Is It a Nightmare or Night Terror? Here's How to Tell Them Apart

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Nightmares are intense dreams while night terrors are episodes where you only partially wake from sleep and may thrash or scream. Nightmares are more common.

While nightmares and night terrors may sound like synonyms, these are actually two different experiences.

Nightmares are intense dreams that may provoke terror, anger, or disgust. You can usually remember them easily. They’re very common, but they only qualify as a mental health condition if they disrupt your daytime life.

Night terrors, also called sleep terrors, are episodes where you partially awake from slow-wave sleep. They generally involve signs of extreme stress, like screaming or waving your limbs. You probably won’t remember them, but a broken lamp or a concerned roommate may clue you in to what happened.

Read on for a crash course in how to tell nightmares and night terrors apart.

Nightmares vs. night terrors

Here’s a quick breakdown of the key differences between nightmares and night terrors:

	Nightmares	Night terrors
In general	Timing: Usually in the last third of the night.Sleep phase: REM phase.Common cause: Stress and trauma.Waking: You’ll typically wake on your own in a lucid state.Activity: You may groan or mumble.	Timing: Usually in first third of the night.Sleep phase: NREM phase, usually during slow-wave sleep.Common cause: Disruption of brain waves during sleep.Waking: You’ll typically be difficult to wake and may be confused for several minutes.Activity: You might thrash, scream, or run out of bed.
In adults	Prevalence: Virtually all adults have had a nightmare in their lifetime. Around 35-45% of adults have at least one a month.Peak: More common with advancing age.Content: Easily remembered. Common themes include failure, helplessness, and interpersonal conflict.	Prevalence: 1-2% have had night terrors at some point during adulthood.Peak: More common before age 25.Content: Difficult to remember. Some adults may have a vague recollection of feeling rushed or panicked, but no more.
In kids	Prevalence: 75% of kids have had at at least one nightmare.Peak: Nightmares usually emerge at age 3and peak between ages 6-10.Content: Easily remembered. Common themes include falling, being chased, or sensing an evil presence.	Prevalence: 56% of kids ages 13 and under have had night terrors at some point.Peak: Night terrors emerge at 18 months and prevalence decreases with age.Content: Almost impossible to remember.

What causes nightmares?

Several factors can contribute to nightmares, including:

Stress and trauma

Nightmares are dreams tainted by stress and trauma from the outside world. A common theory suggests nightmares are your brain’s way of rehearsing your responses to danger.

Your nightmare may not reflect the threat exactly. Instead, it provides a simplified, symbolic representation. If you’re worried about drifting apart from old friends, you might dream of a flood literally sweeping you away from your community.

Nightmares commonly happen after trauma. Around half of people seeking treatment for post-traumatic stress disorder (PTSD) have replicative nightmares. These recurrent dreams force you to re-experience the trauma that caused your PTSD. They tend to be deeply disturbing and may sabotage your ability to sleep.

Early childhood experiences

According to the stress acceleration hypothesis, much of your brain remains under construction before the age of 3 and a half. If something bad happens to you, your brain may rush its development of your fear response. As an adult, your brain may be less efficient at controlling negative emotions while you sleep, leaving you prone to nightmares.

That experience doesn’t have to involve abuse, either. It simply needs to be unpleasant enough to cause a strong stress response. For example, a stubborn case of diaper rash may not seem like a big deal to adults, but to an infant or toddler experiencing pain for the first time, it can be traumatic in its own way.

Medication

Certain medications can increase your chances of having nightmares. These include:

Beta-blockers. These medicines treat high blood pressure and irregular heartbeat.

Dopamine agonists. These medicines treat a range of conditions by mimicking the action of dopamine in your brain.

Selective serotonin reuptake inhibitors (SSRIs). These common antidepressants can help relieve symptoms of depression and anxiety.

What causes night terrors?

Night terrors typically happen when you’re deeply asleep. This period is called slow-wave sleep since the waves of electrical activity in your brain are larger and slower than usual.

People with frequent night terrors tend to have mismatched brain waves during this phase of sleep. When the brain waves clash, they may throw you into a half-awake state. Your body can go from zero to 100, making your heart race and your muscles tense. But your conscious self will likely be “offline” and unaware of what’s going on.

Several factors can predispose you to night terrors:

Genetics. The HLA-DQB1*05:01 allele shows up more frequently in people with sleep terrors.

Family history. If you have night terrors, there’s a 96 percent chance a family member experiences similar concerns. They may have night terrors, bouts of sleepwalking, or both.

Sleep disruption. Restless leg syndrome, sleep apnea, or fever can interrupt deep sleep and throw your brain waves off-kilter.

Medication. Drugs like lithium and sodium oxybate (Xyrem) can deepen your sleep and make night terror episodes more frequent.

How common are they?

Nightmares are much more common than night terrors. Both are more prevalent in childhood than adulthood.

Nightmares

As many as 75 percent of children say they’ve had at least one nightmare. A 2016 study of kindergarteners suggests children’s nightmares happen more frequently, and feel more distressing, than many parents realize.

Nightmares can begin around the age of 3, but they typically become less common after the age of 10.

Adults report nightmares less frequently than children, but some people do have them often. Between 35 and 45 percent of adults have nightmares at least once a month, while 2 to 6 percent of adults have nightmares at least once a week.

Around 4 percent of adults live with nightmare disorder, a condition that involves very vivid and upsetting nightmares. Other symptoms include:

intrusive thoughts about the nightmares

anxiety that persists into waking hours

daytime fatigue due to disrupted sleep

reluctance to fall asleep due to fears about having more nightmares

Night terrors

Night terrors happen most commonly in early childhood, but their prevalence rapidly declines with age.

A 2015 Canadian study followed 1,940 children from the age of 18 months to the age of 13 years. The authors found that 56 percent of participants reported experiencing night terrors at some point.

At 18 months, 34.4 percent of the children experienced night terrors.

By the age of 5, only 13.4 percent of the children had night terrors.

At age 13, only 5.3 percent of the children continued to experience night terrors.

You’re unlikely to develop a new case of night terrors after the age of 5. Among the children surveyed, only 16.5 percent had a first night terror after the age of 5. Most of the older children who experienced night terrors had a history of them in early childhood.

By adulthood, only 1 to 2 percent of people have night terrors. Even then, they’re most common before the age of 25.

Research suggests adults with night terrors are more likely to have a history of anxiety and depression. It’s unclear, though, whether these conditions contribute to night terrors, or vice versa. While mental health symptoms can absolutely disrupt your sleep, poor sleep can also worsen mental health.

How to recognize them

Nightmares and night terrors often resemble other sleepytime phenomena. Here’s how to tell them all apart.

Nightmare vs. bad dream

Nightmares tend to prompt a sense of danger, while bad dreams are usually just unpleasant. A dream that scares you enough to wake you is likely a nightmare. You can sleep through most bad dreams, which means you may not remember them clearly in the morning.

Nightmare vs. night terror

Most nightmares happen during the REM phase of sleep — early in the morning, if you sleep during the night. You will likely wake up alert and able to remember the dream clearly.

Night terrors typically happen during deep sleep, or early in the night. They can last anywhere from 30 seconds to 5 minutes, after which you may go back to bed. You probably won’t remember them in the morning.

Of course, if you sleep in the same room as someone else, they might remember your night terrors. They’re often hard to ignore since they can cause:

screaming or crying

jerking or flailing limbs

rapid heartbeat

tense muscles

profuse sweating

Sweat-drenched sheets or mysteriously broken belongings may also offer a few clues to a night terror episode.

Night terrors vs. sleepwalking

When you sleepwalk, you might engage in simple behaviors, like leaving bed and walking around the house, without conscious awareness. Like night terrors, sleepwalking stems from a disruption to brain waves during the NREM phase of sleep.

Night terrors more commonly involve distress, not movement. You may flail in bed, but you generally don’t go for a jaunt. Sleepwalking typically doesn’t involve strong emotions, and leaving your bed is a key sign.

According to the 2015 study mentioned above, sleepwalking is less common than night terrors. Only about 29 percent of the participants ever had a sleepwalking episode, while 56 percent experienced night terrors.

How to handle sleep disruptions

Although nightmares and night terrors are distinct conditions, they share many of the same triggers. You can lower your risk of experiencing them by:

taking steps to lower your daytime stress levels

limiting alcohol and other recreational drugs before bed

practicing good sleep hygiene by keeping your bedroom dark and quiet

getting enough sleep each night

Find 17 tips to improve your rest.

Helping children cope

A young child with nightmares may need some help calming down. You can comfort your child after a nightmare with calm reassurance, some cuddles, or a beloved toy.

Once your child has settled, consider leaving the doors to their bedroom and your bedroom open. This can help your child feel as if you’re available and sleeping close by, even if you’re actually down the hall. This sense of security can encourage your child to stay in their own bed rather than climbing into yours.

When it comes to night terrors, you probably won’t be able to talk your child through them. They’ll likely be difficult to wake, and shaking or shouting at them may worsen their panic. It’s generally best to avoid intervening unless you believe they might hurt themselves.

If they’re walking around the room, wait a few minutes for the episode to end and then guide them back to bed. More than likely, they’ll return to typical sleep before long. If your child has a night terror while still in bed, try soothing them back to sleep with a lullaby or quiet reassurance.

When to get professional support

Nightmare and night terror episodes usually don’t pose any cause for concern unless they happen frequently and disrupt your daily life.

Support from a therapist or sleep specialist may have benefit if you experience:

Sleep deprivation. For adults, this might involve symptoms like moodiness and poor memory. Children may be prone to tantrums.

Sleep reluctance. Adults may experience insomnia or put off going to sleep, while children may outright refuse to go to bed.

Underlying stress. Anxiety from your waking world can spill over into sleep. Child nightmares often center on physical threats like falling. Adult nightmares tend to focus on more abstract, interpersonal issues.

Injuries. During night terrors, adults may strike others, damage nearby belongings, or even run into walls and furniture. Young children may bruise themselves against their crib or fall out of bed.

Treatment for nightmares

Therapy for nightmares can help you sleuth out possible triggers and begin to process emotions around that trigger.

For example, say a child’s nightmares relate to their parents’ divorce. A family therapist might help the child identify and work through fears of abandonment. Once their anxiety eases, their brain will likely stop “rehearsing” its response to parental rejection.

For repetitive, trauma-related nightmares, the American Academy of Sleep Medicine recommends image rehearsal therapy. This treatment has you recall the storyline of your recurring nightmare. The therapist may then ask you to create a happier ending and rehearse it in your mind. In theory, this can make your dreams more pleasant, or at least less traumatic.

Treatment for night terrors

Scheduled awakening is often the go-to treatment for young children since night terrors occur around roughly the same time each night.

If your child has night terrors around 10 p.m., for instance, you might briefly wake them up at 9:45 p.m. The scheduled awakening can interrupt their brain waves and prevent the night terror before it begins.

For older children and adults, behavioral therapy can often help reduce stress and improve sleep. Although research on therapy for night terrors remains limited, potential treatments include:

psychotherapy

relaxation therapy

hypnosis

Some studies suggest low doses of clonazepam (between 0.5 and 1.0 mg a day) could also help with night terrors. However, evidence supporting this treatment remains limited. Healthcare professionals generally don’t prescribe medication for night terrors unless there’s a chance you could physically hurt yourself during them.

The bottom line

Nightmares are disturbing dreams you can easily remember upon waking, while night terrors are episodes of screaming and flailing that you typically won’t recall.

While children more commonly experience these sleep disturbances, adults can have them too. Treatment often involves reducing stress, processing trauma, and taking steps to improve your sleep.

It might help you rest a little easier to know the occasional nightmare or night terror generally isn’t cause for concern. But without a doubt, they can still feel unpleasant. If you or a loved one have had some rough nights lately, you’re certainly entitled to a hug.

Science of Dreams: What are Nightmares?

Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.

Posted : 2024-09-30 09:08

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