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

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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?

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.

Impor­tant!

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

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).

child, girl, cute
child, girl, cute
child crying, child, divorce
child, boy, lion
boy, child, scream

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.

Life hack!

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.

By Yraa

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