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.

Dressed for the Occasion

Does your little one leak through his diapers? Like to strip down before falling asleep? Wake up whenever you cover him? If so, here are some practical tips to avoid these common sleep interruptions.

Leaky diapers. There are a number of simple solutions for a baby or toddler struggling with leaky nighttime diapers.

·      Use diapers one size larger than his regular, daytime diapers. We use Bambo diapers for day and night, but use one size up at night.
·      Or try an extra absorbent nighttime diaper. Huggies overnites are another highly absorbent option.
·      If you find yourself without a nighttime diaper, consider placing a maxi pad inside his regular one or doubling up.

Disrobing. Yes, you will certainly look back at these moments and laugh. But, when your toddler decides to strip as part of his falling asleep routine, it can wreak havoc on his (and your!) nights. My advice is to head him off at the pass.

·      A strip of electrical tape, strategically placed across the top of his diaper (covering both tabs), can work wonders for keeping a diaper intact.
·      Try placing his zippered pajamas on backwards (zipper up the back).

Blanket Replacing. Summer is around the corner, but on the Cape and Islands, evenings are almost always cool. If you are losing sleep wondering if your baby has rolled out from under his blanket again or he wakes every time you cover him, it’s time to try a new approach.

·      Layer up with two sets of pajamas or a onesy underneath his pajamas.
·      Use a sleep sack over his regular pajamas. It will keep his body and toes warm without impeding his movement. And it has the added benefit of preventing a would-be crib climber from making his escape (at least until he figures out how to work the zipper!). There are many on the market, but my children use this one in the summer and this one for the rest of the year.

The Early Bird Doesn't Catch the Worm

If your adorable little alarm clock wakes up at 6:15am refreshed and ready for action – though it may feel like the middle of the night to us parents – you may have to just go with the flow. 6-7am is a biologically appropriate time for babies to wake. However, if she is groggy, falling apart by 7am, or consistently waking before 6am, you’ll want to tackle the early rising once and for all.

Here’s a look at the most common reasons for early rising…

·      Too late of a bedtime. I know this doesn’t seem logical. We tend to think that if our children stay up late, they will crash hard and sleep in the following morning. Alas, this is rarely the case. Depending on their age, most babies and young children naturally want to fall asleep (not start bedtime routine) between 7-8pm. Missing their “sleep window” triggers the release of cortisol, the “fight or flight” hormone, which can make for a harder bedtime, more wakeful night, and early rising.

·      Nap deprivation in general. Babies and young children who are not getting adequate naps on a regular basis tend to wake early in the morning. It’s important to know approximately how many hours of naps your child needs based on their age (understanding that these are averages – some children will need more, others slightly less). For example, a six month old needs approximately 3.5 hours of naps spread out over 2-3 naps, whereas a two year old needs approximately 2 hours of sleep during their afternoon nap. For more information on how much sleep your child needs, click here.

·      Too big of a wakeful window – Too long of a wakeful window prior to bedtime means that your child is going to bed overtired, with cortisol running through their body. This means we need to base bedtime partly on when our baby woke up from their last (or only) nap. For babies under 6 months, the maximum wakeful window is about 2 hours. As babies approach one year, the window extends to about 3 hours. Some well-rested toddlers and preschoolers can handle a 4-hour window, max. It’s important to watch for your child’s sleepy cues and tinker with bedtime to find out what works best for them.

·      Too drowsy at bedtime – Bedtime is the easiest time to get to sleep. If we act as our child’s sleeping pill, getting them to sleep at bedtime by holding, rocking, feeding, or patting them down, then how can we ask them to do it themselves when they stir at 5am, the hardest time of the day to get to sleep?

If none of these ring a bell, take a look at your child’s sleep environment and make sure that there’s nothing external contributing to the early rising. Perhaps the birds chirp in the tree near their bedroom window or the morning light is streaming in through their curtains. White noise or blackout shades can make a big difference during the early morning hours, when babies are feeling relatively well rested after 9-10 hours of sleep.

Wishing you and your little ones many happy mornings together!