The child screams and cries in a dream: causes and treatment of parasomnia

Quite often, par­ents look for an answer from their acquain­tances or go to the doc­tor with a descrip­tion of a strange sit­u­a­tion: a child who used to sleep nor­mal­ly and wake up for com­plete­ly under­stand­able rea­sons sud­den­ly began to do this with screams, fear, and even breaks out of his hands, it is very dif­fi­cult to calm him down. And in the morn­ing he remem­bers noth­ing at all! Is this a sign of some kind of dis­ease? Why is there a loud cry in the mid­dle of the night, while the baby does not seem to wake up?

This is not at all uncom­mon, and usu­al­ly does not sig­nal any dis­eases (although it can also indi­cate epilep­sy). But you need to know why this hap­pens, how to dis­tin­guish the norm from the pathol­o­gy, and what to do with such ter­ri­ble night attacks.

Parasomnia: what is it?

Sud­den and inap­pro­pri­ate awak­en­ing into the “wrong” sleep cycle can indeed cause such attacks. This is called a spe­cial sleep dis­or­der — para­som­nia.

There are 23 types of dis­or­ders in the para­som­nia group, but four of them are most often detect­ed in chil­dren:

• sleep­walk­ing (what is often called sleep­walk­ing);
• night ter­rors;
• night­mares;
• syn­drome of sleep intox­i­ca­tion or con­fu­sion­al awak­en­ing.

In chil­dren, such dis­or­ders occur on aver­age 10–15 times more often than in adults. The rea­son is that at an ear­ly age, sleep con­trol struc­tures are not yet sta­ble, and there is often a mix­ture of dif­fer­ent sleep cycles and func­tion­al states.

The most strik­ing exam­ple of such a mix­ture is sleep­walk­ing. Dur­ing the phase of non-REM sleep, a behav­ioral pat­tern of awak­en­ing sud­den­ly devel­ops — the child is sleep­ing, but mov­ing, some­times mum­bling.

With night ter­rors, awak­en­ing dis­or­der, the emo­tion­al and veg­e­ta­tive sys­tems are exces­sive­ly active, while the brain is still “sleep­ing”. But with the syn­drome of sleepy intox­i­ca­tion, a dif­fer­ent pic­ture — after wak­ing up, the phase of slow sleep is still active. Then the child (most often raised at night for plant­i­ng on the pot­ty) is dis­ori­ent­ed, may burst into tears, start fight­ing or react very slow­ly to what is hap­pen­ing.

The ten­den­cy to para­som­nia is genet­i­cal­ly trans­mit­ted: accord­ing to research, par­ents with the same child­hood his­to­ry have chil­dren twice as like­ly to suf­fer from awak­en­ing dis­or­ders.

The sit­u­a­tion is aggra­vat­ed by ear­ly age (2–5 years), reg­i­men vio­la­tions, cer­tain med­ica­tions, stress, high fever, lack of sleep and behav­ioral dis­or­ders.

Night terrors or nightmares: what’s the difference?

With night fears, awak­en­ing occurs in the phase of slow sleep, the child cries or screams pierc­ing­ly, and it is clear that he is very fright­ened. And he’s real­ly scared!

As a rule, dur­ing an attack, the baby sits in bed with his eyes open, trem­bling, sweat­ing, unable to respond. If you try to wake him up or hold him, he often starts to fight, break out, shout “Go away, don’t touch!”. Some­times he talks about what he just saw, but con­fus­ed­ly, and in the morn­ing he does not remem­ber any­thing from what hap­pened at night.

An attack can end in dif­fer­ent ways. The child may sud­den­ly calm down and fall asleep, or rather, return to a nor­mal state of sleep. And can con­tin­ue to cry and break out for half an hour. Attempts to wake up rarely suc­ceed and only aggra­vate the con­di­tion. Even if it works out, the kid will not give an expla­na­tion of what hap­pened — he does not remem­ber the attack at all or will tell only frag­men­tary mem­o­ries.

The age of onset of the dis­or­der is 2–4 years. In chil­dren, it occurs in 6.5% of cas­es, and unlike sleep­walk­ing, which devel­ops more often in boys, night ter­rors devel­op in boys and girls with the same fre­quen­cy.

For diag­no­sis, it is impor­tant that there is one of the obvi­ous signs:

• dif­fi­cul­ties with the full awak­en­ing of the child in the process;
• con­fu­sion;
• the inabil­i­ty to remem­ber any­thing in the morn­ing (some­times chil­dren remem­ber some vivid visions, but not the attack itself and the par­tic­i­pa­tion of par­ents);
• dan­ger­ous or poten­tial­ly dan­ger­ous behav­ior dur­ing a seizure — when a child unknow­ing­ly can harm him­self or oth­ers.

What is Awakening Disorder?

The peak peri­od for the appear­ance of night fears is dur­ing the refusal of day­time sleep. Due to the dura­tion of wake­ful­ness, the child gets tired, the sleep rhythm reg­u­la­tion sys­tem is over­loaded.

Because of this, in the non-REM sleep phase, the child sleeps more sound­ly, and when it is time to move into the REM sleep phase, not all sys­tems are able to do this in a time­ly man­ner. Some parts of the brain are acti­vat­ed, the entire ner­vous sys­tem is out of sync, and some of the brain areas “over­loaded” dur­ing the day are quick­ly acti­vat­ed and go into REM sleep with vivid dreams, while oth­ers are still deeply asleep.

This con­tra­dic­tion is expressed in the most pow­er­ful and ancient human emo­tion — fear.

It’s a disease? What to do about night terrors

Although seizures some­times look ter­ri­ble and par­ents are pow­er­less to some­how change the state of the child at this moment, most often such para­som­nia pro­ceeds benign­ly, does not lead to seri­ous prob­lems and dis­ap­pears on its own — sub­ject to the reg­i­men and rec­om­men­da­tions of the neu­rol­o­gist.

How­ev­er, just wait­ing for all this to pass is not worth it. If the attacks are fre­quent, the child stops get­ting enough sleep, his day­time well-being is also dis­turbed. In addi­tion, dur­ing the noc­tur­nal fight-or-flight reac­tion, chil­dren can injure them­selves or oth­ers (fall, push, bruise or hit).

Anoth­er prob­lem is that the pic­ture of night ter­ror (as well as sleep­walk­ing) can coin­cide with an epilep­tic seizure, a psy­chomo­tor seizure. So the child is shown an exam­i­na­tion (polysomnog­ra­phy, night EEG mon­i­tor­ing).

In the case of severe, debil­i­tat­ing para­som­nias, ben­zo­di­azepines are pre­scribed.

How­ev­er, most often no treat­ment is required. What should be done dur­ing an attack?

• Do not pan­ic, do not be fright­ened, do not try to wake the child. Most often, you just need to be there until the attack ends on its own.
• If a child has a pro­nounced motor exci­ta­tion, there are attempts to jump up, run away, beat some­thing, it is nec­es­sary to secure him and gen­tly hold him on the bed or in his arms.
• If there was an inde­pen­dent awak­en­ing, it is nec­es­sary to calm the baby, dis­tract. You can gen­tly ask about well-being, dreams.
• In the process, it is nec­es­sary to observe the behav­ior of the child, in order to then describe the attack to the doc­tor.
• It is not nec­es­sary to dis­cuss the next morn­ing with the child or with him what hap­pened, so as not to devel­op neu­rot­ic reac­tions and increased anx­i­ety. You can and should ask how you slept, what you dreamed — but do not inquire and do not tell your­self.

What to do to treat night terrors?

The main meth­ods of treat­ment are the mode and nor­mal­iza­tion of the emo­tion­al state.

• It is impor­tant to con­trol the mode of sleep and wake­ful­ness: chil­dren who sleep well are less prone to fears. Even if day­time sleep has already been aban­doned, it is worth intro­duc­ing a “qui­et hour” with qui­et games, read­ing, and relax­ing in bed. In the evenings, put them down ear­ly or, if pos­si­ble, extend the morn­ing sleep. Young chil­dren should be brought back to day­time naps.
• The child should fall asleep at the same time (plus or minus half an hour) and as equal­ly and calm­ly as pos­si­ble. Rit­u­als are an impor­tant part of going to bed! It is good to take a warm bath and then fol­low the relax­ation pat­tern: fairy tales, lul­la­bies, for old­er chil­dren — read­ing and music or sounds of nature.
• In the evening, it is worth intro­duc­ing con­ver­sa­tions with dis­cus­sions about what was a good day and what was dis­turb­ing — this will reduce the emo­tion­al stress of the day.
• The child must be sure that his par­ents will pro­tect him and he falls asleep in a safe envi­ron­ment. The bed must be iso­lat­ed from noise, bright light, etc. If, in addi­tion to night ter­rors, there are also night­mares or gen­er­al anx­i­ety is increased, you should use a baby mon­i­tor — the child will be sure that they will always hear him and come to the res­cue.
• Accord­ing to some stud­ies, exces­sive ten­sion and sleep dis­tur­bances can be reduced with weight­ed blan­kets. With para­som­nias of this type, their influ­ence has not been stud­ied, so you can try using an ordi­nary cot­ton blan­ket first, and if it helps, pur­chase or sew a spe­cial one with fillers.