Night Terrors – Helping Children with Nightmares

Helping children with nightmares
Helping children with nightmares

Many children experience nightmares and night terrors, but most grow out of them. They don’t cause any long-term psychological harm to your child.

Night terrors are very different from nightmares.

A child having night terrors may scream and thrash around, and may not recognise you if you try to comfort them. This behaviour occurs on waking abruptly from deep, non-dream sleep. Your child won’t be fully awake during these episodes and will have no memory of it the next morning.

Nightmares occur from dream sleep (REM sleep). Your child may wake up from the nightmare and, depending on their age, may be able to remember and describe the bad dream to you.

Both night terrors and nightmares in children are described in more detail below, along with advice about what you should do.

Night terrors

Night terrors are common in children aged between three and eight years. A child who experiences night terrors may scream, shout and thrash around in extreme panic, and may even jump out of bed. Their eyes will be open but they’re not fully awake.

The episodes usually occur in the early part of the night, continue for several minutes (up to 15 minutes) and sometimes occur more than once during the night.

Why they happen

Night terrors are more common in children with a family history of night terrors or sleepwalking behaviour.

A night terror attack may be triggered by anything that:

increases how much deep sleep your child has, such as tiredness, fever or certain types of medication

makes your child more likely to wake from deep sleep, such as excitement, anxiety, sudden noise or a full bladder

What you should do

The best thing to do if your child is having an episode of night terrors is to stay calm and wait until they calm down. Don’t intervene or interact with them, unless they’re not safe.

Night terrors can be frightening to witness, but they don’t harm your child. You shouldn’t attempt to wake your child when they’re having an episode. They may not recognise you and may become more agitated if you try to comfort them.

After the episode has ended, it’s safe to wake your child. If necessary, encourage them to use the toilet before settling them back to sleep.

If your child returns quickly into deep sleep, they may have another episode. Making sure they’re fully awake before they go back to sleep can break this cycle.

Your child won’t remember the episode the next morning, but it may still help to have a general chat to find out if anything is worrying them and triggering the episodes. It will also help if they have a relaxing bedtime routine. Try not to discuss the episodes with your child in a way that worries them as this may increase their anxiety.

If the night terror episodes are frequent and occur at a specific time every night, you may find that waking your child breaks the cycle. Wake your child 15 minutes before the anticipated time of the episode every night for seven days. This can disrupt their sleep pattern enough to stop the episodes without affecting sleep quality.

When you should seek help

Most children eventually grow out of night terrors. However, talk to your GP if they’re occurring several times a night or occurring most nights.

Your GP will be able to check whether something that’s easily treatable is causing the episodes. For example, large tonsils could be causing breathing problems at night and waking your child.

In a small number of children who have frequent episodes of night terrors, referral to a specialist service may be needed.

Nightmares

Nightmares are common in children aged three to six years. Most children grow out of them.

Nightmares usually occur later in the night and cause strong feelings of terror, fear, distress or anxiety. Your child may wake up and be able to remember and describe the dream to you.

Nightmares in children can be caused by a frightening experience, such as watching a scary film, or by something that’s worrying them.

What you should do

Talk to your child to find out whether anything is worrying them that could be triggering their nightmares. As with night terrors, making sure your child has a relaxing bedtime routine will also help.

Take your child to see your GP if they’re having repeated nightmares (a series of nightmares with a recurring theme). If your child’s nightmares are being caused by a stressful past experience, they may need counselling.

Useful Links

1 in 5 Getting Five Hours Sleep or Less – Check out these amazing ideas for getting better and more sleep!




Dr. Nerina Ramlakhan
Dr. Nerina Ramlakhan
New research shows that one in five Brits are regularly getting a dangerously low level of sleep, with one in six saying that their fatigue severely impacts activities like driving and socialising, with some struggling to stay awake at work. This could be down to stress, with nearly one in three saying that their work has negatively affected their sleep in the previous week. Sleep experts Dr. Nerina Ramlakhan and Dr. Anna Weighall run through the stark findings in their work in the interview below.

· Less than five hours sleep each night is associated with serious negative health outcomes including cardiovascular problems, obesity and diabetes.

· One in six (18%) report a high impact of tiredness on daily functioning (e.g., problems staying awake, socialising, feeling enthusiastic, driving, maintaining concentration).

· Six in seven (86%) of people use some kind of tech before they go to bed with 5% checking emails, 41% using social media, and 42% watching TV.

· Furthermore, more than one in four (27.6%) use technology if they wake in the night, 11% check emails, 15% use social media and 13% watch TV.

· Poor sleep patterns may be affected by the pressures of modern life, including the pressures of work. Nearly half (42%) of those questioned from the full sample reported that they found their jobs stressful and almost one in three (30%) indicated that their work has negatively affected their sleep during the previous week.

· The findings come from a new study by the University of Leeds in conjunction with Silentnight to be presented at the Newcastle British Sleep Society conference on 22nd October.

PatientTalk.Org – Ok so we are talking about sleep or not getting enough, first question I have for you guys is what the difference between tiredness and fatigue is?

Dr. Nerina Ramlakhan – I work a lot with fatigue, chronic fatigue and burnout as well as advising on sleep as well and one of the question that I often ask my patients is what is your energy levels like at the moment out of ten, ten being really high and one being exhausted and that gives me an idea just a quick idea and it also helps them be more aware as well as sort of where they are on the tiredness fatigue scale and I would say the difference between the two is that tiredness we can all experience and sometimes we can get a bit of a tiredness dip in the afternoon, some people tend to be more tired in the mornings when they are not a morning person but fatigue is when it starts to become more evasive and it really starts to effect the quality of life and the ability to function normally so the ability to do things that you would normally be able to do and the things that you would normally enjoy and that fatigue can affect you not just physically but also emotionally and mentality as well.


PatientTalk.Org – Ok that leads onto my next question actually, what medical conditions can result from a lack of sleep.

Dr Anna Weighall – So one of the things that can happen if someone has chronic fatigue is that they can go on to develop quite serious health conditions for example , obesity, diabetes and cardiovascular disease are all more common in those who report low levels of sleep over a period of time.

PatientTalk.Org – Ok and what are the underlying reasons for people having a lack of sleep?

Dr Anna Weighall – So in a piece of research that we have recently conducted in association with silent night we asked our respondents, over a thousand people from across the UK about their sleep habits and about their ability to get a good night’s sleep, we found a couple of things that were practically key so one of them is work stress and work life balance so 30% that’s one in three of our participants reported that work affected their sleep in some way, the other thing that we noticed was that we asked people about their sleep habits ,what they do around bedtime ,what they do when they wake in the night and we found that 86% of our participants used screens or technology of some sort before they go to bed and many of them will use technology if they wake in the night as well .

PatientTalk.Org – Ok I’m sure many of us can understand the work one, in terms of insomnia how can it be treated?

Dr. Nerina Ramlakhan – Well Perry I work with sleep problems I’m a practitioner and I work at a psychiatrist clinic one day a week where we are working with really hard core sleeping patterns and the treatment will go from medication in worst case scenario though too psychology programmes into personal therapy, cognitive behavioural therapy, all the way through to practical advice and I can throw some of the tips and techniques out now but you know I teach my patients and clients all sorts of things from nutritional strategies which can help them to sleep all the way through to technology, hygiene , how to wind down before they go to bed, how to manage over busy minds and even breathing and mindfulness, if you direct your viewers and listeners to the Silentnight website we have got lots of the tips and techniques on there as well.

PatientTalk.Org – Yeah I was going to ask what is the best bedtime routine to get the most amount of sleep?

Dr. Nerina Ramlakhan – Well sleep is so individual, so personal, so what I guide my patients and clients to do is to become more aware of what it is they themselves need in order to be able to let go of the day and rest and relax and then sleep and for some people it might be having a relaxing bath, personally that would make me too hot before I got to bed so it is quite individual, things like what you watch on television even the types of books you read before you go to bed, what you eat before you go to bed, I encourage people to start becoming more aware of these things but the hour to an hour and a half what you choose to do in that time will really set you up for how you are going to sleep. So ideally you would start to disconnect form work, you would start to disconnect from technology, if you are a sensitive sleeper then don’t watch television in your bedroom watch it in another room, preferably don’t watch the news, don’t check the share prices, if you are going through a lot of stress in life then read something that’s uplifting and I even talk to my clients and patients about gratitude exercises before you go to bed keeping a gratitude journal but the idea really is to really bring the levels of stimulation down so the mind and body can prepare to relax and let go off the day.

PatientTalk.Org – What is a gratitude exercise?

Dr. Nerina Ramlakhan – Well in a nutshell and we won’t talk about this now as it’s a 60 minute exercise but right now think about the day you have had so far from when you woke up this morning until now so it’s just gone 1 o’clock and try and find so just go through your day and do it with your eyes closed and try and find as many small positive things that have happened in your day so far and you can think about them or you can take them to the next level which is what I call breathing into your heart and actually giving thanks to them and what it does is an amazing dropping of the shoulders , unclenching of the jaw, relaxing and anite sense of trust and it’s not all woo woo stuff, I mean there is a good degree of science behind this a branch of science called psycho neuro immunology ( PNI) which shows that people who regularly do gratitude exercises have more robust immune systems and their heart is stronger but it also helps promote good sleep , does that answer your question ?

PatientTalk.Org – Yes I was very interested, so how has the research in sleep conducted and what was the main findings?

Dr Anna Weighall – Ok so the research that we conducted in association with Silentnight as part of my work at the University of Leeds was really about getting a detailed picture of the nation’s sleep, the key findings are that many people are not getting enough sleep and reporting less than 5 hours sleep a night which is a worrying low amount of sleep but interestingly the majority of participants reported that they didn’t know how much sleep they thought they should be getting so it was a great awareness that ideally you should be getting around about 8 hours sleep per night which is what the NHS recommend . However when we asked people how much they intended to sleep they report something in that ball park, when we asked people to reflect on how much sleep they actually get they start to report much lower levels than that so we see what we call a sleep debt, so what people need or want in terms of amount of sleep and what they actually get in terms of their sleep behaviour.

PatientTalk.Org – Ok and what would be the one piece of advice you would give to somebody who does not or cannot get a good night’s sleep?

Dr. Nerina Ramlakhan – I would say to really start to prioritise your sleep you know make it important because often in today’s busy busy technology driving world we take our sleep for granted and we run ourselves ragged all day and then we expect ourselves to get into bed and switch off these hyper active minds and body so I would say start giving sleep the respect it deserves. Build rest into your day whenever you can, ideally every 90 minutes to 2 hour get away from technology even if it’s for a few minutes and that in itself becomes a rest , aim to get to bed before midnight at least 3 or 4 times a week and if you can go onto the Silentnight website and have a look at some of those tips because there is some really practical things that you can do just for the next week or so and it can really make a difference to your sleep , I would also say that if you are not sleeping well and it’s been going on for some time believe that it is possible to get a good night sleep , I speak to people who come to my clinic and say ‘ I’ve never slept well since childhood and my parents didn’t sleep well or my grandmother and it’s in my genes in my genetics’ and that’s part of the problem as they just don’t believe that they can sleep well and we can learn behaviours that will give us the sleep that we need and deserve and believe that you can and seek out the advice and respect your sleep.

PatientTalk.Org – Yeah I mean if like me you work in a really stressful environment how do you find the time to grab a few minutes rest when there’s people ringing you and emailing you every two seconds and you’re like please stop this madness.

Dr. Nerina Ramlakhan – Yeah I really hear what you are saying, I work in a lot of very stressful environments apart from the clinic, I go into a lot of big companies and banks, last week I worked in a trading floor of 500 bankers and I taught them how in 60 seconds they can create a physiological state of rest in their body even when things are going fairly crazy around them, so we can make the choice for 10 seconds, 30 seconds to out the phone down or sorry to be basic about this but when we go to the bathroom don’t take the phone with us or to take a 5 / 10 minute lunch break where all we are doing is eating not in front of our technology or for half an hour before we get into bed to mindfully engage with your family with no technology around you , these are choices that we can change and make and increasingly this is what I am showing people and urging them to do , if we start to value our sleep and if we get that sleep, one or two night of good sleep and you will get hooked on it and you will do what it takes to get it.

Dr Anna Weighall – And if I can just come back on that I would say that one of the reasons we wanted to conduct this research is to raise people’s awareness of the importance of sleep because I think very much we have fallen into a snooze and you lose kind of a culture and in fact if we start to realise that sleep is part of our health, part of our emotional and mental wellbeing and we start to treat it in the same way of physical exercise, we know we need exercise and we also now know that we need good sleep, we need to find gaps in our busy life’s to make sure that we are getting the things that we need for as healthy life, In our research Perry the other thing that was really important as a take home message is the very strong relationship between a good sleep and good health, so people who reported good sleep quality on the whole reported a better quality of life and that meant they were enjoying their life’s more, having more positive interactions with their families, having less physical ill health and generally being emotionally prepared for the day ahead sop we really can’t underestimate the value of sleep.

How to make sure you get a perfect night of sleep – check out this new video


Getting a good night's sleep - some tips
Getting a good night’s sleep – some tips
Getting a good sleep is very important. An unspoiled slumber can make you more energetic and positive during the day, while a night of tossing and turning can have just the opposite effect.

There are a number of things that can influence how well you sleep, so it’s essential to know all you can about what makes the transition from being awake to sleeping as smooth as possible.

Jurys Inn have released a short animated video that outlines all the factors that can help you get a great night of sleep.

The video covers aspects of diet, such as foods to go for and foods to avoid, as well as when to exercise and how to occupy yourself in the few hours before bedtime to get the perfect sleep.
There is also advice on things like why a hot bath or a warm drink can help infinitely, making it the ideal guide to getting a great sleep.


Welcome to the 3rd annual Idiopathic Hypersomnia Awareness Week! 7-13th September 2015 #IHAW2015


Hypersomnia Awareness Week
Hypersomnia Awareness Week

Welcome to a guest post from Michelle Chadwick of Hypersomnolence Australia telling us about this weeks  Idiopathic Hypersomnia Awareness Week.  She says:-

“Hypersomnolence Australia launched the first international Idiopathic Hypersomnia Awareness Week in 2013 with a radio interview discussing the importance of community awareness. This year we will be focusing on education with a written tribute tothe renowned Czech neurologist Bedrich Roth who was responsible for identifying and naming Idiopathic Hypersomnia.
This year marks the 35th anniversary of Roth’s classic 1980 text Narcolepsy and Hypersomnia (S. Karger; NY, NY). In our tribute “Bedrich Roth, His Life’s Work and the 35th Anniversary of the Book “Narcolepsy and Hypersomnia” we document Roth’s significant contribution to the pioneering pathophysiology and epidemiological study of narcolepsy and Hypersomnia. Narcolepsy and Hypersomnia contributed to the English literature for the first time the largest most meticulously followed series of all the then known neurological sleep disorders.

We have been discussing Roth’s life work, his book and the current issues with regards to idiopathic hypersomnia with sleep researchers and clinicians throughout the world including Professors Roger Broughton, Michel Billiard, Karel Sonka, Sona Nevsimalova, Isabelle Arnulf and David Rye.

It is clear that:

– Idiopathic hypersomnia is often misdiagnosed and misinterpreted. Education of physicians and sleep specialists is imperative.

– Current testing methods (MSLT) and diagnostic criteria is inappropriate. There is an urgent need for biological markers.


– ICSD3 combined idiopathic hypersomnia is not supported by data. It is a step back in the definition of idiopathic hypersomnia as it potentially encompasses a variety of different diseases.

– The exact prevalence is unknown but is thought by many to be as high as Narcolepsy.

– Further research is required on the genetic aspects of the disease.

– Idiopathic hypersomnia (IH) is a “true” and disabling neurological sleep disorder. People with IH are not lazy, sleepiness is a symptom of the disease and is usually not relived by sleep or medications.

– There are no approved medications specifically for Idiopathic Hypersomnia. Medications used to treat Narcolepsy including stimulants and wake-promoting medications are prescribed to counter daytime sleepiness however there are no medications that assist with the extreme difficulty waking up or the sleep drunkenness. Stimulant and wake promoting medications can be helpful to relieve sleepiness for some patients however for many they are not effective or appropriate. New and appropriate therapies are needed.

– The impaired cognitive ability, the excessive sleep, and continuous feeling of never being fully awake profoundly affects work, education, and quality of life and leaves sufferers at risk of potentially life-threatening accidents.

What can you do to help raise awareness?

  1. Like our Facebook page and join the Facebook awareness week event
  2. Follow us on Twitter tweet and retweet us @Hyper_Sleep
  3. Use the hashtags #IHAW2015 and #HAIHope to tell us what you hope for.
  4. Share our posters or make your own and share them with us!
  5. Change your profile picture and cover photo
  6. Share your Patient Perspective send us an email to hypersomnolenceaustralia@gmail.com
  7. Share the Idiopathic Hypersomnia Fact Sheet electronically or download and print out a copy for your health professionals
  8. Make a tax deductible donation
  9. Share your ideas with us. If you have an idea for raising awareness, fundraising or have a talent you think could help? Then send us an email hypersomnolenceaustralia@gmail.com

 

And don’t forget to share our great “you know you have idiopathic hypersomnia when…” memes!! You can find them here

Sleep disorders and children diagnosed with autism. Read some amazing information in our guest post from Dr. Sonya Doherty

Dr. Sonya Doherty
Dr. Sonya Doherty

Welcome to our latest guest post from Dr. Sonya Doherty. You can read the original post on her blog here. Dr. Sonya Doherty is a licensed and board certified Naturopathic Doctor who is an active member of the CAND. Sonya Doherty completed her undergraduate training at the University of Western Ontario in a Bachelor of Science Honors Kinesiology program.

You may be also interested in a recent discussion blog we ran which looked at this very subject!

If you have a child diagnosed with autism, or who you suspect is on the spectrum, chances are your child is having trouble getting to sleep or staying asleep.  Sleep is essential to support optimal development.  Research at the Arkansas Children’s Research Institute has identified that 90% of children diagnosed with autism havemethylation impairments . Methylation impairment can change the way children produce brain chemicals like serotonin, dopamine, GABA, glutamate and norepinephrine.  With respect to sleep, serotonin is a much need neurotransmitter.  90% of serotonin comes from the gastrointestinal tract.  Up to 85% of children with ASD have digestive problems including constipation, diarrhea, pain and gut flora imbalance.  Serotonin is converted to melatonin with the help of vitamin D.  Vitamin D deficiency is well documented in the autism focused medical research. 

Adequate magnesium levels are required for healthy sleep onset and maintenance.  Many children with autism and ADHD have magnesium levels that are lower than normal.  Magnesium deficiency is the 4th most common nutrient deficiency in North America.  Nutrient deficiencies, digestive problems and methylation impairment combine to negatively impact healthy sleep patterns in ASD.  Children who are experiencing developmental concerns are at a substantially higher risk of experiencing sleep disorders.  The children who need sleep the most are having trouble getting to sleep, staying asleep,  having restful sleep are early waking.

Addressing sleep issues in children with autism is multi-faceted.  Many parents have altered routines to accommodate their child’s imbalanced circadian rhythm.  Putting children to sleep much later than same age peers, results in an exhaustion cycle that exacerbates behaviours and sensory overload.  Your child’s body has two ways to get to sleep. One is at their age appropriate bed time which is supported by appropriate melatonin levels.  The melatonin signal is initiated by darkness and regulates the sleep-wake cycle by causing drowsiness.  Limiting TV, iPads and other screens in the evening is important for children with sleep onset insomnia.  Blackout blinds are also crucial to help support the repair of your child’s sleep cycle.  Melatonin production must be stimulated to increase documented low levels experienced by children with an autism diagnosis.  Use of melatonin is an important “band aid” treatment during this time as children’s methylation cycle is supported and repaired.  Other helpful sleep supports include magnesium glycinate, GABA, L-theanine and botanical medicines like valerian, skullcap, lemonbalm, zizyphus and passionflower.

The importance of melatonin in the management of sleep disorders and gastrointestinal problems in children diagnosed with autism spectrum disorder:

One of the most common questions that I am asked by parents is about melatonin safety.  “Is it safe to give my child melatonin?”

I think the below information will make it clear that it may be unsafe not to give your child with autism melatonin.

The International Child Development Resource Center performed a systematic review and meta-analysis on melatonin and autism.  Their findings show that most children diagnosed with autism have:

  • Abnormalities in their melatonin levels
  • Gene abnormalities that contribute to lower melatonin levels
  • Show positive changes with respect to sleep duration, onset and night time waking
  • Show improvement in autistic behaviours

Sleep problems in autism usually start at the same age as developmental regression, suggesting a higher vulnerability at this period of life. Healthy sleep patterns are essential to support neuroplasticity and development so it is important to address sleep disorders as soon as possible.  According to the Center of Pediatric Sleep Disorders, studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run.

Melatonin, however, has a larger role to play in development beyond its function as a synchronizer of the biological clock. Melatonin is a hormone that helps in the regulation of the gastrointestinal system.  The gut is 100% responsible for post-natal development.  In the gut, melatonin, governs intestinal reflexes, motility, the immune function, gut secretions, energy balance, pain regulation and protects against inflammation.  The gut contains at least 400 times more melatonin than the pineal gland  The GI tract produces its own melatonin which suggests it plays a large role in maintaining gut health; both in a healthy digestive tract and in gut disorders.  Children diagnosed with ASD have alterations in their gut flora in addition to higher prevalence of constipation, diarrhea, reflux and pain.  The balance of good bacteria is not the same as typically developing children.  Melatonin levels change gut flora and improve anti-microbial actions.  With the startling numbers of children experiencing both gut issues and sleep issues, this new research about melatonin’s role in gastrointestinal health could provide clues about treatment and repair of these biological systems.

Other interesting information about melatonin:

  • Melatonin is also synthesized by the bone marrow cells, white blood cells, mast cells and skin cells
  • It is a powerful antioxidant
  • Melatonin helps to protect mitochondria from oxidative stress which damages cells
  • Melatonin also helps to support glutathione production.  Glutathione is widely considered the most important antioxidant in the body.  In another study, The Arkansas Children’s Research Institute found that children diagnosed with autism have up to 80% of their glutathione depleted.  Glutathione depletion may be part of the central mechanism for developmental delay because the role it plays in protecting the brain from toxicity
  • There is research to support that melatonin helps to support healthy immune function by fighting infectious disease including viral and bacterial infections
  • Melatonin has shown some promise in modulating the immune function in autoimmune disease