We’ve all been there – from somewhere deep in your dreams, a disturbing story starts to unfold and before you know it … bam! You’re jolted awake. Your heart and your head are racing, and you find yourself retracing the terrifying events of a fictional plot that stole your peaceful sleep. Other times, it’s the screams of your little one from down the hall. They’re upset, disoriented, hysterical over a horrific dream.
How can we tell if the things that rob us of rest are technically considered night terrors or nightmares? And how can we cope with the upsetting effects of both events? Srinivasan Devanathan, MD, PPG – Sleep Medicine, explains the differences and offers strategies for addressing these unsettling scenes.
Night terrors
First, we must understand, when we divide sleep into stages of sleep, we’re looking at two categories: non-REM sleep (NREM) and REM sleep. Abnormal behaviors, such as night terrors, are arousal disorders, which occur in that deeper NREM sleep, specifically in a stage called slow-wave sleep. This tends to be within 90-120 minutes of falling asleep.
Symptoms
A night terror, like sleepwalking, is a sudden-onset behavior that comes with extreme agitation. While symptoms can be mild, many individuals will appear terrified, and often cry, scream, sweat or hyperventilate. Loved ones should not try to intervene if an individual is experiencing night terrors. They are most common in children, ages 4-12, though adults can also experience night terrors.
Causes
Often, parents or loved ones feel they are responsible for the night terrors, but this isn’t true. There are a number of potential triggers, including:
- Stress or anxiety
- Caffeine
- Inadequate sleep or chronic sleep deprivation
- Disrupted or adjusted sleep schedule (such as removing a nap from a child’s day)
- Forced awakening
- Family history
- Other conditions, such as Tourette’s syndrome
- Frequent migraines
- New or foreign sleep environment
- Exposure to too much light or noise
- Medications (such as sleep aids and antidepressants)
- Going to sleep with a full bladder
- Fever
People might compare the symptoms to the fight-or-flight response often initiated during a panic disorder episode, however, night terrors only happen during sleep. Panic attacks can occur at any time.
Strategies for coping
Unlike nightmares, individuals who have night terrors seldom recall the event the next day. One of the most helpful things a loved one can do is document the times of occurrence. Once you have a month or so of sleep diary data, you can start to notice patterns.
This intel will allow you to implement the scheduled awakening method, if you choose. This method involves a gentle awakening initiated 15-30 before a night terror event would typically occur. You want to wake the child just slightly, perhaps by tapping him or her on the shoulder or a small nudge to encourage them to change positions. This alters the slow-wave structure in the brain and lessens the chance the individual will experience a night terror. You need to apply the method for several weeks to see best results.
It’s important to address any modifiable triggers and practice good sleep hygiene so the individual is getting adequate rest. The prognosis is very good for this condition, and night terrors often resolve in adolescence.
Nightmares
Nightmares occur during REM sleep, which is the latter half of sleep. We cycle through REM a few times, so people can have multiple dreams or nightmares in the same night.
Symptoms
Individuals experiencing nightmares will appear agitated, though not as much as those having night terrors. Another differentiator is that after a nightmare, the person can recall at least some, if not all, of the dream.
Causes
While nightmares can occur for numerous reasons, there are some common contributors, including:
- Stress
- Traumatic events – This could something extreme, like abuse, or an event, such as getting chased by a dog
- Anxiety disorders
- Insomnia
- Family history
- Medications
- Media – Scary movies or books, or suspenseful television shows
- Major life event – Often, things like pregnancy, moving or changing schools bring a mix of positive and negative emotions. These can manifest in our dreams.
It’s important to remember, what’s frightening to a child might not be frightening to an adult. Never disregard a child’s feelings.
Strategies for coping
Generally speaking, if you can identify triggers and avoid exposure or address the underlying issue, that’s the best way to avoid having nightmares.
With children, utilize security items, such as stuffed animals or blankets, that offer them comfort. Try dimming the lights, playing with a flashlight or giving them a night light so the environment isn’t entirely dark. Make sure the light isn’t too bright, so as not to hinder sleep. Hang a dream catcher over their bed and read stories that address the issue in a healthy way, such as “Go to sleep, little monster”.
If the nightmare has already happened, there are some strategies for calming the individual. When someone experiences night terrors, they can often fall back asleep fairly quickly. This isn’t always the case with nightmares. Talking and working through the problem can help ease fears. Remember, children are highly sensitive, so shaming adds additional stress. It’s good to reassure the child that they are safe. It’s only a dream.
Specifically, there are three techniques for helping the child (or adult) process their nightmare:
- Dream rehearsal imagery – Ask the child to draw a picture of their bad dream and then take it and crumple it and throw it away. Ask them to think about the bad event and give it a silly or happy ending. Maybe the monster ends up going for ice cream or he just wanted a hug. Come up with an alternative ending together.
- Systematic desensitization – With this process, you work with the child (or adult) to go from a very fearful initial process to a soothing process. You walk through the dream and address the sources of fear in an effort to switch them into sources of comfort. If, for example, they saw a barking dog, you then ask them to picture walking up to the dog, petting the dog, then the dog licking them, etc. Use familiar, comfortable scenarios.
- Relaxation strategies – These techniques include deep breathing and guided meditation. It can be used in general or with specific dreams. Maybe they visualize the thing that prompted fear, and then take some deep breaths and visualize something less intimidating. There are a number of resources online for guided relaxation exercises to promote healthy sleep.
These strategies take the power out of the bad dream. They strip the authority from the fear and give it to the things that comfort. It’s important to practice these habits and try different soothing measures.
Consider seeing a Sleep Medicine professional if nightmares begin disrupting the sleep cycle, creating fatigue during the day or happening at a high frequency.
