Have you ever experienced a situation where a 12-month-old child starts crying in their crib an hour after being put to bed, twisting and turning as if trying to find a comfortable position? Or when a 6-year-old suddenly gets out of bed and starts walking around the room? Or even when a 17-year-old adolescent begins running around the room, throwing things, and possibly even harming themselves? All these scenarios involve a sleep disorder known as parasomnia. This article focuses on primary parasomnias, sleep disorders directly related to the sleep state, including night terrors, confusional arousals, and bad dreams (nightmares). Each sleep disorder has its own characteristics, and it’s important for us as parents to recognize them and adjust our responses accordingly.
Sleep Disorders During the NREM Phase
These disorders usually occur in the first few hours after falling asleep, during the transition from deep sleep to lighter sleep. In this phase, a child may briefly wake up, open their eyes, move around, turn over, or adjust their blanket, and then fall back asleep without any issues. However, sometimes the process is not as smooth.
Night Terrors
Night terrors are characterized by intense screaming, wide-open eyes, anxiety, and fear. There may also be sweating and rapid heartbeat. The child is inconsolable and looks as if they are possessed. Night terrors typically occur between the ages of 2 and 12. They can be triggered by disruptions in the usual sleep routine, such as a trip, daycare, or illness accompanied by a high fever. The child has no memory of the event the next morning. The best solution is ensuring enough sleep and possibly moving bedtime 30 minutes earlier.
Confusional Arousals
These are brief awakenings during the night, lasting from 5 to 15 minutes or longer, during which parents may not be able to fully wake the child. Although the awakenings are intense, the child quickly returns to sleep on their own. Confusional arousals are typical for children up to 5-6 years old and are related to brain development, confirming normal maturation of brain functions. In milder cases, children may mumble or speak incoherently, or even sit up in bed. In more intense cases, the child may walk or run around the house and may not recognize their parents if encountered. Confusional arousals are a milder form of night terrors. Attempting to wake the child can worsen the situation, prolonging the episode and potentially turning it into a night terror.
Sleepwalking
Sleepwalking usually occurs in children aged 6 to 16 and can happen 3 to 12 times a year. Research shows that stress or personality type doesn’t play a role in sleepwalking. It often results from an irregular sleep schedule, extreme tiredness, or illness accompanied by high fever. There may also be a genetic factor involved. Sleepwalking manifests as getting out of bed and walking around the room or house two to three hours after falling asleep. The child appears distressed and does not respond if asked questions. Sleepwalking may involve opening doors, windows, dressing, or eating. The only way to manage sleepwalking is to ensure a safe environment for the child, such as closing windows, removing toys from the floor, and arranging furniture to minimize risk. It’s important not to try to wake the sleepwalker, as they will wake up on their own without any memory of the event.
| Behavior | Age | What to Do | General Suggestions |
|---|
| Confusional Awakening | 6 months – 6 years | Observe the child, ensure they don’t harm themselves, let the episode pass, gently guide them back to bed (if calm), don’t ask about the awakening in the morning | Ensure sufficient sleep, provide daytime naps, maintain a regular routine, avoid TV and devices before bedtime |
| Quiet Sleepwalking | Undefined (since child can walk) | Speak softly and calmly, gently guide them back to bed, avoid commenting on or reminding them of the event in the morning | Ensure adequate sleep, maintain a normal routine, create a safe environment, close windows and doors |
| Agitated Sleepwalking | From 6 years to adolescence | Keep a distance, ensure the child doesn’t harm themselves or others | Same approach as with quiet sleepwalking, consider consulting a psychologist if the situation is too dangerous |
| Night Terror | 10-11 years to adolescence | Don’t try to wake them, wait for the episode to pass, avoid conversation that might fully awaken them, intervene only if they may harm themselves | Same approach as with sleepwalking, ensure a safe environment, close windows and doors, arrange the child’s room safely |
Sleep Disorders During the REM Phase
The most common sleep disorder during the REM phase is bad dreams, also known as nightmares. Nightmares typically occur in the early morning hours or during the last part of the night, often accompanied by crying. The child can be comforted and awakened from a nightmare. After waking up, they are usually distressed and uneasy. Children as young as three years old can remember having a bad dream and can often describe it.
Nightmares
Nightmares may involve scenarios like drowning, a scary lion, or other distressing events. They occur in the REM phase, where dreams take place, starting around age two. By about five years old, a child can understand that it was just a dream. Before that, they may confuse dreams with reality; for example, a three-year-old who dreams of being stung by a bee might still believe they hear it buzzing even after waking up. A seven-year-old can wake up from a bad dream and calm themselves back to sleep without assistance.
During a nightmare, the child breathes heavily and loudly. Nightmares are more common when the child sleeps on their back. Parents can wake and comfort the child from a nightmare. Recent studies suggest that nightmares are not necessarily linked to specific emotional or personality issues, but anxiety or psychological problems can trigger them. All dreams reflect emotional conflicts from the child’s life. Nightmares can be triggered by illness or even seemingly without reason, such as when a child transitions to a different room, starts daycare, or is hospitalized. Between ages 7 and 11, nightmares become less frequent. However, during puberty and adolescence, bad dreams may reappear as children face new emotional, sexual, and cognitive changes.
Key Differences: Nightmares vs. Night Terrors
| Aspect | Nightmares | Night Terrors |
| Description | Frightening dreams occurring in REM sleep, followed by full awakening. | Partial awakening from deep NREM sleep. |
| Awareness | The child is aware after waking and may cry for help. | The child appears distressed during the episode but is calm upon fully waking. |
| Timing | Occur in the second half of the night. | Typically occur 1-4 hours after falling asleep during the deepest sleep. |
| Behavior | Fully awake, crying, frightened, may recall the dream. | Not fully conscious, may scream, cry, mumble, or move about, but does not respond to others. |
How to Handle Bad Dreams and Night Terrors
If your child has bad dreams, try to comfort and reassure them. You can wake and console them if they are crying. However, if your child experiences night terrors or confusional arousals, do not wake or shake them. Instead, ensure their safety, and avoid mentioning the event the next morning.
For any of the sleep disorders mentioned above, it’s important to maintain good sleep hygiene, a consistent sleep schedule, and proper nutrition. Also, avoid excessive TV watching, overtiredness, and overstimulation before bedtime.
FAQs
Why do confusional arousals occur more frequently in children than in adults?
Children experience a much deeper fourth stage of sleep compared to adults, so transitioning from this deep sleep to lighter sleep can lead to confusional arousals.
What factors contribute to the occurrence of confusional arousals?
Developmental factors, extreme tiredness, high stimulation, inconsistent sleep, disrupted sleep-wake cycles, sleep disorders, illness, medications, and inherent biological factors.
What are general recommendations for managing confusional arousals?
Ensure adequate sleep, maintain a regular daily routine, eliminate disruptive nighttime activities, set appropriate limits, and create a calm, safe sleep environment for the child. Secondary options include relaxation exercises, psychological counseling, or medication if necessary.