The Difference Between Nightmares and Night Terrors

answering all your most frequently asked questions when it comes to nightmares and night terrors

What Are Nightmares?

Nightmares are intense, detailed dreams that may make you scared, nervous, or even angry. You may be able to remember a nightmare if it was the last dream you had before waking or if you woke up during it. Nightmares are very common. However, they only are considered a mental health condition if it negatively impacts your day-to-day life.

What Sleep Phase Do Nightmares Happen In?

Nightmares happen during Rapid Eye Movement sleep (REM), which consists of 20% of our sleep and takes place mainly during the very early morning. During REM sleep, our brain processes information and emotions.

What Causes Nightmares?

A theory suggests that nightmares are your brain’s way of rehearsing your responses to the real world. Nightmares commonly happen after trauma or during times of stress. About half of people who are in treatment for PTSD have recurring nightmares. An early negative childhood experience can also cause nightmares to happen. 

Medications such as Beta-blockers(treat high blood pressure), Dopamine agonists(treat different conditions by mimicking dopamine in your brain. ), and selective serotonin reuptake inhibitors (common antidepressants) can also cause nightmares.

Are Nightmares Common?

Almost all adults have had a nightmare in their lifetime. It is stated that about 35-45% of adults have one once a month. Nightmares are more common in elders and children. They typically start around age 3 when abstract thought develops, and by age 10, they are less common.

Why Do Nightmares Happen?

People can have nightmares due to high stress or anxiety. Another reason someone can experience nightmares is due to past trauma.

How Do Nightmares Affect Sleep Quality and Quantity?

It can negatively impact an individual's sleeps quality and quantity. They may feel anxious about having nightmares and stay up to try and avoid that scenario. Or they may have a hard time falling back to sleep after a nightmare. 

If someone is not getting enough high-quality sleep it can irritability and performance problems the next day.  If they become chronic it can increase the risk of conditions such as Type II Diabetes, heart disease, obesity, depression and anxiety.

Are Nightmares Normal?

It is normal to have nightmares every so often. You should contact your doctor if nightmares are happening several times a week, affect your life/mood, you start having nightmares when starting a new medication. It can be helpful to keep a nightmare journal to share with your doctor. 

How Are Nightmares Related to Mental Health Conditions?

Research tells us that if an individual has consistent nightmares, they have greater PTSD symptoms than those who do not. PTSD can lead to an individual developing anxiety or depression as well. This in itself increases the likelihood of having nightmares. 

Adults who have anxiety and/or depression are more likely to have nightmares as well.

Is There a Common Type of Nightmare?

Common themes include failure, being chased by someone/something, and death or health-related nightmares.

What Are Night Terrors?

Night terrors are when you are half awake from slow-wave sleep. There is more distress during this episode, such as screaming or aggressively moving your arms. You will most likely not remember this in the morning as you are not fully conscious.

What Sleep Phase Do Night Terrors Happen In?

Night terrors happen in the first third of the night when we are mostly in Non-REM sleep, which is a deep state of sleep.  The waves of electrical activity in your brain are larger and slower during Non-REM sleep.

What Causes Night Terrors?

There is a disruption of the brain waves when you are sleeping. The brain waves clash and cause a half-awaken state. It is like your body going from 0-100 in a blink of an eye. Although we are not 100% sure why night terrors happen, they typically occur when someone is overtired, feverish, or stressed. 

Are Night Terrors Common?

Only about 1-2% of adults have experienced sleep terrors during their adult years. It tends to be more common before the age of 25. It is estimated that 56% of children 13 or younger have experienced night terrors at some point. They can affect your child as soon as 18 months, and the occurrence decreases with age.

How Can You Tell If Someone is Experiencing Night Terrors?

Many may not recall this event in the morning. Usually, there is a parent, spouse, roommate, or bed partner who will make this person aware of the issue.

So…What’s the difference?

Nightmares typically happen early in the morning during REM sleep, whereas night terrors occur early on in the night, about 90 minutes after falling asleep. Episodes of night terrors are typically longer than nightmares and can last up to 5 minutes. 

In addition, when someone is experiencing a night terror, they can appear to be awake even though they are not fully conscious.  On the other hand, when someone is having a nightmare, it is apparent that they are sleeping.

Why Do They Often Get Mixed Up?

People assume that when someone appears distressed when they are sleeping, they are having a nightmare. It is easy to just refer to everything as a nightmare.

Is One More Serious Than the Other?

A night terror can be more intense for someone witnessing it. However, having either of these for an extended period of time can lead to sleep deprivation and impact your emotional and physical well-being.

What is the Difference Between a Nightmare and a Bad Dream?

Bad dreams are usually unpleasant, but the individual is not afraid.  If you experience a nightmare, you may feel a sense of danger or fear. It is more intense than a bad dream.

What is the Difference Between a Night Terror and Sleep Walking?

When sleepwalking, you are in a calm state. You are doing day-to-day things without conscious awareness. You won’t have strong emotions. Night terrors usually involve distress and not as much physical movement. You may move around in your bed, but you aren’t as likely to get out of bed.

Are There Treatment Options Available for Nightmares and Night Terrors?

Treatment for nightmares includes Cognitive Behavioral Therapy (CBT), which consists of working with a trained therapist to swamp negative thought patterns with more positive or neutral ways of thinking.   Another technique commonly used by therapists is Image Rehearsal Therapy.  It is a form of CBT where the patient recalls the dream and then changes the theme, storyline, or ending to something more positive and then rehearses the rewritten dream scenario so that the patient can displace the unwanted content when the dream occurs. 

Psychiatric medication may be required for PTSD- related nightmares.

For night terrors in children, focusing on developing good sleep hygiene, such as implementing an earlier bedtime and a calming bedtime routine, is usually the most effective treatment.  With adults, a bed partner can try waking the person about 15 minutes before the night terror typically occurs so that they start a new sleep cycle when they fall back to sleep.

What is Nightmare Disorder and How is it Treated?

Most people have a nightmare every so often. It is when an individual is consistently having nightmares, it is considered a disorder.  In terms of treatment, psychotherapy is the most commonly used. They may use imagery rehearsal therapy. Prazosin is a medication that could be given to help with nightmares triggered by PTSD.

How Can Nightmares and Night Terrors Be Prevented?

Establish healthy habits such as managing stress, exercising, practicing good sleep hygiene, eating healthy, and avoiding alcohol and sugary drinks/foods before bed. Check out my other blog articles for more tips!

When Should Someone See a Doctor or Sleep Expert?

See your doctor or seek the advice of a sleep expert (like me) if either happens frequently enough to disrupt your day-to-day life. If you rule out a medical condition, hidden sleep sabotagers are likely to blame. Register for my free mini-training to learn more!

 

Sweet Dreams…

Kelly Murray is a certified sleep coach and an award-winning pediatric sleep consultant based in Chicago offering sleep coaching services nationwide.