How Are Nightmares Different From Sleep Terrors?

Jeanclaude Gaddahfi

Sleep terrors, sometimes called night terrors, are another type of parasomnia in which a sleeper appears agitated and frightened during sleep.

Sleep terrors don’t involve a full awakening; instead, a person remains mostly asleep and difficult to awaken. If awakened, they likely will be disoriented. In contrast, when a person wakes up from a nightmare, they tend to be alert and aware of what was happening in their dream.

The following day, a person with nightmares usually has a clear memory of the dream. People with sleep terrors very rarely have any awareness of the episode.

Nightmares are more common in the second half of the night while sleep terrors happen more often in the first half.

What Is Nightmare Disorder?

While most people have nightmares from time to time, nightmare disorder occurs when a person has frequent nightmares that interfere with their sleep, mood, and/or daytime functioning. It is a sleep disorder known as a parasomnia. Parasomnias include numerous types of abnormal behaviors during sleep.

People who have occasional nightmares don’t have nightmare disorder. Instead, nightmare disorder involves recurring nightmares that bring about notable distress in their daily life.

What Causes Nightmares?

Stress and anxiety: Sad, traumatic, or worrisome situations that induce stress and fear may provoke nightmares. People with chronic stress and anxiety may be more likely to develop nightmare disorder.

Mental health conditions: Nightmares are often reported at much higher rates by people with mental health disorders like post-traumatic stress disorder (PTSD), depression, general anxiety disorder, bipolar disorder, and schizophrenia. People with PTSD often have frequent, intense nightmares in which they relive traumatic events, worsening symptoms of PTSD, and often contributing to insomnia.

Certain drugs and medications: Using some types of illicit substances or prescription medications that affect the nervous system is associated with a higher risk of nightmares.

Withdrawal from some medications: Some medications suppress REM sleep, so when a person stops taking those medications, there is a short-term rebound effect of more REM sleep accompanied by more nightmares.

Sleep deprivation: After a period of insufficient sleep, a person often experiences a REM rebound, that can trigger vivid dreams and nightmares.

Personal history of nightmares: In adults, a risk factor for nightmare disorder is a history of having had recurring nightmares during childhood and adolescence.

Though not fully understood, a genetic predisposition may exist that makes it more likely for frequent nightmares to run in a family. This association may be driven by genetic risk factors for mental health conditions that are tied to nightmares.

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How to Help Children Cope with Nightmares

For children who experience occasional nightmares, reassurance is often the most effective tactic. Parents should discuss fears and anger triggers with their children in a relaxed setting. This can help promote feelings of relaxation before bedtime, which in turn may improve their sleep quality and minimize their risk of disruptive dreams.

That said, too much reassurance can have the opposite effect. Parents can encourage their children to comfort themselves after waking up from a bad dream as opposed to relying on their family members for comfort. Co-sleeping with children after a nightmare occurs or remaining in their room until they return to sleep are generally frowned upon because these practices have been linked to an increase in nighttime waking episodes for infants and young children.

How Is Nightmare Disorder Treated?

Infrequent nightmares don’t normally need any treatment, but both psychotherapy and medications can help people who have nightmare disorder. By reducing nightmares, treatments can promote better sleep and overall health.

Treatment for nightmares should always be overseen by a health professional who can identify the most appropriate therapy based on a patient’s overall health and the underlying cause of their nightmares.

How Can You Help Stop Nightmares and Get Better Sleep?

If you have nightmares that interfere with your sleep or daily life, the first step is to talk with your doctor. Identifying and addressing an underlying cause can help make nightmares less frequent and less bothersome.

Whether nightmares are common or occasional, you may get relief from improving sleep hygiene. Building better sleep habits is a component of many therapies for nightmare disorder and can pave the way for high-quality sleep on a regular basis.

There are many elements of sleep hygiene, but some of the most important ones, especially in the context of nightmares, include:

Following a consistent sleep schedule: Having a set bedtime and sleep schedule helps keep your sleep stable, preventing sleep avoidance and nightmare-inducing REM rebound after sleep deprivation.

Utilizing relaxation methods: Finding ways to wind down, even basic deep breathing, can help decrease the stress and worry that give rise to nightmares.

Avoiding caffeine and alcohol: Caffeine can stimulate your mind, which makes it harder to relax and fall asleep. Drinking alcohol close to bedtime can induce a REM rebound in the second half of the night that may worsen nightmares. As much as possible, it’s best to avoid alcohol and caffeine in the evening.

Reducing screen time before bed: Using a smartphone, tablet, or laptop before bed can amp up your brain activity and make it difficult to fall asleep. If the screen time involves negative or worrying imagery, it may make nightmares more likely. To avoid this, create a bedtime routine with no screen time for an hour or more before going to sleep.

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