How to Tell the Difference Between Nightmares and Night Terrors

While nightmares and night terrors, or parasomnias, have some features in common, they are different experiences. Nightmares have occurred when an individual awakens from a vivid dream with an intense feeling of fear and/or dread.^[1] In contrast, night terrors are partial arousals from sleep during which an individual may shout, thrash their arms, kick, or scream.^[2] In addition, night terrors rarely occur in adults, while nightmares are experienced by people of all ages.^[3] Because nightmares and night terrors are two different types of sleep experiences, they should be differentiated and handled differently.

EditSteps

EditLearning About Nightmares

1. Learn the traits of a nightmare. Nightmares are a type of undesirable sleep experience that occur while you are falling asleep, sleeping, or waking up. There are several characteristic features of experiencing a nightmare:
   
   • The storyline of the nightmare is often related to threats to your safety or survival.^[4]
   • People experiencing nightmares will awake from their vivid dream with feelings of fear, stress, or anxiety.^[5]
   • When the dreamers of nightmares wake up, they will often remember the dream and be able to repeat the details.^[6] They will be able to think clearly upon awakening.^[7]
   • Nightmares often keep the dreamer from falling back to sleep easily.^[8]
2. Expect nightmares to occur in people of all ages. Nightmares are most common in children ages 3-6, with up to 50% of children experiencing nightmares during these ages.^[9] However, nightmares are often experienced by adults as well, especially if the individual is experiencing a particularly high amount of anxiety or stress.
   
3. Recognize when nightmares occur. Nightmares occur most often later in the sleep cycle during Rapid Eye Movement (REM) sleep. This is the period of time when dreaming is most prevalent, and it is when both good dreams and nightmares most commonly occur.^[10]
   
4. Consider possible root causes of nightmares. While nightmares can occur for no reason at all, seeing or hearing something that frightens or alarms a person can result in a nightmare. The sights or sounds that cause a nightmare can be things that have really happened or things that are make-believe.^[11]
   
   • Common causes of nightmares include illness, anxiety, the loss of a loved one, or a negative reaction to a medication.^[12]
5. Prepare for the aftermath of nightmares. Nightmares usually leave the dreamer with intense feelings of fear, terror, and/or anxiety.^[13] It may be very difficult to return to sleep after a nightmare.
   
   • Expect to console your child after a nightmare. He or she may need to be calmed down and assured that there is nothing to be frightened of.
   • Adults, teens, or older children experiencing nightmares may benefit from speaking with a counselor who can help identify what might be a source of stress, fear, or anxiety that is manifesting as nightmares.

EditUnderstanding Night Terrors

1. Determine if a person is likely to experience night terrors. While night terrors are relatively uncommon overall, they occur most often in children (experienced by up to 6.5% of children). Night terrors may be a consequence of the maturation of the central nervous system.^[14] In contrast, night terrors are rarely experienced by adults (only 2.2% of adults will experience night terrors).^[15][16] When adults experience night terrors, it is often due to underlying psychological factors such as trauma or stress.
   
   • Night terrors in children are usually not a cause for alarm. There is no evidence suggesting that a child who experiences night terrors has a psychological problem or is upset about or disturbed by something.^[17] Children usually grow out of night terrors.^[18]
   • Night terrors do seem to have a genetic component. Children are more likely to experience night terrors if someone else in the family suffers from them as well.^[19]
   • Many adults who have night terrors also have another psychological condition, including bipolar disorder, depressive disorder, or an anxiety disorder.^[20]
   • Night terrors in adults can also be caused by post-traumatic stress disorder (PTSD), or by substance abuse (particularly alcohol abuse).^[21] It is crucial to consider potential underlying causes of night terrors in adults and address these underlying causes if need be.
2. Identify the behaviors associated with night terrors. There are certain behaviors that are often associated with night terrors. Common behaviors include:^[22]
   
   • Sitting up in bed
   • Screaming or shouting in fear
   • Kicking his or her feet
   • Thrashing his or her arms
   • Sweating, breathing heavily, or having a rapid pulse
   • Staring wide-eyed
   • Engaging in aggressive behavior (this is more common in adults than in children)
3. Recognize when night terrors occur. Night terrors often occur during non-REM sleep, most commonly occurring during the short wave period of sleep. This means that they often will happen during the first few hours of sleep.^[23]
   
4. Don’t expect to awaken a person having a night terror. People who are having a sleep terror episode will often be very hard to awaken. However, if they do awaken, they will often emerge from sleep in a confused state, and may be unsure why they appear to be sweaty, out of breath, or why their bed may be in disarray.
   
   • Expect the person to have no memory of the event. Occasionally people may recall vague information about the event, but there is no recollection of vivid detail.^[24]
   • Even if you do manage to wake up the person, s/he will often be unaware of your presence or be unable to recognize you.
5. Be patient with the person experiencing the night terror. It is likely that he or she will have a difficult time communicating, even if s/he appears to be “awake” after the night terror occurs. This is because the night terror occurred during deep sleep.
   
6. Beware of dangerous behaviors. A person having a night terror may pose a threat to him or herself or to others without knowing it.
   
   • Watch out for sleepwalking. A person who is having a night terror can engage in sleepwalking, which can pose a serious threat.
   • Protect yourself from combative behavior. Abrupt physical movements (punching, kicking, and thrashing) often accompany sleep terrors and can cause injury to the person having a sleep terror, someone sleeping next to them, or someone attempting to control them.
7. Handle a night terror appropriately. You should not attempt to wake up a person who is having a night terror unless s/he is in danger.^[25]
   
   • Stay with the person having a night terror until s/he has calmed down.

EditDifferentiating Between Nightmares and Night Terrors

1. Determine whether the person has woken up. A person who has a sleep terror episode will remain asleep, while someone who has a nightmare will wake up and may remember vivid details about the dream.^[26]
   
2. See whether the person is easy to awaken. Someone who is having a nightmare can be easily awoken and brought out of the nightmare, but this is not the case with a night terror.^[27] In the case of the latter, the person will be extremely difficult to wake up and may not actually emerge from their deep sleep.
   
3. Observe the state of the person after the episode. If the person who has experienced the episode appears confused and is unaware of the presence of others in the room, s/he has likely experienced a night terror and will often immediately return to sleep. On the other hand, if the person wakes up with feelings of fear or anxiety and seeks out the comfort or company of another person (especially in the case of children), s/he has had a nightmare.
   
   • Remember that a person who has had a nightmare will often take longer to fall back to sleep.
4. Note when the episode occurs. If the episode occurs during the first few hours of sleep (most commonly about 90 minutes after falling asleep), it most likely has occurred during the early short wave period of sleep. This indicates that the episode is probably a night terror.^[28] However, if the episode occurs later on in the sleep cycle, it most likely has occurred during REM sleep and is a nightmare.
   

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EditTips

• Night terrors are most common in children. It is important to see a doctor if night terrors become more frequent, disrupt the sleep of family members, cause you or your child to fear sleeping, or lead to dangerous behaviors (such as getting out of bed and walking around the house) or injury.^[29]
• If night terrors begin in childhood but persist beyond the teen years, or if they begin in adulthood, it is important to visit your doctor.^[30]

EditSources and Citations

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