Circady Insomnia Blog

Things that Go Bump in the Night: Nightmares vs. Night Terrors

Posted by Angela Ballard on Aug 29, 2018 2:15:00 PM

Learn about the difference between bad dreams and night terrors.

Bad dreams, nightmares, and night terrors… Sometimes, sleep can be a little scary. But understanding what’s going on and the different types of night frights can help. I, for one, always feel better when I can put a name to a phenomenon. The right vocabulary can also be useful when you’re discussing sleep concerns with your doctor or sleep therapist.

With that in mind, from bad to worse, here’s a brief scary dream glossary.

Bad Dreams

These are dreams that are not pleasant, but aren’t so frightening that you jolt yourself awake, either. Sometimes you can remember storylines, images, or other details about your bad dreams but they usually don’t stick with you the way nightmares do — probably because they aren’t as emotionally upsetting.

Nightmares

We’ve all had them — dreams that are vivid and disturbing — so much so that we often remember them in great detail. They are called nightmares, and anyone, from children to adults, can experience them. According the Psychological Bulletin, 4-10% of the population and 2-6% of adults experience weekly nightmares. 

Nightmares are most common during the Rapid Eye Movement (REM) period of sleep. Medications, and depression can contribute to nightmares. But nightmares are also strongly linked to stress, anxiety and trauma. In particular, nightmares (and night terrors, discussed below) are associated with the type of trauma that can cause post-traumatic stress disorder or PTSD. This level of trauma is due to a person having either experienced or witnessed a terrifying event. It's especially common during war or combat but is also a serious concern in civilian life. 

No matter the cause, nightmares can lead to disturbed, fragmented and — obviously — less restful sleep. If you or a loved one experiences nightmares that are impacting daytime functioning or the ability to get adequate rest at night, it may be time to talk to a doctor.

It’s important to seek help because nightmares can sometimes cause a person to feel afraid to go to sleep (contributing to a cycle of insomnia) and can also factor into alcohol or drug use (with the aim of being able to, hopefully, relax and go to sleep.) Neither of these things is good for sleep or wellbeing! We encourage those affected by frequent nightmares to seek help, and in the meantime, to try the following tips for more peaceful rest:

  • Talk about the nightmares during the day as a way to process them.
  • Avoid stress- or anxiety-inducing media especially in the evenings.
  • As part of bedtime routines, focus on soothing, relaxing things.
  • Talk to your doctor if nightmares become worse or more frequent or if they interfere with daytime functioning at work, at home, or socially. Recurrent nightmares have been associated with poor overall sleep quality and depression and therefore expert advice is warranted. 

Fortunately, though, even individuals who have frequent nightmares often find that things settle down over time. But if the nightmares persist, there’s treatment, too. Clinical guidelines from the American Academy of Sleep Medicine recommend cognitive behavioral therapy (CBT) to help resolve nightmare issues. 

Experts also recommend lifestyle changes and good sleep hygiene to promote higher quality sleep and decrease the frequency and severity of nightmares.

Night Terrors

Night terrors are similar to nightmares but take place during non-REM sleep and are much more intense. Night terrors usually include anxiety, enlarged pupils, sweating, and increased blood pressure. The affected sleeper can scream, act terrified, and thrash in bed. Sleepwalking may occur and the person may seem wide-awake but is actually still asleep. A night terror can last for 10 to 30 minutes — which will likely seem like a very long time to bystanders. Despite the temptation, don’t try to wake up someone in a night terror. It likely won’t work, experts say, and it’s better to just wait it out, instead. Afterwards, the dreamer will usually relax and settle back into bed without remembering the ordeal.

Night terrors are most common in kids, but can continue into or show up in adolescence or adulthood. Occasional night terrors usually go away on their own but if night terrors are persistent, are accompanied by daytime anxiety, or result in other problems, it’s time to discuss them with a doctor, as they can be a symptom of anxiety or post-traumatic stress disorder (PTSD).

PTSD can happen to anyone. Data shows that about 7 or 8 out of every 100 people will have PTSD at some point in their lives, 8 million adults have PTSD during a given year (that’s more than the population of Washington state),  and about 10 out of every 100 women develop PTSD sometime in their lives compared to about 4 of every 100 men.

But while PTSD is common in the general population, it’s even more common among veterans and the military. The National Institutes of Health (NIH) estimates that PTSD afflicts approximately 31% of Vietnam veterans, 10% of Gulf War (Desert Storm) veterans, 11% of veterans of the war in Afghanistan, and 20% of Iraqi war veterans. With nightmares or night terrors being one of the major symptoms of PTSD, holistic approaches to sleep, sleep therapy, and PTSD are important fields. According to the National Sleep Foundation, 96% of people with PTSD suffer from vivid nightmares that can feel overwhelmingly real. Fortunately, there are treatments with research showing that sleep-related interventions (like CBT-i) can improve both rest and PTSD-related dreaming.

Family members, loved ones, and housemates can obviously find a person’s night terrors disturbing. Does it help to know that the individual him- or herself will not usually remember the night terrors? And that there are some things you can do to assist your loved one in the moment? Experts at Stanford recommend the following: 

  • Making soothing comments during the night terror.
  • Avoiding attempts to wake up the person and refraining from shouting.
  • Protecting the person from injury if you can (while protecting yourself, as well)
  • Helping to prevent night terrors by encouraging your loved one to get enough sleep.
  • Asking your loved one to discuss night terrors with a doctor if they become more frequent or regular, if they last for more than 30 minutes, if there is associated daytime fear or stress, if there is resulting excessive daytime sleepiness, or if there are other symptoms or concerns.

The good news is that; most of the time, we don’t have scary dreams. Most of the time we just have run-of-the-mill dreams that we promptly forget. In fact, the National Sleep Foundation says we forget 95–99% of our dreams even though we dream four to six times per night. Still, if nightmares or night terrors are disrupting your sleep, causing anxiety, or otherwise becoming a concern, talk to your healthcare provider or sleep therapist. Wishing you sweet dreams!

Topics: Causes of Insomnia

About Our Blogger

Angela Ballard

Angela is a specialist in sleep disorders and related illnesses. In this blog, she shares experiences in her personal life, and as a nurse dealing with such conditions.

Topics include:

  • Tips for managing your sleep
  • Information on insomnia and related illnesses
  • Diagnosis and treatment options

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