Nightmares 

  • Author: Daniel R Neuspiel, MD, MPH, FAAP; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Mar 9, 2011
 

Background

Sleep disorders or parasomnias occur in 35-45% of children aged 2-18 years. Common sleep disorders in children include sleepwalking, sleeptalking, night terrors, and nightmares.

Nightmares are defined as "recurrent episodes of awakening from sleep with recall of intensely disturbing dream mentation, usually involving fear or anxiety, but also anger, sadness, disgust, and other dysphoric emotions."[1]

Nightmare disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as repeated awakenings with recollection of terrifying dreams, usually involving threats to survival, safety, and self-esteem.[2]

Nightmares are frightening events for a child and may be concerning for the family; however, they are sporadic in most children.

Upon awakening from a nightmare, the child is alert and able to recall the dream in detail. The child's reaction to the nightmare may interrupt the parents' sleep. In the morning, children often recall the arousal and the sleep disturbance may impair the child's daily functioning.

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Pathophysiology

Sleep is divided into two distinct states: rapid eye movement (REM) and nonrapid eye movement (non-REM). REM and non-REM sleep alternate in 90-minute to 100-minute cycles. REM sleep is characterized by EEG activity similar to a wakeful pattern. In older children and adults, 75% of sleep is non-REM sleep, which consists of 4 stages. Dreaming and nightmares occur during REM sleep and are more frequent in the second half of the night.

Nightmares are often confused with night terrors, which are episodes of extreme panic and confusion associated with vocalization, movement, and autonomic discharge. Children with night terrors are difficult to arouse and console and do not recall a dream or nightmare. Night terrors occur during non-REM sleep.

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Epidemiology

Frequency

United States

Prevalence varies because of different diagnostic criteria and different study populations. Nightmares have been noted to occur in 2-11% of young children "always and often" and in 15-31% of young children "now and then."[3] Some studies estimate as many as 50% of children aged 3-6 years have nightmares that disturb both their and the parents' sleep. Approximately one third of adults with recurrent nightmares have onset of symptoms in childhood.

Race

Nightmares occur in all races and cultures, with no reported differences in prevalence.

Sex

Young children exhibit no gender differences in nightmare prevalence.[4] In one study of children aged 13-16 years, more girls than boys reported nightmares.[5]

Age

Onset typically occurs between age 3-6 years. Peak incidence occurs in children aged 7-9 years.[6]

Parasomnias are more common in preschool children, occurring in 88% of children aged 2.5-6 years.[4]

The prevalence of nightmares and other parasomnias declines in school age and adolescence, presumably due to progressive neurological maturation and reduction in separation anxiety.[7]

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Contributor Information and Disclosures
Author

Daniel R Neuspiel, MD, MPH, FAAP  Director of Ambulatory Pediatrics, Levine Children's Hospital, Carolinas Medical Center; Adjunct Clinical Professor of Pediatrics, University of North Carolina School of Medicine

Daniel R Neuspiel, MD, MPH, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American Public Health Association, New York Academy of Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Erin Hollingsworth Stubbs, MD  Faculty Physician, Division of General Pediatrics, Levine Children's Hospital, Carolinas Medical Center

Erin Hollingsworth Stubbs, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson, MD  Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and coding manual. 2nd. Westchester, IL: American Academy of Sleep Medicine; 2005.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th. Washington, DC: American Psychiatric Association; 1994.

  3. Partinen M, Hubin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC. Principles and Practice in Sleep Medicine. Philadelphia: WB Saunders; 2000:pp 558-579.

  4. Petit D, Touchette E, Tremblay RE et al. Dyssomnias and parasomnias in early childhood. Pediatrics. 2007;119:e1016-e1025. [Medline]. [Full Text].

  5. Nielsen TA, Laberge L, Paquet J, et al. Development of disturbing dreams during adolescence and their relation to anxiety symptoms. Sleep. Sep 15 2000;23(6):727-36. [Medline].

  6. Muris P, Merckelbach H, Gadet B, et al. Fears, worries, and scary dreams in 4- to 12-year-old children: their content, developmental pattern, and origins. J Clin Child Psychol. 2000;29:43-52. [Full Text].

  7. Kotagal S. Parasomnias of childhood. Curr Opinion Pediatr. 2008;20:659-665. [Medline].

  8. Bloomfield ER, Shatkin JP. Parasomnias and movement disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. Oct 2009;18(4):947-65. [Medline].

  9. Sadeh A. Cognitive-behavioral treatment for childhood sleep disorders. Clin Psychol Rev. Jul 2005;25(5):612-28. [Medline].

  10. Hauri PJ, Silber MH, Boeve BF. The treatment of parasomnias with hypnosis: a 5-year follow-up study. J Clin Sleep Med. 2007;3:369-373. [Full Text].

 
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