Coffee with Sam: The Truth about Nightmares

Dr. Tom Jackson is a psychiatrist who has specialized in the treatment of sleep disorders and anxiety for the past thirty years.

I recently had the chance to have a virtual cup of coffee with Dr. Tom Jackson, who I think is best described as a jack-of-many trades. A trained psychiatrist, he has some interesting ideas about kids and nightmares. Though he is not married and has no children of his own, he has been helpful in raising many children and feels that, in his case, the sheer quantity of kids he deals with more then makes up for not having any biologically. Let’s see what the good Doctor has to say that may keep our little sweeties in their own beds, and quiet….please……

Samantha Feuss- It’s not often one comes across a nightmare expert- how did that come about?
Dr. Tom Jackson- My knowledge regarding nightmares grew out of my interest in the treatment of sleep disorders, which goes back thirty years. Shortly after finishing my specialty training in psychiatry I found myself frustrated by the limited treatment options available for insomnia—basically just a few medications, all with potentially serious side effects. So it was at that time that I began developing an alternative approach to helping people with insomnia using the skills I had developed as an audio engineer through my production of music. So, my focus on treating sleep problems led me to dealing with nightmares in both children and adults because it is one of the fundamental issues that can interfere with sleep.

SF- How old are children before they typically begin experiencing nightmares?
DTJ- Sleep experts have delved into this particular issue by studying young children utilizing all-night EEG’s or polysomnographs. There’s not full agreement yet on how early they may begin, but some experts believe infants may have nightmares even before they have developed the verbal skills needed to describe their experience. But by age two nightmares are not uncommon.

SF- Nightmares affect so many children. Do you find that there is anything special a parent can do to reduce the chances of experiencing nightmares?
DTJ- Yes, there are a number of things parents can do to decrease the chances of a child having nightmares. So let me outline tem for you:

1. Prevention is the best cure. Prevention is the challenge, but also the best solution. Make bedtime a comfortable and safe experience for the child. Spend time with him at bedtime, reading, playing a board game, cards, talking about the day’s events, and otherwise helping him to relax. A soothing bedtime ritual might also include a gentle massage, a warm mug of herbal (caffeine-free) tea, or even something as simple as being tucked in with regular hugs and kisses.
2. Discuss your child’s dreams with him. If your child experiences frequent nightmares (several a month), you may want to work with him during the day to try to determine what underlying fears may be causing them and then try to resolve the trouble on that level. What is the child actually afraid of? Discussing the content of nightmares with the child can help shed light on this critical question. Once you know what your child is afraid of – whether it’s spiders or the possible death of a parent – you can then focus your attention on that fear, rather than the nightmare. Once the fear precipitating the nightmares goes away, it is entirely possible that the nightmares themselves will as well.
3. Examine your child’s daily routine. In addition to discussing the content of your child’s bad dreams in an effort to uncover their cause, it may also be worthwhile to review what is happening in your child’s daily life. Might there be something at home or school or elsewhere going on that could be causing enough distress to possibly lead to bad dreams? Also, monitor the television programs and movies your child watches and the video games your child plays so as to avoid those that might be too scary, violent, or otherwise disturbing.
4. Discuss your child’s daily life with him. By age 3, your child can begin to talk directly with you about any concerns and worries that could be triggering nightmares; then you can offer reassurance and guidance for dealing with those causes. Allow your child, at any age, to express feelings in appropriate ways. Try to assure your child that his feelings are understandable and normal. It is important to maintain open communication with him by expressing your willingness to discuss any concerns he may have, no matter how difficult or touchy the issue may be. If your child has difficulty expressing either the content of the nightmares or the concerns in waking life that could be causing them, consider exploring these issues in more creative and less explicit ways, for example by drawing or playacting.
5. Speak with a doctor if it seems necessary. A nightmare disorder occurs when frequent and repeated nightmares continually disrupt a child’s sleep and are beginning to negatively affect his waking life. If the nightmares continue even after you’ve employed measures to end them, it’s advisable to discuss your concern with your child’s doctor.

SF- My grandmother, who normally knows her stuff, swore that too much sugar before bed gave kids nightmares. Any proof to that?

DTJ- Your grandmother may have been very wise, but on this one she missed the mark. But she wasn’t alone in this belief, because a certain amount of conventional lore linking sugar to nightmares does exist. This issue has been scientifically studied and there is no evidence that excessive sugar causes nightmares. Now, that said, there is some evidence that eating too much before bedtime can cause increased brain wave activity while sleeping and it is possible this could result in more vivid dreams and, perhaps, nightmares. So this is the closest link we have, but it isn’t specific to sugar.

SF- What is the difference between a nightmare and a night terror?
DTJ- Nightmares are most common during REM sleep, which happens predominantly during the second half of the night, whereas night terrors are not associated with dreaming and occur primarily in the first half of the night. With nightmares, a child may moan softly and make small movements, but with night terrors you are likely to observe sudden episodes of screaming, crying, and thrashing around in bed or the child may get out of bed and run around wildly. The child may be sweating, breathing rapidly and have dilated pupils and remain agitated for minutes up to a half hour. Other distinguishing features are it is nearly impossible to awaken a child having a night terror and they will demonstrate a lack of memory for the event in the morning. Not only is it very difficult to awaken a child in the midst of a night terror, this should not be attempted because even if you are able to awaken them, they will be confused and disoriented, causing even greater problems. Just let the episodes pass without intervening, except to the degree necessary to keep the child safe. There is no danger unless the child is trashing about in a manner that may cause harm, in which case you should clear the area but do not try to restrain the child. If a child gets out of bed, gently guide them back. Fortunately, night terrors do tend to go away, over time, on their own.

SF- Do kids typically have more bad dreams at certain times of the year, like around Halloween?
DTJ- I am unaware of any research that would support this concept, but my logic tells me it’s very likely true. There’s evidence that about 30% of the time nightmares often contain elements of a television show the child has just watched. Since there are more scary TV shows and movies this time of the year, it would be surprising if nightmares weren’t more frequent. On the other hand, we now seem to be experiencing what I call “year-round Halloween.” It seems like on any given night when you turn on the TV there are shows featuring vampires, zombies, ghosts, werewolves or shape-shifters. I regularly urge parents to activate and program the V Chip that is in every television sold since the year 2000 that allows them to filter out programming that is not age-appropriate.

SF- When a child is going through a traumatic event, changing (or starting) schools, or experiencing a loss, peaceful sleep can be hard to come by. How can we help lull our little ones into dreamland, and keep them there?
DTJ- There are a number of things parents can do to promote optimal sleep, all of which come under four areas of what is referred to as sleep hygiene.

Sleep hygiene refers to the set of habits and guidelines that promote consistently restful and sufficient sleep at night and complete alertness during the day. It’s what you can do (and in some cases, not do) to help your child (and you) sleep easy and well.

The clearest sign that a child has poor sleep hygiene—or could at least use some improvements in the area—is if he experiences nighttime sleeplessness and/or daytime sluggishness.

1. Bedtime schedule. Create a bedtime routine that works for you and your child, and then stick to it. Sleep and waking cycles need to act in harmony with all other body cycles, such as body temperature, metabolism, dietary schedule and hormonal activity—our circadian rhythms. Our bodies are designed to naturally seek out homeostasis, or the condition in which all body systems find balance. In order to achieve that homeostasis, all these circadian rhythms must sync smoothly with one another.

For any bedtime schedule to work, it requires two key components:

• It must include both a regular bedtime and a regular waking time. Make sure the times you select are practical and realistic for you and your child’s other life schedules.
• It should stay consistent seven days a week. If you must adjust it for weekends, then don’t adjust it by any more than an hour in either direction or else you defeat the whole purpose. Their physiology simply will not know when it’s time to sleep or be awake. And this goes double for teenagers.

Adults may find this framework an even harder challenge to meet than their children do because adult schedules usually differ from weekdays to weekends and in many cases from weeknight to weeknight. Unfortunately, this irregularity in your own schedules may make it difficult to enforce a regular bedtime schedule in your children, but it makes it no less necessary.

At the same time, in order to be effective, the sleeping and waking times you set must not merely be consistent and practical for your schedules, but it must also enable your child to get a sufficient amount of sleep. These days, most experts place the right amount at around 11 hours for five-year-olds, 10 hours for ten-year-olds and 9 hours for eighteen-year-olds. Forty percent of children don’t get adequate sleep and how any seniors in high school get 9 hours? It turns out that less than 5% get more than 8 hours.

Think of a bedtime schedule like setting your child’s biological clock. Set it right and your child’s bodily rhythms begin to naturally run like clockwork.

1. Bedtime routine. Establish a regular bedtime routine for your child. A regular bedtime routine, about 1/2-hour long leading up to bedtime itself, is how you can best help your child to prepare for a good night’s sleep. A bedtime routine involves engaging in comforting and familiar activities that are also relaxing.To be avoided during this critical time period are heavy emotional conversations, TV and video games, lots of liquids, rough-and-tumble play and cardiovascular/aerobic exercise, and big meals and sugary snacks. Remember to keep bedtime snacks light.Good bedtime routine activities include reading a story together, stretching, relaxing family time, and listening to tranquil music, nature sounds, or a relaxation CD.

   As children grow older, you can be more flexible with bedtime routines, which may grow to include a walk outside, a chat on the back porch about the day’s events or future plans, or perhaps playing a board game or card game or doing a puzzle together. Older children may want to retire to their rooms to read, listen to music or work on a favorite hobby before retiring for the night and possibly listening to one of my sleep programs.

   Whatever activities you and your child decide upon, the cornerstone of your child’s bedtime routine is that he knows what time to slip into pajamas and brush teeth, what time to be in bed, and how much time can be spent on in-bed activities such as reading.

2. Environmental conditions of the bedroom. Certain qualities of the setting in which you set your child down to sleep can play a significant role in the quality of sleep.-Set a bedroom temperature that’s comfortable and will remain consistent throughout the night, erring on the cooler side as it’s more supportive of healthful sleep than an excessively warm room (that being anything over 75 degrees); and keeping that temperature consistent throughout the night can help avert nighttime waking.
   • Make the room sufficiently dark. A small nightlight is okay, if needed, but too much brightness interferes with restful sleep.
   • Ensure sufficient ventilation/air circulation, such as by cracking the door open or using a ceiling fan set on low; refrain, however, from leaving a window wide open all night for both safety and health reasons.
   • Provide your child a quiet sleeping environment, for reasons that should be obvious.
   • Shut off the television, and what’s more, take the television out of your child’s bedroom (children with a TV in their bedroom average an hour less sleep).
   • Keep the bed for sleeping, in other words refrain from getting your child in the habit of associating his bed with anything other than sleeping, such as playing, reading, eating, or watching TV.
   • Dress your child in comfortable pajamas, as the more comfortable he is the easier a time he will have of falling asleep and staying asleep.
   • For the same reason, provide your child with a comfortable mattress and pillows, bedsheets and blankets.
3. Daytime behaviors and habits. Many of the factors that influence your child’s sleep the most don’t even occur at night. On the contrary, a variety of habits and behaviors that have a major impact on his sleep occur in broad daylight.

The following are suggestions of daytime behaviors supportive of good sleep hygiene.

• Expose your child to sunlight first thing in the morning, as it helps to set circadian rhythms for the rest of the day. Additionally, ensure your child gets sufficient exposure to natural sunlight on a daily basis.
• Don’t use your child’s bedroom for punishments or time-outs, as a child must feel comfortable, safe and happy to be in his bedroom in order to fall asleep and sleep soundly.
• Monitor the content of your child’s television viewing, Internet surfing and video game playing, as exposure to excessively violent, disturbing or confusing images could be responsible for many sleep disturbances, such as nightmares.
• Confront bullying or other prevalent emotional issues in your child’s daily life, as any number of daily stressors could directly impact your child’s sleep.
• Avoid caffeine, especially late in the day.
• Discuss your child’s medicines with his pediatrician, as some medications (including prescription drugs, over-the-counter medicines, and all-natural/herbal remedies) could have side effects that interfere with your child’s restful sleep. If your child turns out to be on such a medication, your doctor can usually help you find adequate alternatives devoid of such side effects.

Improvements in your child’s sleep patterns likely won’t happen overnight, but once you begin implementing good sleep hygiene practices in your child’s life, you’re bound to notice positive results in due course.

SF- When a child wakes with bad dreams, it is sometimes hard to comfort them and get them to go back to (their own) bed. What do you recommend?
DTJ –

1. Remind them they were dreaming, but don’t expect that to settle the issue. Children younger than age 6 may still have difficulty understanding the nature of dreams and that they aren’t real.
2. Cuddle with your child and gently stroke his back or neck.
3. Listen to your child’s fears with empathy, understanding that the fears are real and should not be discounted.
4. Remind your child they can think comforting thoughts to sooth themselves. Suggest, for example, he imagine the nightmare scenario ending in a happy manner. Don’t underestimate the effectiveness of this technique, called Image Rehearsal Therapy. Recent research has shown it to be surprisingly effective.
5. Provide a nightlight and make sure it isn’t casting scary shadows in the room.
6. Provide a security object for your child, like a stuffed toy, to keep in bed or perhaps allow the family pet to be nearby for nighttime company.
7. If your child is too afraid to go back to sleep you may have to stay in the room until the time comes.
8. If your child is very frightened, you may need to do a relaxing activity together like reading a story. If you really need your sleep and don’t have time to do this, providing one of my DreamChild Adventures sleep programs (Magic Carpet or Playhouse on the Beach) is an ideal solution. The programs have consistently helped children with bedtime fears and nightmares, so not only will they help your child fall back to sleep, they provide the added benefit of relieving nightmares.
9. If necessary, you might lie down with your child, but you probably want to think twice about letting them join you in your bed. Now why might this be? By allowing your child, under this circumstance, to leave his bed, it suggests to the child that sleeping in his own bed is what causes nightmares, which becomes a set-up for future problems–you may find yourself dealing with a child at your bedroom door on a nightly basis complaining of nightmares.

SF- We have tried it all around here- nightlights, “good” monster stuffed toys, “monster spray”, checking under beds and in closets, roaring to scare monsters and ghosts away, letting the dog sleep in his room, bedtime tea, lavender massages before bed- I can keep going, LOL- but nothing seems to work. What would you tell a parent like me, who can’t chase away their kiddo’s bad dreams?
DTJ- First off, stop acting as if monsters are real! A child watching a parent checking, night after night, under the bed and in the closet for monsters or ghosts, is likely to become convinced their fears are justified and one of these nights….

But when nightmares do not respond to a parent’s best attempts to help the child with them, and if they are frequent, severe, interfering with the child’s sleep and beginning to have a negative impact on the child’s waking life, the problem has become a nightmare disorder and it’s time to consult with the child’s doctor. There could be something physical or some deeper psychological issues that need to be addressed.

SF-Do many kids who experience nightmares end up sleepwalking or talking?
DTJ- I’m unaware of any research that demonstrates a relationship. Nightmares happen in REM sleep, sleepwalking in deep sleep and sleep talking happens in transition between sleep stages. So they are really quite independent of one another. But, there does seem to be a significant relationship between night terrors and sleepwalking. And, by the way, whereas I warned against awakening a child experiencing a sleep terror, there are no problems associated with awakening a child who is sleepwalking.

SF- How do we reduce anxiety at more stressful times in their lives, and help them sleep well and worry-free?
DTJ – As you are of course aware, some degree of anxiety is a normal part of all of our lives, children included. But when it rises to the level of interfering significantly with a child’s ability to function or enjoy his day-to-day life, it is a problem that should be addressed.

Anxiety is the perception of danger when, in reality, none exists—it is fear of the imaginary, a spiraling cascade of “what ifs.” Fear or anxiety sets off the “fight or flight” response (also called the stress response). The imagined dangers that anxiety creates range from embarrassment and humiliation to physical harm and even death. When a danger is real, you take action in response to the fight or flight reaction. But when there is no real threat, it leaves the individual stuck in this very uncomfortable, hyper-alert state. And, in truth, it isn’t the triggers for a child’s anxiety that the child is actually afraid of, it’s the physical sensations of fear—the stress response.

Therefore, the more a child avoids these anxiety inducing situations, the more anxiety those situations, and thoughts about them, produce. In other words, the more the child engages in the very situations which trigger anxiety, the less anxiety those situations will produce. Children need to learn they are bigger than their fears.

Helping with Anxiety

1. Reassurance doesn’t work—trying to help a child see that the fear is unfounded only makes them feel like you don’t understand what they are going through and that you see them as weak.
2. So, you need to validate the realness of the child’s feeling, whatever the trigger, not as being justified but as being real. Recognition of feelings without judgment is the trick.
   • “That must be very frightening.”
   • “That sounds like it feels awful.”
3. The best thing you can do to help a child with anxiety is to get him to talk about it—when not experiencing it. The act of turning and facing it rather than hiding and running, in a psychological sense, is a huge first step. Confronting one’s anxiety creates an immediate sense of accomplishment and improved self-confidence.
4. Help the child separate from the anxiety and see that he is not his anxiety. It’s difficult to observe an emotion and experience it at the same time—observation creates an immediate separation between the observer and that which is being observed. You can have them discuss the various intensities or even grade it on a scale of 1- 10.
5. Your child can learn that when you don’t run from it, but face it, it tends to dissipate all by itself. It’s not something you can do for your child. They have to face it down for themselves. They need to learn that anxiety feeds on fear and if they refuse to give in to their anxiety and the uncomfortable feelings, the anxiety has nothing to feed on and retreats or withers away.
6. Teaching your child how to relax can be instrumental in handling anxiety. You can’t force them to do this, it must be of their own volition, but you can guide them. The relaxation response if the opposite of, and the solution to, the stress response. This is a way to help a child take back some control. The stress response is something that happens to us, but the relaxation response is something we can make happen. Common relaxation techniques include:
   • Deep abdominal breathing- consciously breathing down into the belly
   • Progressive muscle relaxation- focusing on relaxing each individual muscle group
   • Visualization- conjuring up pleasant and relaxing images in the mind
7. Deep restful sleep is a fundamental aspect of relaxation and a key component of achieving a relaxed mind and body and is a first-line defense against anxiety.
8. Avoid caffeine because it activates the sympathetic nervous system, which is in charge of the fight or flight response.
9. Eat a generally balanced diet
10. Get adequate exercise, which causes the body to secrete endorphins, hormones which enhance mood and relieve anxiety.
11. When anxiety rises above what is considered normal or appropriate, to the level that it pervades day-to-day living, setting up insurmountable limitations, anxiety surpasses the mere problem stage and rises to the level of a full-fledged anxiety disorder. In these circumstances a thorough examination by a trained professional is warranted and may uncover a disorder such as Generalized Anxiety Disorder, Social Anxiety Disorder, Specific Phobic Disorder, Panic Disorder or Separation Anxiety Disorder, which may require professional intervention.

Dr. Thomas Jackson is the creator of the DreamChild™ Adventures audio programs and author of the companion guide, DreamChild™ Adventures in Relaxation and Sleep. He is currently Medical Director of a public mental health clinic and in private practice. For more information, please visit www.3DAudioMagic.com and www.ThomasJacksonMD.com