Dennis Rosen, MD is the associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital and author of Successful Sleep Strategies for Kids. If you have a sleep-related question to ask, please email it to Thrive@childrens.harvard.edu.
Q: Over the last several weeks, my 6-year-old has been waking up about two hours after falling asleep. She screams and cries inconsolably for about 20 minutes, goes back to sleep and then doesn’t remember anything when we ask her about it the next morning. This has been happening three or four times per week for a few months. Any suggestions on how we can help her?
-Frazzled in Philly
A: Dear Frazzled,
What you are describing sounds like night terrors, which are quite common in young children. Unlike nightmares, which usually occur in the second half of the night, night terrors tend to happen in the first few hours after sleep onset. Another difference between the two is that while a child will likely remember some aspects of a nightmare after she awakens, with night terrors there is no recollection of them the next morning.
All sleep is not the same. Over the course of the night, we repeatedly cycle between deep, light and REM (rapid eye movement) sleep, sometimes awaking as we shift between the different sleep stages. When the transition between deep sleep and wake isn’t complete, parts of the brain wake up while others remain fast asleep.
This can lead to behaviors that reflect aspects of both the waking and sleeping state and can result in what are called “confusional arousals.” They include night terrors, sleep walking and sleep talking.
In general, anxiety, an irregular sleep schedule, insufficient sleep, illness and other physical discomfort increase the chance of night terrors and other confusional arousals.
How can you reduce the chances that your child will have a night terror? Start by keeping her on a regular sleep schedule. Put her to bed each evening—and wake her up in the morning—at a regular time, which allows for an age-appropriate amount of sleep.
You also may find it helpful to sit with her in the last few minutes of the evening as she is getting ready for sleep, and go over the events of the day to try and identify any sources of anxiety. If you do, try talking her through the problems or refocusing her attention on more pleasant and soothing topics through soft conversation or by reading a story together.
When confusional arousals do occur, it isn’t necessary to try and wake her up or to forcibly “pull her out” of them, even though it can be difficult to watch her cry or scream as she sleeps. The most important thing you can do is keep her safe by guiding her back to bed and waiting for the episode to resolve on its own.
If your child has a sleep-related issue that requires medical attention, please call our Center for Pediatric Sleep Disorders at 781-216-2570, or visit The Center for Pediatric Sleep Disorders website and click the "request an appointment" button.