When it comes to comparing night terrors and nightmares, you might assume that they’re both bad dreams of varying intensities. But night terrors (also known as sleep terrors) are more than just super-intense nightmares. These are actually two separate sleep conditions with some pretty important differences, which are important to learn if you’re not sure which one you’re dealing with. Below, we’ll dive into both and cover some ways you can try to stop whichever is plaguing your rest.
Nightmares are, unfortunately, something you’ll probably experience occasionally.
The unpleasant dreams we know as nightmares are very common. The American Academy of Sleep Medicine (AASM) estimates that anywhere from 50% to 85% of adults report having at least an occasional nightmare.
In case you’ve been lucky enough to avoid nightmares yourself, they’re essentially incredibly vivid bad dreams that tend to get scarier gradually, rather than be terrifying right away. Think of nightmares like scary movies, where there’s usually a build-up.
Here are some other common signs that you’re dealing with nightmares, according to the Mayo Clinic:
- Your dream revolves around threats to your safety, survival, or something disturbing
- You sweat
- Your heart pounds
- You remember that you’ve had a nightmare when you wake up (maybe not all the details, but some at least)
- You can’t fall back asleep easily
According to the Mayo Clinic, there are a few things that increase the likelihood of having a nightmare, including consuming scary media (looking at you, r/nosleep and horror-movie lovers), medications including some antidepressants, lack of sleep, sleep disorders like restless legs syndrome, and stress. Recurring nightmares, or bad dreams where the same theme or events play out, are especially prevalent among trauma survivors and people with PTSD, according to the U.S. Department of Veterans Affairs.
Occasional nightmares are common and nothing to worry about (unpleasant though they may be). All that said, it’s notable if your nightmares aren’t just occasional annoyances. You might have what’s known as nightmare disorder if you have nightmares frequently or if they disrupt your sleep, make it hard to fall asleep, or get in the way of your daytime functioning.
Night terrors are far less common than nightmares in adults.
Night terrors are considered a parasomnia, a type of disorder marked by abnormal occurrences during sleep. These episodes involve sudden bouts of intense fear, screaming, and thrashing around while you’re still asleep.
Night terrors tend to affect kids more than adults, according to the Mayo Clinic. Almost 40% of children will experience night terrors, but most outgrow them by their teen years. There isn’t a similar statistic for night terrors in adults (the Mayo Clinic describes it as a “much smaller percentage” than in children), but generally they’re considered relatively uncommon. One old but often-cited 1999 study in the Journal of Clinical Psychiatry interviewed nearly 5,000 adults in the United Kingdom, finding that 2.2% of respondents reported night terrors.
What we do know is that night terrors are more common in people with mood or anxiety disorders, as well as PTSD. According to the Mayo Clinic, a few things can trigger night terrors, including sleep deprivation, stress, fevers, and changes in sleep schedule. Sleep apnea, restless legs syndrome, and alcohol use can also increase the likelihood of night terrors.
Here are more night terror symptoms to know:
- You may sit up in bed and look scared
- You may stare wide-eyed during the episode, even though you’re not actually awake
- You may sweat and breathe more quickly
- You may have a quicker pulse and flushed face
- You may be inconsolable
- You may wake up and have no idea you had a night terror
That last symptom is especially worth emphasizing because if you sleep alone, you could have night terrors and not even know it, whereas if someone else sleeps in bed with you, they might be able to tell you about your night terrors. Also noteworthy: A lot of people who have night terrors sleepwalk. We think this is because night terrors and sleepwalking have similar underlying mechanisms in the brain during sleep. Because of sleepwalking, night terrors can be physically dangerous too—say, if you get out of bed and wind up hurting yourself.
There are a few key differences that set nightmares and night terrors apart.
For starters, nightmares and night terrors typically happen at different points in the sleep cycle. Nightmares occur during rapid eye movement (REM) sleep, the stage of sleep when vivid dreaming is most likely to happen, according to the American Sleep Association (ASA). Night terrors typically happen during non-REM sleep, specifically stage-three sleep. This stage is also called deep sleep and is when, according to the ASA, extremely slow brain waves start to appear, interspersed with faster waves.
Another major difference between nightmares and night terrors is how you might react when you wake up. With nightmares, you may wake up easily and still feel scared or any other number of negative emotions but ultimately be able to think clearly, the Mayo Clinic says. But when it comes to night terrors, you may be hard to wake up, and be confused if someone does manage to wake you.
What does nightmare treatment entail?
For mild cases of nightmares, I recommend something called image rehearsal therapy. It works by desensitizing a specific nightmare so it’s less scary. During the day, write out your nightmare, remembering the early details. But near the end of the story, during the most frightening part, create a non-scary ending. Visualize this story a few times a day. When the story appears in your nightmare, the ending might change to be more like the one you’ve created. In my experience, this may extinguish the nightmare over time.
Image rehearsal therapy may also help for nightmare disorder, as can options like talk therapy with a mental health expert, the Mayo Clinic says. If it seems as though your nightmares may be tied to an underlying condition (like restless legs syndrome) or a medication you’re taking, treatment may involve addressing those aspects to see if your nightmares recede.
How do you treat night terrors?
When it comes to treating night terrors vs. nightmares, I go about night terrors differently. I recommend mapping the timing of night terrors and setting an alarm before they strike. Part of this rests on your bed partner, if you have one, since you may not realize you’re having night terrors on your own. Ask them to keep track of the time of your terrors so you know when to set the alarm. Wake up with the alarm and go back to sleep. In some cases, I’ll have a patient do an overnight study in a sleep lab, where we videotape their behavior and monitor their brain waves, breathing, and heart rate. (This may be helpful if you suspect you’re having night terrors but don’t sleep with anyone who can confirm it for you.)
There are some other strategies you can try to deal with nightmares and night terrors.
On top of some of the specific coping strategies I mentioned above, there are some lifestyle changes and activities that might help with both nightmares and night terrors.
In both cases, the Mayo Clinic recommends trying your best to get adequate sleep—which may seem counterintuitive if nightmares or night terrors are what’s disrupting your sleep in the first place, I know. But fatigue can leave you more at risk for both, so establishing a consistent and relaxing bedtime routine is a solid place to start. Try calming activities like reading (nothing scary!), doing puzzles, meditating, doing relaxation exercises, or snuggling under a weighted blanket. Trying your best to reduce stress in general, not just at bedtime, can also help.
You might also want to change a few things in your sleeping environment depending on if you’re dealing with night terrors vs. nightmares. If you have night terrors, you should make sure your space is clear of tripping hazards or sharp and fragile objects in case of sleepwalking. If you have nightmares, maybe try a night-light (they’re not just for kids!) or go out of your way to make your room extra cozy and safe-feeling.
No matter if you have nightmares or night terrors, see a doctor if your sleep is getting in the way of your quality of life.
If you’re experiencing frequent, troublesome nightmares, or you’re just not feeling like you’re getting restful sleep, it may be time to see a sleep doctor. Are you feeling sleepy during the day because the nightmares are keeping you up, or because you’re avoiding sleep due to bad dreams? Are you having a hard time focusing at work? Then, yes, it’s time to see your doctor.
Using how you feel during the day as a signal for when to see your doctor works for night terrors too, especially because you won’t always know that you’ve had one. If you’re sleepy during the day, feeling unfocused, or are having trouble functioning normally without a clear reason why, it’s time to talk to your doc. You might also notice unexplained injuries or bruises from thrashing around during a night terror—another sign that you should see your doctor. And if you’re having a combination of sleepwalking and night terrors, it’s most definitely time to talk to someone. They will give you additional advice to make the bedroom safe, like sleeping on the floor, using a sleeping bag, or setting alarms on doors and exits.
Sleep is one of the body’s most important processes, and nightmares and night terrors can majorly mess it up. So if you’re experiencing either and they aren’t going away on their own, get help so you can try to avoid being stuck in a cycle of bad dreams forever.
Additional reporting by Anna Borges