Caitlin Whyte (Host): Welcome to Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Caitlin Whyte. And today, we're diving into the perplexing world of nightmares and night terrors. And with me today is Dr. Michelle Carabello, a pediatric pulmonologist and Sleep Medicine specialist at Children's Health. We'll chat all about some typical causes and triggers of nightmares, how they differ from night terrors. And how to respond in the moment to ease these late night events. Now, doctor, start us off. What is the difference between nightmares and night terrors?

Dr. Michelle Carabello: The main differences between nightmares and night terrors are what time of night they occur, and whether or not the child remembers them the next day. So, night terrors tend to occur classically one to two hours after sleep onset is the most common time, and they happen in a very deep stage of sleep that we call non-REM sleep, where the child is actually very deeply asleep and completely unaware of what's going on. So, sometimes parents even tell us that they can almost set their watch by it. Like, the child goes to bed at 8:00. And every night at nine 30, they're going to have a night terror. They tend to be that consistent with it.

And the description of the night terror is a little bit variable. Some kids will get out of bed, some kids won't. But the classic description is they open their eyes as though they're awake, but typically they're not actually awake. Because like I said, these events happen in a very deep stage of sleep and they have no idea what's going on because they're deeply asleep when they happen. So, some parents will describe, "My child wakes up," but they're not actually waking up. And usually, there's a scream involved, the tear apart. The textbook description is a blood curdling scream. So, it can be terrifying to parents and siblings and other people who witness it. But it doesn't bother the child at all. And the next morning, the kid has no idea. You know, "Hey, Joey, how'd you sleep last night? What happened? And he'll say, "I slept fine. What do you mean?" So, we encourage parents to not harp on this too much or distress the child by making the child worry that something bad happened during the night or even that they did something wrong.

The contrast with nightmares is that nightmares happen in a different stage of sleep called REM sleep. And that's the stage where we get our most vivid dreams. And nightmares are more likely to happen in the latter portion of the night compared to night terrors that happen early in the night. And generally, the child is aware of what's going on and is consolable and remembers it the next morning, that they're able to verbalize that they had a nightmare. They may or may not remember exactly what the nightmare was about, but they know that they had a bad dream, responsive and consolable, and they recall it the next day, whereas with night terrors, they have no idea the next day what happened. And if you try to console them, generally, it doesn't work with a night terror because they're deeply asleep and they don't even know that you're there. They don't recognize your presence.

Host: And at what ages are nightmares and night terrors most common in our kiddos?

Dr. Michelle Carabello: This is where they're very similar. So, both nightmares and night terrors tend to start around toddler age. And most kids outgrow them by adolescence, not a hundred percent. But the majority of the time, it peaks around mid-childhood. So, it starts around age two or three. It can peak around age five or six, and then kind of starts to slow down in frequency throughout the elementary age years with them most of the time disappearing in adolescence, and that's true for both nightmares and night terrors.

Host: Now, what are some typical causes or triggers for each one?

Dr. Michelle Carabello: Well, we know that for night terrors, there's definitely a genetic component to this. At the end of the day, we don't know exactly what causes night terrors, but they do often run in families along with a variety of other sleep disturbances like sleepwalking, sleep talking. These all fall in the same category of diagnoses with night terrors. And oftentimes, there's a really tight genetic component. Like, sometimes I'll ask the parents, "Do you happen to know if you had night terrors as a kid?" And they'll say, "Yeah, they went away when I was nine or whatever." And I'll say, "Well, she's probably going to have night terrors until she's about nine." You know, it tends to correlate pretty tightly.

We also know that there are certain triggers for night terrors in kids who are prone to them. So, the most common is sleep deprivation. So if a kid is not well rested, that's more likely to trigger a night terror on that night. And also, things like stress, anxiety, illness, sleeping in a foreign environment, so if you go on vacation and you're in a hotel or you're at a friend's house, more likely than it is to happen at home. At the end of the day, we can't always predict with certainty on any given night why or when is the night terror going to happen

Nightmares can have similar triggers like stress and anxiety. Sometimes exposure to frightening media can trigger nightmares in kids as well as stressful life events. And sleep deprivation can also bring about nightmares in kids who are prone to them. And this is because when a kid is not well rested, their body is trying to catch up with more of those deep stages of sleep where night terrors occur, and nightmares can also occur in a different deep stage of sleep. So when the body's trying to play catch up because of sleep deprivation, it can bring about these events because the body's getting extra of those deep stages of sleep.

Host: And how could parents best respond in the moment when their child wakes up from a nightmare or night terror, and we hear that screaming down the hall?

Dr. Michelle Carabello: So, the response is actually is different. With a night terror, we do not recommend trying to wake the kid. We don't want parents to, you know, kind of shake the child, "Hey, snap out of it." Not that is not necessary and actually can make things worse, not better. So, we say if they do get out of bed, just kind of gently and calmly guide them back to bed, and wait it out. You're certainly welcome to put an arm around them, try to comfort them. But honestly, that's usually not necessary because the kids are deeply asleep when these happen and they're not even aware of your pre presence. But it can be sometimes, I think, reassuring to the parents just that they're providing some comfort to the child. So, it's mostly just keep them safe, keep them calm in bed, and wait it out.

With a nightmare, the child will actually wake up and be frightened and be aware of what's going on. So, it's appropriate, of course, to comfort your child during a nightmare and give them the reassurance that they're safe, they're at home, you're there, and you won't let anything bad happen.

Host: Do nightmares or night terrors signal an underlying sleep disorder, or any other medical concerns?

Dr. Michelle Carabello: The majority of the time, they're completely benign and not associated with any other underlying medical disorder. So if it fits a pretty typical description for a nightmare and a night terror, most of the time, I just try my best to educate and reassure the families that this is okay, this is normal, and your child will outgrow it.

Occasionally, if the night terror doesn't really fit the classic description, for example, if let's say it starts in the teenage years, that would be atypical or if the events are happening multiple times per night or lasting over an hour, those would all be atypical for a classic night terror. So in those cases, I will occasionally request a sleep study to try to characterize the event and see what's going on and see what their brainwaves are doing, make sure that it doesn't seem like it's actually a nocturnal seizure or something else. But again, when it's just a really typical textbook description, usually, that's completely normal and benign and nothing to worry about, even though I know it is very frightening to witness.

Host: And when should parents bring up their child's sleep disturbances with a doctor?

Dr. Michelle Carabello: Well, anytime a parent is worried, I think it's a good idea to mention it to your doctor and just run it by them and get their input and see if your primary care doctor has any concerns. They certainly can refer the child on to see a sleep specialist for additional assistance. So, I'm all about open communication between parents and pediatricians. And if you have any unusual behavior or concerns that you want to bring up to your doctor, the worse that could happen is the doctor says, "It's okay, nothing to worry about," and then, you know it's nothing to worry about. But I think it's important to bring up any concerns about your child's health with your doctor.

Host: And to wrap it all up for us, Doctor, what is the best advice for parents to create calm, reassuring bedtime environments that might help these episodes?

Dr. Michelle Carabello: Great question. We want parents to establish a really consistent bedtime and evening routine with kids with a nice, calm, wind down period before bed and a consistent bedtime every night. Like I mentioned, sleep deprivation is one of the biggest triggers for both nightmares and night terrors. So, it's important to make sure that kids are adequately rested, and that includes creating a healthy sleep environment that is calm and dark and quiet.

So, we recommend that electronics be off a minimum of one hour before bedtime, preferably two hours before bedtime. And after that, do calm wind-down type activities, whether reading or, you know, coloring or doodling for kids who enjoy that and shower. And just a really consistent bedtime routine can be helpful so the body knows what to expect and knows when it's time to go to sleep.

We also want lights to be off in the evening before bed. So in that last hour before bed, start kind of winding down the overhead, bright lights and using dimmer lamps instead. And that onset of darkness is the cue that tells your brain to release melatonin to make you sleepy so kids can get to sleep easily and get their healthiest, best quality sleep.

Host: Well, thank you so much for joining us today and for sharing this info, Doctor. For more information, visit childrens.com/sleep If you found this podcast helpful, please rate and review it or share the episode. And please follow Children's Health on all your social channels. Thank you so much for listening.