NIGHTMARES AND SLEEP TERROR DISORDERS

Topics in Mental Health

By Shlomo Y. Radcliffe

Nightmare Disorder

What is Nightmare Disorder?

Nightmare disorder is a common sleep disorder often found in children. During the course of Nightmare Disorder, a child may awaken from sleep several times a week with a detailed memory of extremely frightening and long dreams, often involving threats to the child’s self-esteem, safety and/or survival. The child may eventually develop a fear of going to sleep because he or she anticipates having scary dreams.

Symptoms of Nightmare Disorder (DSM-IV Criteria)

In order to be diagnosed with Nightmare Disorder, the child must meet the following conditions:

• The nightmares do not exclusively occur during another mental disorder.
• The nightmares are not caused by the direct physical effects of any substance or medical condition.
• The child frequently awakens with detailed recall of frightening dreams.
• On awakening from a bad dream the child becomes fully alert, aware of where he is and what is happening.
• The dreaming experience causes significant upset and leads to difficulty in important areas of functioning like school or social life.

Causes of Nightmare Disorder

More than half of cases of nightmare disorder start before the age of ten and onset is before age 20 in two-thirds of cases. A major stressful event in life often precedes the onset of nightmare disorder. In many cases three or more nightmares occur per week. Children often outgrow nightmare disorder without any particular treatment. If the onset of nightmare disorder is in adulthood, however, it can last for decades when untreated. Nightmare Disorder is particularly common in children and adults with physical or mental health problems, although it can definitely occur in children without any other presenting health issues.

Treatment of Nightmare Disorder

Psychotherapy and the Benzodiazepine medications such as diazepam and Benadryl elixir (diphenhydramine) may help relieve frequent cases of nightmare disorder. However, in most cases of childhood Nightmare Disorder, the only treatment needed is comfort and reassurance. Self-help techniques like WHEE (whole healing easily and effectively by Dr. Daniel Benor - see wholistichealingresearch.com) can be taught to parents and children in order to provide immediate relief from bad dreams and other nightime fears. WHEE can help a child return to a calm state in only a couple of minutes.

Sleep Terror Disorder

What is Sleep Terror Disorder?

Sleep terror disorder is another common sleep disorder than often affects children. Sleep terror disorder (also called night terrors) may be diagnosed when a child awakens from a dream with: a loud scream, intense fear, rapid breathing and sweating. The child will seem confused as to where he is, what time it is and what is happening in the present moment. The child usually has no memory of the frightening dream. He is unresponsive to attempts to comfort him, although he may “return to himself” a few minutes later. The dream experience usually causes significant upset.

Children experiencing sleep terror disorder may get out of bed and act as if they are fighting. It is possible that the child may harm herself in this process. During an episode of sleep terror, children are not fully awake and it may not be possible to awake them. The average bout of sleep terror usually last less than fifteen minutes. People with sleep terror disorder will commonly only have one episode per week.

Symptoms of Sleep Terror Disorder (DSM-IV Criteria)

Repeatedly the child suddenly awakens during sleep, often starting with a scream of panic.

• During the episode, the child displays significant fear and may breathe rapidly.
• The child cannot recall the dream in detail at the time of the episode and cannot recall anything during the episode later on.
• Any attempts to comfort the child during the episode are not very successful.
• The episodes cause significant distress or impair regular day-to-day life.
• The symptoms are not the direct cause of a medical condition or the use of substances (including medications).

Demographics of Sleep Terror Disorder

Sleep terror disorder is much more common during childhood than it is in adulthood. Sleep terror disorder usually begins sometime during the age of 4-12 and usually will disappear sometime during adolescence. This disorder is more common in boys than it is in girls and is not associated with any psychological disorders in children.

Treatment of Sleep Terror Disorder

As long as sleep terror is not interfering with the child’s life then there may be no need for treatment. Simply waiting quietly with the child for the terror to pass is usually the best intervention. For instance, a parent can lie down beside the child until the child is calm again and falls back to sleep. The parent may also try to help the child using the WHEE technique (see treatment of Nightmare Disorder above). Although parents may feel distress seeing their child so distressed, it’s helpful to keep in mind that the child will actually have no recall of the event the next morning! Sometimes just giving the child a few days of extra rest (early bedtimes) and a calming routine is enough to end a cycle of Sleep Terrors. However, if sleep terror disorder persists and is interfering with the child’s life there are some steps that are suggested for parents to take such as: rearranging bedroom furniture to avoid injuries, taking the child for some for of psychotherapy or play therapy and, if so inclined, looking into alternative treatments that have been shown to be effective for this disorder. It is possible that certain breathing disorders may contribute to the development of Sleep Disorder and these should be ruled out by a medical practitioner. When present, treating the breathing disorder will relieve the night terrors. In particularly severe cases of Sleep Disorder, medication may be employed.. A common medication for example is diazepam - a sleep-inducing medication that can sometimes prevent sleep terror from occurring during sleep. Sleep terror does not usually carry on into adolescence.