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;
- 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;
- 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.
There is a big difference between night terrors and nightmares, also a form of parasomnia! In a nightmare, children and adults wake up in REM sleep, quickly regain full consciousness and remember what scared them.
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.
If night terrors are frequent, you can try the method of waking up early an hour after falling asleep. Gently waking the baby and letting him fall asleep again — this changes the sleep cycles and prevents them from being confused.
If the attacks are repeated, you definitely need a doctor, first of all, a neurologist.