Kids and Nightmares
Dear Dr. Lanny: It seems like my daughter just began sleeping through the night and she started getting nightmares. She’s 3. She screams and yells and sometimes wakes up upset. I, selfishly, would like to be sound asleep at 2 a.m. myself, but lately that doesn’t seem possible. Is there anything I can do?
A: So you want to have a peaceful night’s sleep, do you? You should have thought of that before deciding to have a kid. Children and restful parental sleep are incompatible concepts. But don’t worry. Before you know it, your waking-in-the-middle-of-the-night baby will be an adolescent, and then you’ll look back on these as the good old days.
Sleep disturbances are many and varied, but for practical purposes there are only a few common problems: nightmares, night terrors and sleepwalking. These collectively are called parasomnias. They are almost always temporary and not serious.
Your description may represent either nightmares or night terrors. Nightmares are familiar to everyone and represent a problem that occurs during REM (rapid eye movement) sleep. I am not going to go into greater discussion about sleep stages other than to note that sleep usually alternates between REM sleep, when we tend to dream, and non-REM sleep. A normal night’s sleep includes both these stages. Nightmares generally occur in the middle of the night or the early morning hours when REM sleep is more common. When your child awakens from a nightmare, she can describe what it was about: “There was a shark like the one in Finding Nemo, but it had two heads, claws and horns, and it was after me.”
Nightmares tend to occur in toddlers and may relate to a time of active imaginations and developing fears. Although an exact cause is unclear, stress, anxiety, frightening and inappropriate movies or television programs may contribute, as may irregular sleep schedules. No treatment, other than a parent’s TLC is usually necessary, unless a specific event (for example, a house fire or domestic violence) is involved.
Night terrors occur during non-REM sleep, earlier in the night, typically, than nightmares. Night terrors also are more disruptive to the household. A parent may be watching television or have gone to sleep only to be awakened by a screaming and incoherent child. Your daughter may be sitting up in bed with her eyes open, but she will not respond to her name or your touch, and presents a frightening picture. After a while she may fall back to sleep, or she may become fully conscious. In either case, she is unlikely to have any memory of what happened.
Even though night terrors can be very upsetting to a parent, they are essentially harmless and will clear up without need for diagnostic tests or medications.
Sleepwalking represents the last and perhaps the oddest of the parasomnias. Sleepwalking occurs in non-REM sleep and usually affects older children. A sleepwalker’s eyes may be open, but they are unfocused looking. The sleepwalker may respond to questions or instructions, but often with nonsensical answers. If a sleepwalker wakes up, he may be disoriented or confused. As with the case of night terrors, a sleepwalker will have no memory of the event in the morning. Sleepwalking is not dangerous unless the child trips over something or leaves the house. If you have a sleepwalker, it’s a good idea to keep the usual walkways in the house free of unfamiliar objects and to use high latches or other door securing techniques.
Sleepwalking may relate to anxiety, stress, poor bedtime patterns, or certain medications. If your child is a sleepwalker, consider talking the matter over with her doctor. As with the other parasomnias, the outlook for sleepwalkers is generally very good.
So, returning to your 3-year-old. Provide a loving home, a comfortable and safe place to sleep—undisturbed by outside noises—and give her a regular and calming bedtime routine, which of course includes a book before lights out. That’s all you should do, and in 15 to 20 years she’ll be out of the house and you can get a restful night’s sleep.
Meanwhile, I can recommend three wonderful children’s books for everyone, but particularly for those with fears of nighttime, or daytime, monsters:
There’s a Nightmare in My Closet, by author/illustrator: Mercer Mayer
Clyde Monster, by author Robert Crowe and illustrator Kay Chorao
Harry and the Terrible Whatzit, by author/illustrator Dick Gackenbach
My kids are grown and I’m not up to date on new and undoubtedly wonderful stories. If you have recommendations, please send them along.
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.