Night terrors and other sleep disturbances
nightmares; bad; dreams; sleepwalking; sleep; walking; talking; night; terrors; parasomnias; head; banging; rocking; starts; jerks; muscle; teeth; tooth; grinding; grind; bruxism; sleepwalk; walk;
Contents
Many children have times when their sleep is disturbed because of nightmares, night terrors or sleepwalking. Night terrors may be called sleep terrors, because they can happen during any sleep, such as a daytime nap.
Any sudden change in the pattern of a child's sleep may be triggered by something stressful happening in her life, but these sleep disturbances can happen when there are no new stresses. Children are more likely to have disturbed sleep if other people in the family have also had sleep disturbances.
Nightmares
- Nightmares are frightening dreams which wake children up and leave them feeling upset and scared that something awful has happened or is going to happen.
- Nightmares happen during 'dreaming' sleep, and most dreaming sleep happens towards the end of the night, so children usually wake with nightmares in the second half of the night.
- On waking from a nightmare, a child will know that you are there, and usually be able to tell you what has frightened him if he is old enough to be able to put it into words.
- For more information about nightmares and what to do see our topic Nightmares.
Night terrors
Night terrors happen less often than nightmares, and can sometimes seem like nightmares, but they are different in several ways. Up to 3% of children experience night terrors at some time.
- Night terrors do not happen during dreams. With night terrors, children are unable to remember any bad dream or to tell their parents what is frightening them, and in the morning they will not remember that anything has happened.
- Night terrors usually happen in the early part of the night, often about 1 to 2 hours after the child has gone to sleep.
- It seems that a child almost wakes up, but does not completely wake (a 'partial wakening'). After a nightmare, children fully wake up and cry until you come to them.
- During an episode of night terrors, children can cry, shout or sometimes scream, but do not know that you are there.
- A child may be sitting in bed or be out of bed, with eyes wide open, calling for you, but she does not 'see' you and may push you away if you try to comfort her.
- She is likely to have a rapid heart rate, be breathing fast, and be sweaty, crying, shouting, or even screaming or groaning.
- She may continue to cry or shout for a few minutes, sometimes up to 20 minutes, and rarely, for an hour or longer.
- Then, quite suddenly she will relax, maybe look around briefly and go quickly back to sleep.
- These awakenings often happen for several days in a row, sometimes longer, and then go away for a while. They may come back when the child is unwell, overtired or stressed.
Most parents will have been woken up during the night just as they became deeply asleep. They would have felt terrible, almost ill, if they had to get out of bed - this may be similar to the feelings of night terrors.
What causes night terrors?
- The cause of night terrors is not known, but having night terrors runs in families (it seems to be inherited). Usually there are other people in the family who have had night terrors, or sleepwalking or sleep talking.
- Night terrors usually start happening when a child is around 4 to 7 years old (sometimes younger) and may happen off and on until the child reaches puberty. It is unusual for them to happen in older teenagers or adults.
- Night terrors seem to happen more often when there is a stressful event such as starting school, but often there is no obvious stress in the child's life.
- Sometimes they occur on nights when a child is unwell.
- They often seem to happen when a child is not getting enough sleep.
- Some people have linked night terrors to developmental stages in children's lives, such as toilet training, but many others do not think these are linked.
- Having night terrors is not linked to having psychological problems later in life. They seem to be a temporary 'phase' which children grow out of.
What to do about night terrors
Even though he may not let you comfort him, you need to go to your child, make sure that he is safe, and stay with him until he can relax back into sleep.
- Talking gently and touching or cuddling him may help him become calm, but if this causes him to be more distressed, just sit nearby.
- If he is doing something unsafe, such as climbing onto furniture, you do need to stop him, even if he fights you.
- You do not have to make him wake up, or shout at him. Trying to wake a child may make him more agitated. Just let him go back to sleep when he calms down.
- Don't talk with him about the night terrors the next day. He will not remember then, but may be very embarrassed and worried about them.
- Some people have suggested trying planned waking for about a week.
- Since the night terrors tend to start around the same time each night, go to him about 10 to 15 minutes before then.
- Rouse him a little so that he is almost awake, talk to him, perhaps take him to the toilet or give him a small drink of water.
- After about 5 minutes, let him go back to sleep.
- This might change his sleep pattern enough so that he does not have the partial wakening later in the night.
- Think about what is happening in his life and see if there is anything that might be stressful and could be changed. This may not have an effect, but it is worth thinking about.
- If your child is not getting enough sleep, try to get him into a better sleep routine. Our topic Sleep - 6 months to 3 years has ideas about how to do this.
- Work out how to take care of yourself. It is very distressing being woken by a child whom you cannot comfort.
- Remember that night terrors are much more upsetting to watch than they are to experience. Children do not have any memory of what has happened, and do not suffer any psychological harm from them.
- Remember also that night terrors are not a sign of mental health problems.
- Talk to other people in your family and see if there is a family pattern.
- Talk to your neighbours about what is happening, so that you do not have to worry about what they may think about your child screaming during the night.
Night terrors usually go away within a week or so, but if they persist, talk to your doctor. It is common for them to come back several times until your child is older.
Sleepwalking
Sleepwalking, like night terrors, seems to be due to a child or adult partially waking up, and it also tends to run in families. Up to 30% of children sleepwalk at least once, though only a small number do it often. It does not happen during a dream and the person does not remember having walked during her sleep. Many children who sleepwalk also have some night terrors.
- Sleep walking usually happens during the first few hours after falling asleep. It may last for a few minutes, or maybe up to 20 minutes.
- A child may sit up in bed, get out of bed and seem as though she wants to go somewhere such as to the toilet or to get something to eat.
- She may move around her room, go to other places in the house or even go outside.
- A younger child may crawl around the cot or bed.
- She may have her eyes open and be mumbling, but not be able to see you, nor understand what you say, nor talk to you.
- She may let you take her back to bed, or to the toilet, then back to bed, without being really awake.
- Young children may then go quickly back to deep sleep, while older children may appear to fully wake up for a moment, then go back to sleep.
- It seems that some children sleepwalk more if they are unwell and have a fever, or get overtired. Sometimes they sleepwalk if they have a full bladder.
- Sleepwalking doesn't mean that your child has emotional or psychological problems unless there is some other stress in the child’s life.
- Most sleepwalking happens when children are between 3 and 7 years old. As they grow older they sleepwalk less, but quite a few adults sleepwalk sometimes.
What to do about sleepwalking
You do not have to wake a sleepwalking child, and it often makes a child quite upset if you do wake him. However nothing bad will happen if he does wake up.
- The most important thing is to make sure your child is safe.
- Do not have bunk beds.
- Lock doors and windows, and put heaters, electric cords and any other dangerous objects out of the way.
- Keep floors clear so there is nothing to trip over.
- If you have stairs, put barriers across them.
- Some parents tie a bell to the child's door to let them know if the child opens the door.
- If you find your child sleepwalking, guide him back to bed.
- Make sure that he is getting enough sleep and has a regular sleep pattern.
- Protect him from being teased, and let him know that sleepwalking is not a sign of any problems or illness. If someone else in the family used to sleep walk, it may help him to know about it.
Sleep talking
Sleep talking is so common that it needs to be thought of as normal. It also it runs in families.
- The usual pattern is that a person (child or adult) is deeply asleep and lying still, then after an hour or so of sleep quite suddenly moves around in the bed restlessly, says some words, and then goes back to deep sleep.
- What is said may be clear, or mumbled and unclear.
- The person may even sit up and appear to look around before going back to sleep.
- Sleep talking occurs during a partial wakening, like night terrors, not during a dream, and the person does not remember talking.
Head banging and rocking
- Head banging by a young child just as he or she is about to fall asleep is common.
- Up to 30% of 12 month old children bang their head.
- It usually starts by about 8 to 9 months, and is rare after 2 years.
- Rocking in bed is even more common, with between 40% and 60% of children rocking rhythmically when they are around 9 months old, decreasing to about 5% to 10% when they are 5 years old.
There are theories that head banging and rocking might be due to not enough stimulation or contact with parents during the day, but it seems likely that something that is this common is 'normal', and for some reason head banging and rocking help little children to relax into sleep. After all, younger babies very often settle into sleep more easily if they are rocked.
- Rocking and head banging that lasts for a short time when a child is falling asleep do not appear to be linked to psychological problems, but if a child is also rocking a lot or head banging while awake, and there are other behaviours that you are concerned about, talk to your doctor about her development.
- Even though the sound of the head banging might be quite loud, it seems that it does not hurt children.
What to do about head banging
There usually does not seem to be any reason to try to stop the behaviour, and trying to stop it is often not successful.
- It has been suggested that gently stroking a child's head while he is going off to sleep may help him relax, but you might find that you are having to do this every time he goes to sleep.
- If the child is being injured (getting bruises) by hitting his head against something hard, you could try making the side of the cot softer - but keep soft toys, cot bumpers and pillows out of the cot. Usually this does not work, and the child will still find a way to bang his head by pushing the soft things away. See our topic Safe sleep for babies and toddlers.
- Move the cot away from the wall if the banging or rocking is making a noise that disturbs others.
- Check and tighten all of the screws and other fastenings on the cot often, because the banging and rocking can loosen them.
Sleep 'starts'
Sleep 'starts' or jerks are sudden, usually single jerks of the arms, legs or whole body at the beginning of sleep. These are very common for children and adults of all ages, and are considered normal. The reason why they happen is not known, although some people think they happen more often when the child or adult is stressed.
Teeth grinding
Some people call teeth grinding at night (bruxism) another sleep disorder. It tends to happen most around the same 'partial wakening' time of the night as night terrors, sleepwalking and sleep talking.
- All people grind their teeth some of the time, especially young children, from the age of about 10 months, who have recently started to have teeth come through.
- Only some people have problems due to teeth grinding.
- In babies, teeth grinding does not cause problems.
- Older children and adults can put very high pressure on their teeth by clenching the jaw. This can cause damage to the teeth, sore cheek muscles and headaches.
- If your child is grinding his teeth, ask your dentist to check and see if some help is needed.
Resources
South Australia
Child and Youth Health - Parent Helpline 1300 364 100
If your child is having very disturbed sleep, an assessment by a specialist in child health could be of use, and maybe a referral to a Sleep Disorders unit.
References
Finn Davis K, Parker KP, Montgomery GL. 'Sleep in infants and young children: part two: common sleep problems,' J Pediatric Health Care 18(3):130-137, 2004.
Mindell JA, Owens JA. 'A clinical guide to pediatric sleep: diagnosis and management of sleep problems,' Lippincott Williams and Wilkins, 2003.
Stores G. 'Practitioner review: assessment and treatment of sleep disorders in children and adolescents,' Journal of Child Psychology and Psychiatry, Vol 37, No 8 pp907-925, 1996.
Written in partnership
Child and Youth Health and Parenting SA
Related Parent Easy Guide (Parenting SA web site) - PDF format
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.