications seem to increase the onset of these sleep disorders.
Night terrors are often attributed to stress experienced by the little one during the day; restless sleep increases the likelihood of an episode occurring. Unpleasant dreams are more common when the child is anxious or worried about something and are often based on these worries.
Unlike what happens in nightmares, hereditary factors seem to play a causal role in the presentation of night terrors. About 80% of children who suffer from it have relatives who have also suffered from these sleep disorders. this one the genetic basis is shared with sleepwalking.
Differences between nightmares and night terrors
fundamentally the differences between nightmares and night terrors are as follows:
1. Chances of waking up
Unlike what happens in nightmares, in night terrors, the child usually does not wake up easily despite the efforts of the parents. If he wakes up he is confused and disoriented, does not respond properly to his surroundings and a certain sense of fear invades him. The episode usually lasts 10 to 20 minutes and then you can go back to sleep. The episode is often not remembered when they wake up the next day, and if they do remember anything, it’s usually isolated and blurry fragments.
2. The sound phase
Night terrors, like sleepwalking and unlike nightmares, occur in deep sleep and not during REM phases. They usually emerge during the first third of the night. During deep sleep, muscle tone is weak and the heart rate and respiratory rate decrease.
How to act in the face of these episodes?
If our child suffers from nightmares or night terrors, it is better to act calmly, trying to normalize the situation. If children see their parents alarmed or worried, their anxiety will be greater.
Intense light should also be avoided as it could lead the child to develop a phobia in the dark, associating it with fear. It is not a good idea to talk in detail with the child about what happened because they may become more active and this will prevent them from going back to sleep.
it is recommended stay with the child until they have calmed down enough and you can go back to sleep, but you have to stay in your room and sleep in your own bed. If parents convey to their child that each time they have an episode they will be able to sleep with them, they will reinforce the sleep disorder and encourage inappropriate habits.
Treatment of night terrors
Night terrors cause real panic in the parents, rather than the child himself, who, as we have seen, will not normally remember the episode. In mild cases, parents should remain calm and don’t try to wake your child during the horror episode.
It is advisable to ensure that the child does not fall out of bed or suffer any physical damage during the episode, as he is sleeping soundly and is not aware of what is going on around him.
Usually these sleep disturbances go away over time and they usually don’t need psychological treatmentExcept in cases which, because of their frequency or intensity, constitute a problem for the child and it is necessary to consult a health professional.
Pharmacological treatment is not recommended in minors, because drugs such as benzodiazepines can produce strong side effects and when they stop taking their benefits go away, so they do not solve the problem in any way.
An effective psychological technique in parasomnias such as night terrors and sleepwalking is the programmed awakening technique, Which involves waking the child up before the time when the disorder usually manifests itself. This is done to shorten the sleep cycle and thus prevent the onset of the episode.
Treatment of nightmares
Parents should try to reassure their children after nightmares and try to put them to sleep, trying not to be overly worried or anxious. For older children, ages 7 or 8, you can talk about the nightmare the next night, trying to find out if there is anything worrying you that could be responsible for these terrifying dreams.
If so, it is important promote good sleep hygieneIn other words, regular sleep patterns that help the child know that bedtime is approaching.
It may also be helpful to avoid large dinners and violent or horror programs or movies that stimulate a child’s imagination, as well as to change inappropriate habits or stimuli that may interfere with their rest.
In some severe and frequent cases of nightmares, when they have been around for a long time or occur very often, are very intense and cause significant discomfort, it may be advisable to consult a psychologist.
There are effective techniques that teach the child to cope successfully with dreams that cause anxiety, such as Imagination testing therapy, consisting of rewriting I reinvent the dream so that its content stops generating fear.
- Serra, JC, Sánchez, AI, Miró, I. and Buela-Casal, G. (2004). The child with sleep problems. Pyramid editions: Madrid.
- American Association for Sleep Disorders (1997). International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual (2nd ed.). Rochester: Minnesota.