Some children have more trouble than others do in getting a good night’s sleep. Common problems are sleep apnea, nightmares, night terrors, and sleepwalking.

Sleep Apnea

Unlike periodic breathing, sleep apnea is an abnormal condition in which children (or adults, for that matter) stop breathing for a few moments. Then they rouse from sleep long enough to choke, cough, shift position, and start breathing again before returning to sleep. This process may happen many times—even hundreds of times—each night. The child generally will not realize it is happening and cannot tell you about it. Apnea means absence of breathing. One form of this condition is called obstructive sleep apnea because the airways are partially obstructed or blocked during sleep. In children, it is most common between ages two and five.

The nighttime symptoms include snoring or noisy breathing, choking, sweating, and waking during the night. During the day, children may be sleepy, falling asleep at meals or during play. Or they may seem hyper, wired, unable to sit still or calm down, cranky, and irritable. In the long run, sleep apnea can impair children’s growth and development, harm their performance in school, and, in severe cases, cause heart problems.

Sleep apnea often goes undiagnosed for a while. Although any child may snore temporarily if he has a cold, regular nightly snoring should be discussed with your child’s doctor.

The most common cause of sleep apnea in children is enlarged tonsils or adenoids that partially block the throat when the throat muscles relax during sleep. The usual treatment is removal of the tonsils, adenoids, or both, through surgery. Other causes or contributing factors may be abnormalities of the jaw or throat, allergies, frequent respiratory infections, obesity, and some neurologic problems such as cerebral palsy. Children with Down syndrome are at high risk for obstructive sleep apnea. If doctors can’t eliminate or treat the underlying conditions, they may recommend CPAP (continuous positive airway pressure), in which the child leeps with a mask over his nose that is attached to an air compressor. The air he inhales is under pressure, which forces the airways to stay open.

Nightmares: Monsters in the Night

Nightmares are as inevitable a part of childhood as skinned knees. How early they start is unknown, but children describe dreams as soon as they can talk. In young children, they generally are thought to reflect psychological tasks or conflicts that are a normal part of growing up, such as separation anxiety or competing desires to be in control and to please parents. Preschoolers typically have nightmares about monsters or wild animals, which are thought to represent the child’s aggressive urges.

Preschoolers generally can understand that nightmares are not “real” and cannot hurt them but may still feel deeply frightened. If your child calls out in the night, comfort her with hugs and reassurance, reminding her that nightmares are not real and that you are there to protect and love her. Don’t belittle her fear; let her know that everyone gets scared by nightmares sometimes. You will probably need to sit with your child for a while, perhaps until she falls back to sleep.

If nightmares occasionally occur, they are nothing to worry about. A nightlight, hall light, or flashlight kept by the bed “just in case” may help. It also makes sense to avoid scary movies, books, TV shows, and video games, especially right before bed.

Nightmares often peak in the preschool years, along with fear of the dark. Sometimes nightmares mirror upsetting events that happen during the day. If some task, such as learning to use the toilet, seems to be causing heavy stress, you might ease up or delay it a while. You can also encourage your child to talk about feelings he finds frightening, reassuring him that everyone has such feelings and helping him distinguish between feelings and behavior.

If your child’s nightmares or daytime fears seem excessive to you, talk to your child’s doctor, who may refer you to a specialist in child development issues. In some cases, nightmares or fear of sleep can be a symptom of physical or sexual abuse. If you suspect this, talk to your child’s doctor immediately.

Night Terrors: Asleep at the Switch

Your sleeping child lets out a heart-stopping scream. When you run to her, her eyes are wide open, her face contorted in an unnatural way, her hair wet with sweat. She may be sitting up, or out of bed, or thrashing around in such an odd way that you wonder if she is having a seizure.

Even though she may be calling for you, she may not recognize you. Trying to touch or calm her makes things worse. What’s going on? This is a night terror, one of the most dramatic—and generally harmless—sleep events of childhood. Unlike nightmares, night terrors are not dreams and do not occur during REM sleep, when dreams occur. Instead, they occur when a child in deep non-REM sleep is switching to another stage and somehow gets “stuck” between stages. This “between” state—which combines features of waking and sleeping—is called “partial arousal.” Walking and talking during your sleep can also occur during partial arousals. A tendency toward partial arousals seems to run in families.

Night terrors (or sleep terrors, as they are also called) generally occur in children ages two to six. In this age group, they do not indicate any underlying problem and are usually outgrown. They may occur only once, or every once in a while, or much more frequently. They last 5 to 30 minutes and usually end as the child falls back into peaceful sleep without ever having wakened. Children generally will not recall the episode the next day, although some may remember feeling frightened.

Less is more when it comes to helping a child with night terrors. Don’t try to wake or question her before or after the episode. If she’ll accept it, you can touch or speak to her softly, but many children reject such contact. Keep the lights low and simply watch her to make sure she doesn’t hurt herself while moving around. If your child has frequent night terrors, make sure the room she sleeps in is as free of hazards as possible. Can night terrors be prevented? Usually not. But children who are overtired may be more likely to have them, so you can try an earlier bedtime or longer naps to see if that helps. In some cases, partial arousals also increase at times of emotional stress.

Sleepwalking

Like night terrors, sleepwalking occurs when a child gets stuck between deep sleep and waking and usually does not indicate an underlying problem in a young child. There’s no need to wake a sleepwalker; you can usually gently lead her back to bed. The parent’s main job is to protect a sleepwalker from injury. The area around the child’s bed should be clear of rugs she can slip on or furniture she can trip over. You may need to install gates at the top and bottom of stairs, block off the kitchen, or put a bell or alarm on the child’s door to alert you when she’s walking about.

Other Sleep-Related Problems

Some children develop rhythmic disorders associated with sleep, such as head banging, head rocking, and body rocking, which involve movements that range from mild to seizurelike thrashing. Other rhythmic disorders include shuttling (rocking back and forth on hands and knees) and folding (raising the torso and knees simultaneously). During the rhythmic movements, your child may moan or hum. These movements seem to occur during the transition between wakefulness and sleep or between one stage of sleep and another. There is no known cause for this type of disorder, but medical or psychological problems are rarely associated with it. Other common sleep-related problems include bedwetting and tooth grinding (bruxism).