Nightmares and Night Terrors

Happy September everyone. I apologize for contributing so infrequently recently. My mother passed away from metastatic breast cancer in June, and as the primary caregiver for my children and her, it has been an epic roller coaster. But as our children constantly remind us, life marches along – and alas, so do sleep challenges!

I’ve had a lot of questions recently about nightmare and night terrors. Knowing how to differentiate between them is essential to figuring out how to tackle them.

Nightmares are common, particularly in children between 2-3 years old when their imaginations are developing but the lines between reality and fantasy are blurred.

·      Occur during REM sleep
·      Child will seek comfort from parent and recognize you
·      Child can recall nightmare, or parts of it
·      It may take time for them to get the frightening thoughts of their mind and fall back asleep
·      Can occur during times of stress or when a child is reliving a traumatic experience, but also normally occur in well-adjusted, happy children every once in a while

What you can do:

·      Avoid playing scary or stressful games
·      Avoid exposing your child to potentially frightening shows, videos, books, and stories (children are far more sensitive than we often think)
·      Make sure room decorations are sleep-friendly and calming
·      During episode, respond quickly and sensitively, calmly reassuring them of their safety
·      Make sure your child is getting enough sleep (11 uninterrupted hours at night, plus a nap, is typical for most young children) as sleep deprivation can increase nightmares
·      Avoid high-dose vitamins prior to bedtime and check with your pediatrician to make sure medications are not interfering with your child’s sleep
·      Don’t lead the witness! If your child learns that night awakenings elicit overly sympathetic reactions from you (“Oh no! Did you have that scary nightmare again?! Oh my poor baby…!”), you may be inadvertently feeding a much larger behavioral pattern.

Night Terrors look (and are) very different from nightmares.

·      Occur during NON-REM sleep, usually within 2 hours of falling asleep
·      Child may scream, appear anxious and/or have a racing heartbeat
·      Child may be inconsolable
·      Child often does not recognize you and may seem frightened by you and/or push you away
·      Episode usually lasts 5-15 minutes
·      Child usually doesn’t remember it (though parents sure do!)

What causes night terrors?

·      Occur more often in boys
·      Child more likely to experience them if either parent had a parasomnia disorder such as sleep walking, sleep talking, or night terrors themselves
·      Commonly triggered by sleep deprivation or a disturbance in the child’s sleep pattern (jetlag, sickness, obstructive sleep apnea, stress)

What you can do:

·      Ensure your child is physically safe during the episode but avoid interfering, which can make things worse
·      Consistently put your child to bed earlier at night
·      Keep your child on a regular sleep schedule
·      Do not discuss the terror with (or in front of) your child
·      If the night terrors are persistent, keep a log to help identify any patterns (occurring at the same time each night or during weeks when bedtime was late)
·      If you find the night terrors are happening at the same time, rouse your child 15 minutes beforehand so that she mumbles or rolls over, every night for 7-10 days.

As upsetting as nightmares and night terrors can be for parents, it’s important to know that they are normal experiences and not necessarily signs of major stress or unhappiness. The calmer and more reassuring you can be in the heat of the moment, the less disruptive the episodes will be for everyone.

Ensuring Good Sleep, Even on the Road!

Here are some tips to make your vacation as smooth as possible, sleep-wise.

Prepare a sleep-friendly environment. Whether you’re staying in a hotel, rental house, or with family, try to create a sleep-friendly environment for your little ones. Bring along unwashed crib sheets (the familiar scent will be soothing), favorite loveys and blankets, sound machine, and night light. If you’re not sure the window shades will be dark enough, pack black trash bags and masking tape or thumbtacks for makeshift blackout shades. The Phil & Teds “Traveller” cot is a great alternative to traditional pack n plays; it is small and light enough to fit inside your suitcase, has no uncomfortable crossbars, and has the added advantage of an optional top in case you’ve got a climber on your hands. (More on that subject in another post!)

Respect your child’s need to sleep – even on vacation. Yes, your child may miss a few naps due to travel and bedtime may be a little later due to older cousins. But try to not abandon your child’s schedule altogether, particularly if you are away for more than a few days. If normal crib naps are not possible, plan to drive during nap times, squeeze in catnaps to take the edge off, and opt out of a late dinner if your little one is showing signs of fatigue. You’ll be glad you made the sacrifice – over-tired children usually don’t make the best travel companions anyhow.

Maintain the rituals. Try to maintain your family’s pre-sleep routine, or at least an abridged version of it. The familiar books, songs, and other positive sleep associations will be especially comforting to them as they adjust to their new environment.

Talk to your children. Even one year olds often understand a lot more than we think. Let your little ones know that you are doing things differently than usual because you are traveling. “Today we are going to take our naps in the car because we have a long drive to grandma’s house. You can rest in your car seat, and we will wake you up as soon as we get there!”

Avoid using the same crutch you just broke. Sure, some sleep regressions may happen during travel. However, if you have recently worked hard to stop nursing your baby to sleep, try rocking her or patting her down instead. It’s less confusing and less intermittent reinforcement, which means ultimately it will be easier to undo.

Nip bad habits in the bud. Let your little ones know that once you are back home, it’s back to business as usual. So if you had a co-sleeping nurse-athon in order to keep her quiet at your in-law’s house, the “open bar” officially closes when she kisses grandma goodbye. It’s much easier (i.e. less crying) to tackle new sleep issues before they are fully engrained.

Enjoy your vacation!