Nightmares - OPPSA WEBSITE

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Pediatric Sleep Disorders > Infant and Pediatric Sleep Complaints
Most parents can remember a time when they were young and were awaken by a scary dream. You may have needed comfort, reassurance, or just the presence of your mom or dad to return back to sleep. When you consider that 75% of children report experiencing at least one nightmare and 10% to 50% of young children require some type of adult assistance during the night following a nightmare, parents are spending a significant amount of time addressing these issues. Nightmares occur during REM sleep and typically result in awakening from sleep. The content of nightmares varies across the developmental spectrum with younger children exhibiting themes of monsters or separation from caregiver, and older children experiencing themes related to frightening movies or media viewed and disturbing daytime experiences. Life changes, stressors, or traumatic events (e.g., move to a new home, starting school, parental divorce etc.) can also be associated with nightmares.
Nightmares should be differentiated from sleep terrors. Nightmares have the following characteristics:
 typically occur in the latter half of the night when our sleep cycle is predominated by REM sleep
 your child remembers partial or whole descriptions of the nightmare
 they will remember waking up and interacting with you
 they will not be confused or disoriented during the awakening
 they may have difficulty returning back to sleep
Frequent and chronic nightmares can be associated with psychiatric disorders such as anxiety disorders, bipolar disorders, and schizophrenia. However, it is important to remember that most nightmares are common and are part of the normal developmental process.
What to expect when you arrive at the sleep clinic
When you arrive for your initial consultation with the sleep team, the team will spend time evaluating your child’s medical history, developmental history, family history (including medical history, psychological history, parenting skills, and limit-setting abilities), and your child’s behavioral history. A detailed history of your child’s sleep behaviors and the frequency and severity of nightmares will also be discussed. Your child will have a brief physical examination. If any medical causes are suspected of contributing to your child’s sleep problems (e.g., gastroesophageal reflux, periodic limb movement, restless sleep, sleep apnea etc), further medical evaluation may be recommended including an overnight sleep study.
Treatment for nightmares includes reducing the likelihood of experiencing a nightmare by avoiding exposure to frightening or age inappropriate images and media, reducing stress, and ensuring adequate sleep. Our sleep psychologist will work one-on-one with your family to help parents provide appropriate reassurance without providing excessive attention to the nightmares. Your child will be encouraged to develop individual coping skills including use of their imagination to facilitate a sense of master and control, relaxation strategies, and systematic desensitization. Use of a nightlight and security object may also be recommended. If nightmares are persistent and unresponsive to behavioral interventions, a referral for a psychiatric consultation may be needed.

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