Nightmares in Children

Thesis: The causes, effects and treatments of

nightmares in children

Word Count: 2406

KALIANNAN KUMARAVEL SUMI

ABSTRACT:

Nightmares in children are one of the most under-researched yet fascinating

subjects. Nightmares in young children is very common, but after an extent they become

traumatizing and impact the individual’s life in various adverse ways. Though traumatic

nightmares are more harmful and show immediate effects, idiopathic nightmares inflict the

most harm in children in the long run. Children get nightmares based on socio-cultural

factors like their monetary background or their social lives. Hereditary also plays into effect

in influencing nightmare frequency in children. Trauma based nightmares tend to be more

intense and distressing. But treatments like dream image therapy and inculcating lucid

dreaming have been proved to help with nightmares in children.

 I. INTRODUCTION

Dreams are a natural part of our everyday life. Most individuals have multiple dream

sequences in a single night, and some do not experience dreams at all. Every individual has a

different dream pattern and they vary considerably from one person, family, community,

culture or even nature. Dreams are one of the most intriguing, confusing and yet most

researched components of the human life. Since every person’s sleep pattern tends to be

different, researches have not found complete answers to all questions related to dreaming

especially in children. Dreams are the most difficult of all the workings of the mind for

children to comprehend, and thus it becomes difficult for them to convey it in a manner that

enables researchers to understand. Another major reason for the complication for

researches about dreams is that they tend to forgotten and are most often altered during

reinterpretations, which may lead to false conclusions and derivations.

II. NIGHTMARES, NIGHT TERRORS AND BAD DREAMS

Nightmares and night terrors are two often confused terms that are thought to be

the same. Nightmares are disturbing dreams that rattle you awake from sleep. During

nightmares, the dreamers experience vivid, scary and distinct sequences of which they can

often describe in detail. One in four children, approximately, between the ages five to

twelve experiences frequent nightmares and this tends to increase with a surge in anxiety

and stress (National Sleep Foundation). This is common and not a cause for concern, unless

they become traumatic. Night terrors are similar to nightmares but are much less common,

though they are more prevalent in children aged four to eight. Night terrors tend to induce

terror or panic in the dreamer, which will cause them to scream, shout or frantically thrash
out. People experiencing night terrors also can cultivate sleep walking in extreme cases

where night terrors are very frequent. Unlike nightmares, dreamers cannot recall any part

of their dream and do not feel distraught after the episode. Though they are more

distressing to witness, night terrors aren’t harmful. Another major difference between

nightmares and night terrors is that while nightmares occur during the REM sleep, night

terrors typically tend to happen in the non-REM sleep stages, that is during the early part of

the sleep. Bad dreams are the most common type of nightmare that happens to every

person. They are a step down in intensity from both general nightmares and night terrors

but causes emotional disturbances in dreamers. In bad dreams, the storyline, themes and

images can most probably be remembered by the dreamer, but the distress caused in

comparatively less.

III. NIGHTMARES IN CHILDREN

Nightmares are lengthy and story like sequenced that seem real and may incite

anxiety and fear or other dysphoric emotions (American Psychiatric Association, 2013). They

arise during the rapid eye movement sleep (REM sleep) and are therefore more likely to

occur in the second half the night, when dreaming is longer and intense. Nightmare has

been a topic that has elicited considerable interest amongst researches in the past few

years. However, the in-depth studies about the causes and effects of nightmares in children

and adults, are rather few. Nightmares in children and adults are extremely common. They

generally begin when a child is two years and increase in intensity around the ages four to

five. Though the intensity of nightmares abates, an average school or college going student

has between four and five nightmares per year, and an adult has about one to two per year
(Bullard, Davidson, 2016). Bad dreams and nightmares are especially common in children

than in adults. It is reported that 75% of children have at least had one nightmare or bad

dream in their lifetime (Fisher & Wilson, 1987; Mindell & Barrett, 2002). Despite the

frequency of nightmares in children, the various studies based on the subject have been

mostly focused on adults. This lack of research on children might be connected to the belief

that children have difficulty distinguishing between reality and fiction (Bernas, Dandurand,

Floress & Kuhn, 2016). Conversely, according to Sharon & Woolley (2004), children have a

more developed appreciation of the distinction between dreams and reality. Children

between the ages five to ten have extremely vivid nightmares that can be remembered

even years later, as this is the age their imagination and descriptive nature develops. This

trend drops significantly as children grow older.

IV. IDIOPATHIC NIGHTMARES

Occasional nightmares are considered ubiquitous and normal in children. However,

frequent and chronic nightmares can lead to considerable distress and anxiety amongst

children (Mindell & Barret, 2002). Frequent nightmares are mainly associated with family-

related factors and traits, such as insomnia and parasomnia, and parental predisposition.

According to Xin Li, Man Yu, Ping Lam, Zhang, Martin Li, Ching Lai & Kwok Wing (2011),

Familial aggregation plays a huge in role in instigating frequent nightmares in children

(p.487-493). Children with parents whose socio-economic background was lagging

cultivated more frequent nightmares than those children who came from a well-settled

background. Family traits like short temper, over-thinking, introversions, and lack of

confidence in general can lead to social isolation, bullying, and other events that can cause
trauma and anxiety amongst children. These factors can also be the cause of nightmares in

children. Research also shows that frequent nightmares is strongly associated with

hyperactivity, temper outbursts, and mood disturbances (Xin Li et al., 2011). Another major

reason for prevailing nightmares in children, as stated by Simrad, Nielsen, Tremblay, Boivin

& Montplaisir (2008), are sociodemographic characteristics including being a single child,

maternal separation and low or high family income. Other common factors that influence

nightmares in children are generalized depression, trauma and other mental health issues.

Further, anxiety is also a major contributing factor to nightmares in children. Though

researches regarding the correlation of the two in children are sparse, Vela-Bueno, Soldatos,

and Julius (1987) found a significant relationship between the frequency of nightmares and

anxiety in children. This is equivalent to the discoveries in nightmares among adults where

anxiety is a key cause. But this might not always be true. Though some children face anxiety

which can lead to nightmares, Fisher and Wilson (1987) found a positive trend between

nightmares and frightening TV content and over-excitement, in a study of children in grades

one to ten. The causes of nightmares in children, are therefore not the same for every

individual and are varied.

V. TRAUMATIC NIGHTMARES

Nightmares that occur due to trauma caused by extreme situations that have made a

huge negative impact are called traumatic nightmares. The most known and common types

of traumatic nightmares are, A. Post Traumatic Nightmares, B. Schizophrenic Nightmares

and C. Nightmares in Narcolepsy. 

 A. POST TRAUMATIC NIGHTMARES

Mental disorders are also one of the major concerns for frequent nightmares in

children. PTSD is one of the mental conditions in which traumatic nightmares and sleep

problems are a primary symptom (Spoormaker & Montgomery, 2008). Post Traumatic

Nightmares are frightening dreams which awaken a dreamer where it is influenced by

negative emotions like sadness, fear and other extreme negative emotions. Research shows

that about 3% - 15% of girls and 1% - 6% of boys develop PTSD (US Department of Veterans

Affairs). Youngsters with PTSD experience a lot of emotional distress, leading them to have

traumatic nightmares. Sufferers of the mental disorder undergo two processes: Rumination

and catastrophizing. During the rumination process, they keep thinking about the traumatic

event and during the catastrophizing, they await or expect something worse to happen,

increasing the chances of suffering nightmares (Raghavan, 2017). Recurring nightmares that

relive the trauma over and over are common along with having disturbing nightmares

during the day, among children with PTSD. During these nightmares, they experience strong

emotions, such as rage, intense fear or grief, that would have been appropriate reactions to

the original traumatic event. Parental PTSD is also a factor that leads to depressing

nightmares in children. Studies show that children with parents who have PTSD have

increased emotional problems, amplified depression (Yehuda, Bell, Bierer & Schmeidler,

2008), which can be major causes intense nightmares.

 B. SCHIZOPHRENIC NIGHTMARES

Psychotic experiences and schizophrenia are known to have an established

relationship (Fisher, Caspi, Poulton, Meier, Houts, Harrington, Arseneault & Moffitt, 2013).

One probable risk factor that is a potential reason for the development of these psychotic

experiences is children is disturbance of sleep. Though the most common association of

nightmares with psychiatric conditions is post-traumatic stress disorder, they are not rare in

the schizophrenia population too. Schizophrenic patients experience auditory, kinetic, visual

and tactile hallucination, strange and unusual ideas, incoherence of thoughts, irrational

feelings and emotional chaos, which also characterize the experiences of nightmares.

According to Cannon, Walsh, Hollis and Kargin, frequent nightmares in children were

directly associated with increased probability of developing schizophrenia in the future

(2013). Therefore, Schizophrenia and nightmares have an intimate connection (Seeman,

2017). Schizophrenic patients tend to accept impossible events as real and during dreams,

cannot distinguish between reality and their imagination. Since the boundary line between

reality and fabrication is very feeble in children (Bernas, Dandurand, Floress & Kuhn, 2016),

the experiences with nightmares among schizophrenic children is very distressing.

C. NIGHTMARES IN NARCOLEPSY

Narcolepsy is a sleep-wake disorder, in which patients suffer from excessive daytime

sleepiness, overwhelming sleep attacks and cataplexy. It is atypical of narcoleptic patients,

according to Terzaghi, Ratti, Manni F & Manni R, to be unable to profoundly distinguish

between reality and dream mentation during sleep paralysis (2011). Similar to nightmares in

schizophrenic patients, children affected with narcolepsy experience distressing nightmares.

Narcoleptic children are also found to experience more vivid, longer, more negative and

extremely complex nightmares during dream mentation as compared to healthy children

(Rak, Beitinger, Steiger, Schredl & Dresler, 2015, P.787-792). Some narcoleptic patients also

tend to have lucid dreams. Lucid dreaming enables the dreamer to influence the dream,

therefore giving potential to alter negative dreams. This causes many narcoleptic children

who have lucid dreams find their nightmares less distressing. Frequent and increased

nightmares in narcolepsy (Schredl, Binder, Feldmann, Göder, Hoppe, Schmitt, Schweitzer,

Specht & Steining, 2012) can be explained by two main factors. First, daytime stress caused

by the impairments of narcolepsy, like sleep deprivation, cataplexy and hallucinations in

some cases. These stress factors affect nightmare frequency and cause health deterioration.

Second, brain activation in limbic areas and particularly the amygdala might be higher in

narcoleptic patients due to their hyperactive REM sleep system, leading to more intense and

prolonged nightmares.

VI. EFFECTS OF NIGHTMARES

Frequent nightmares in children can have adverse effects in the mental and

psychological health. The relationship between frequent nightmares and child anxiety and

stress is bidirectional (Reynolds & Alfano, 2016). Instances that invoke stress and anxiety are

known to be factors that increase the frequency and intensity in nightmares, but in some

cases, the nightmares itself are a reason for the child to become anxiogenic (eg. Zaccagnino,

Gahagan, Spencer, Jellinek & Stein, 2012). Children who awaken for nightmares begin to

associate aspects of their bedrooms and familiar places like the closet and darkness with

fearful dream images and instances in nightmares leading to physiological hyperarousal

(Bernas et al., 2016). Children develop conditioned responses because of frequent traumatic

nightmares (Spoormaker, Schredl, & van den Bout, 2016). As a result of this, children

develop paranoia related to the nightmares and begin fostering tactics to avoid situations

that remind them of aspects in their nightmares. Some children may begin to insist on

sleeping with the lights on or not enter the bedroom altogether by entering their parent’s

bed. Children who have difficulty distinguishing between reality and dreams find their

nightmares even more distressing. The disturbances occurred due to nightmares in children,

negatively impact not only the children, but also the parents (Meltzer & Mindell, 2007).

Traumatic nightmares in young children can also lead to the development of phobias.

Further, according to research, frequent nightmares in children can also lead to adverse

psychopathological symptoms in the future.

VII. TREATMENT

With the help of modern day improvements in science and health care, it has

become possible to cure and treat people of their trauma and nightmare distress.

Researchers believe that each nightmare is connected to some part of past experience or

fear of any object and to cure a person of nightmares, it is necessary to find the cause or

root of it and give them the help they need. Nowadays, psychiatrists give consultation and

therapy sessions to children to try to identify what bothers them in their sleep and to help

them reduce their post nightmare distress. Treatments, either in the form of pharmaceutical

drugs (Medicines) or psychological treatments like behavioural therapy are also common for

children. Medicines like olanzapine and risperidone are prescribed to treat post traumatic

nightmares (Pae, Lim, Peindl, Ajwani, Serretti, Patkar & Lee, 2008) . Behavioural therapy
includes doing yoga, image rehearsal therapy and relaxation methods. Lucid dreaming is one

of the most sought after treatment for children in recent times. It involves an awareness of

the dream, even while the dream is ongoing. According to Voss, Holzmann, Tuin & Hobson

(2009), it is a hybrid state of consciousness, with features of both sleep and waking mental

processes. Lucid dreaming was found to be correlated with a decrease in nightmare distress

(Harb, Brownlow & Ross, 2016).

VIII. CONCLUSION

Nightmares have become increasingly common in this generation. Children

experience a lot of stress and factors that lead them to develop anxiety and other disorders

that take a toll on their mental health, thus leading them to have frequent nightmares. The

basic causes of nightmares in children are mostly anxiety, stress and other socio-cultural

factors, though hereditary also plays a significant role. In traumatic nightmares and in

idiopathic nightmares, the causes and effects are found to be bi-directional. PTSD,

Schizophrenia and narcolepsy have nightmares as their primary symptoms. Most

researchers suggest that curing children from their nightmares will improve their mental

health remarkably. Frequent nightmares in children, leads them to develop certain phobias

in extreme cases, and in normal cases tend to develop conditioned responses. Though

nightmares in children aren’t very harmful unless they lead to extreme mental distress, it is

safe to treatment. The most common treatment is sleeping pills, while for children

undergoing trauma, lucid dreaming is the most efficient method. In conclusion, nightmares

in children are always not given as much importance as they should be. They can have huge

effects on the mental health and development and can adversely affect them in the future.
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