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LIVING WELL 2

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Waking Nightmare
For many kids, night terrors are a frightening reality.

For Sawyer, the episodes are hard to forget. “Usually it happens when I’ve stayed up late and watched a movie,” says the Bryn Mawr 10-year-old. “But last night I walked into my dad’s room to say goodnight. When he wouldn’t wake up, I walked out and just started crying, fading in and out.”

Sawyer finally made his way to bed and fell asleep, but not without having to first battle the intense tangle of emotions that accompany night terrors.

Sawyer’s night terrors began about four or five years ago and they’ve gotten worse over time, which is unusual. “Children often outgrow them by virtue of maturation of the brain,” says Dr. Rochelle Goldberg, medical co-director of sleep medicine services for Main Line Health.

The night walking associated with the terrors can be calm and aimless, with the child seeming to have no purpose or destination. They might urinate in unusual places, like a parent’s closet. But moms and dads are advised that this is not a sign that their kids are acting out. “The emphasis is not psychiatric,” Goldberg points out. “But it often bears that wrap.” But if parents should consult a professional if they notice the episodes becoming ritual-like and repetitive (such as a child sitting up in bed and clapping her hands) as it may be an indication of seizures.

Goldberg once treated a 7-year-old boy with night walking who would go into his baby sister’s room in the middle of the night and rattle her crib. His parents were understandably scared and confused because they didn’t know whom to protect first. Eventually the boy developed a resistance to sleep because he was afraid of what he might hurt his sister and make his parents mad at him.

To avoid undue family stress, adults must try to be vigilant in recognizing a problem, improving their child’s sleeping conditions and, most importantly, communicating positively.

Facing the Fear
The first step in helping a child suffering from night terrors is to recognize the problem—although if it happens once, experts says there’s no need to rush to a doctor. Then parents should think about possible triggers for the terrors. Have they been sleep deprived around holiday time, staying up late and traveling far distances? Do they have a fever or viral infection that could be interrupting their sleep? Or it could be general stress. Goldberg warns that even the sort of stress that fragments sleep is enough to cause sleep terrors, sleep walking and confusional arousal.

Once parents identify the triggers, they need to prevent them by creating a safe and happy sleep environment by allowing their children time to wind down before bed.

“Make a routine; make it familiar; set limits,” Goldberg says. “Children need to know that this is bed time.”

Their bedroom should be a calm, dark and neutral place—meaning no TVs, DVD or CD players, and computers with blinking screen savers or lights. When children divide their time between two homes, it’s important for parents to coordinate efforts and make sure that the sleeping ritual is consistent. “Safety equals neutrality of environment,” Goldberg says.

Finally, parents need to communicate positively, never conveying the idea that they’re afraid of what their child might do in the middle of the night. That could lead to sleep resistance, which aggravates the problem. Verbally or nonverbally, parents must convey the idea that they love the child, and that he’s safe.”

If natural trigger prevention and a consistent sleep environment don’t solve the problem, parents can bring their children to a sleep center for an office evaluation. The next likely step is an overnight sleep test—or polysomnogram—in which doctors look for things like sleep apnea and various other factors that can contribute to sleep disorders.

The test measures 18 medical parameters, including heart and respiratory rate, muscle and brain activity, oxygen level, sleep movements, and body position. All of these details are necessary because doctors don’t typically see a full-blown episode in the lab.

“If we schedule the sleep test for two Tuesdays from now, that doesn’t guarantee that a child is going to have a sleepwalking incident on that particular night,” says Dr. Jodi Mindell, associate director of CHOP’s sleep disorder center. Doctors prefer that children come to the lab a few hours before bedtime so they can “chill,” says Mindell, because it really is a “funky experience.” They’re asked to bring their favorite pillow, blanket or stuffed animal. To quell kids’ discomfort, sometimes technicians will even put sleep monitors on teddy bears. “It’s all tape and glue—no needles—and a bazillion wires,” Mindell adds. “It’s mostly just intrusive, not invasive.”

Other Factors
Sleep apnea is a common sleep disorder that can contribute to night terrors. The disorder is different in children—tricky because they don’t show the normal adult symptoms of snoring, gasping or choking.

“They can just have loud, noisy, even funny breathing usually noticed by a sibling sharing a bedroom,” Goldberg says.

The peak childhood age for sleep apnea is anywhere from 4 to 6 years old, when children’s tonsils can cause obstruction of the airway. Kids can also develop sleep apnea when their tonsils and adenoids are inflamed due to a cold.

Children with sleep apnea can be skinny or round, overweight or underweight. Apnea also can occur in kids with small jaws or jaw deformities.

A prime apnea indicator is when a child sleeps in funny positions—with their head hanging over the side of the bed, for instance. “Their body is thinking, ‘How can I get my body in a position that protects my airway?’” Goldberg says.

Daytime sleep apnea symptoms can vary from sleepiness to hyperactivity. The child may be bouncing around the classroom and can’t sit still, or she could be just the opposite—sleepy, inattentive, not able to stay on task. A teacher might ask them a question, and they respond with, “Were you talking to me?”

Parents shouldn’t be satisfied with just letting their children grow out of sleep apnea, because from age four to six they are at a critical learning age and if they’re consistently sleepy during school, it could effect their intellectual evelopment.

There are a few options for treatment of sleep apnea. Children could have their tonsils removed after an evaluation with an ear, nose and throat doctor. If the apnea is weight-related, trained professionals can help develop a nutritional plan, while taking care not to create any body-image issues for the child. Another option is a nasal CPAP mask, which provides “continuous positive airway pressure” and makes it easier to breathe.

Another sleep disorder that affects children is worth noting: restless leg syndrome, or RLS. Symptoms creep in during quiet sitting or resting time and just prior to falling asleep.

“Kids usually describe it at jumpy legs, Coca-Cola legs, bubbles and fizzy stuff. They shift around because they legs are tingling, like with push pins,” Goldberg says.

RLS affects the lower extremities—usually from the calves down—and pain is not a typical symptom. If you think your child is having “growing pains,” it’s not a bad idea to have him checked for the disorder.

Cutting caffeine out of the child’s diet can help, but Goldberg warns, “RLS is not being caused by a Starbucks latté.” Another possibility is that the child is anemic, and iron supplements can help alleviate symptoms. Various dopamine medications are also a readily available option. Some cause nausea and headaches, but since they’re usually taken just before bedtime, most children sleep through the uncomfortable side effects.

 


 

Online Resources
www.sleepfoundation.org. The “Sleep for Kids” link provides information about the importance of sleep, sleep disorders, and tips for getting a good night’s rest. The site includes quizzes to test children’s knowledge and games to make learning about sleep fun.

www.stanford.edu/~dement/index.html. You’ll find the heading “Children and Sleep Disorders” in the Sleep Well Index. It provides comprehensive answers to questions about common childhood sleep disorders.

www.rls.org. The site includes a network of patient support groups; funds research through a competitive grants program; and seeks to increase the number of scientists studying the disorder.

 


Knowing Night TerrorsDr. Jodi Mindell, co-author of Take Charge of Your Child’s Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens (Marlowe & Company, 320 pages), offers these tips:

 

1. Make sure you’re able to determine whether your child experienced a nightmare or a night terror. Who is more upset in the morning? If it’s the child, it was a nightmare. If it’s the parent, it was a night terror.

2. Be patient. Episodes can last anywhere from a few minutes to a half an hour.

3. Night terrors look bad, but your child really is OK. They might appear possessed; they might even do something as strange as standing on the bed in the dark. But they aren’t experiencing stress.

4. l Keep your distance and keep them safe. It’s important to have as little interaction with the child as possible. Don’t touch them or say their name—that will only make it last longer.