Nightmare or Night Terror?
If you, or your child, have ever experienced shouting, thrashing and intense fear during sleep, the cause may be night terrors. For some, the experience will cause you to awaken breathless, sweaty, with a racing heart rate and trembling with fear. But for others, during an episode it can be difficult to awaken the sufferer. While similar to a nightmare, night terrors are much more dramatic and take both a physical and emotional toll on the sufferer. (1)
When a child has a nightmare, the theme or vision often repeats itself for weeks, months or even years. Nightmares occur during the REM (rapid-eye movement) stage of sleep, allowing them to be more readily remembered while night terrors occur during deep, non-REM sleep stages. (1)
Night terrors can happen at any age, from infancy to late in life. It is estimated that only 3 percent to 6 percent of children experience them, while a significantly larger percentage of children experience occasional nightmares.
There are few statistics on night terrors in adults, but they can be related to other sleep disorders including sleepwalking. The American Academy of Sleep Medicine estimates that night terrors affect 2.2 percent of adults. While there are a number of causes including certain medications, too much caffeine, or being over-tired, in adults night terrors may be a sign of underlying health conditions including PTSD, sleep apnea and restless legs syndrome. (2, 3)
In children, night terrors often go away on their own by the age of 12. But during the years when they are active, it can be a significant challenge to both children and their parents.
Treatment for night terrors depends on the cause; if an underlying health condition is determined, like sleep apnea, and it is treated, this sleep disturbance will likely abate. For the vast majority of children and adults who experience night terrors, changing bedtime routines and the sleeping atmosphere, increasing physical activity and removing certain stimulants from the diet can help too.
- What Are Night Terrors?
- Signs and Symptoms
- Causes and Risk Factors
- Conventional Treatment
- 7 Ways to Help Manage Night Terrors
What Are Night Terrors?
Night terrors, or sleep terrors, are part of a larger category of sleep disorders called as parasomnias. This is a group of abnormal sleep patterns and disruptions that also include sleepwalking, sleep eating, sleep paralysis and sexsomnia. (4)
Night terrors are characterized by the individual trembling and shaking with fear. Some individuals may awaken while others may remain asleep and be very difficult to awaken. A rapid heart rate, being drenched with sweat and being breathless are other common symptoms of night terrors.
Night terrors are often considered just severe nightmares, but this is incorrect. There are significant differences between the two. Nightmares most often occur during lighter sleep phases (REM) and are incredibly realistic and vivid. They can rock you with fear and panic and when you awaken, you can remember being chased, or falling or the terrifying monster hiding under the bed.
Nightmares in children can make for extremely long nights for parents and adults alike. As the vision of the fear is so real and so clear, it can be difficult to comfort the child so they can return to sleep.
Night terrors, on the other hand, occur during non-REM cycles of sleep, and instead of being vivid dreams, you experience feelings of terror, but not actual visions. Often, the physical signs, the breathlessness, trembling and thrashing occur before you wake up, making the symptoms of the night terrors even more frightening. In fact, night terrors may activate your natural fight-or-flight response.
When you do awaken, you don’t remember why you are terrified or shaking. There isn’t a vision of the fear that caused the reaction; just the overwhelming sense of danger and panic. For children, this often means that once the physical signs of night terrors have abated, they can return to sleep, often in just five to 10 minutes. (5)
Related: Lucid Dreams: When They Occur and How to Have Them
Signs and Symptoms
- Thrashing about the bed
- Talking nonsensically
- Sitting up in bed
- Acting out violently when touched
- Scratching others or themselves
- Difficult to be awakened
- Unresponsive to commands
- Confusion or disorientation
- Tachycardia (rapid heart rate)
- Tachypnea (rapid breathing)
- Flushed skin
- Sweating, often profusely
- Wetting the bed
- Intense terror
- Wide eyes and dilated pupils
- Elevated blood pressure
Causes and Risk Factors
Night terrors are typically caused by overarousal of the central nervous system during sleep. Other factors that can contribute to this sleep disorder include: (1)
- Being overtired
- Head injuries
- Certain medications for depression, anxiety and high blood pressure (5)
- New sleeping environment
- Lack of sleep
- Too much caffeine
- Sleep apnea
- General Anxiety Disorder
- Restless Legs Syndrome
- Bipolar disorder
- Substance abuse
Generally, treatment is not necessary as most cases resolve on their own. However, if night terrors are accompanied by sleepwalking, the goal needs to be keeping the child, or the adult, safe.
During an episode of night terrors, repeating soothing statements and providing physical comfort can help. And, while it may seem counterintuitive, during an episode waking the child or the adult may not be necessary or advisable. (6)
Prompted awakenings, or anticipatory awakenings, as a nightly routine may help to prevent night terrors and sleepwalking in children, according to Harvard Medical School. The technique involves measuring the length of time between when the child falls asleep and the episode begins. Then, for seven nights in a row, the child is awakened for five minutes in the 15 minutes before night terrors are expected. After seven days, the cycle of night terrors may be broken. (7)
In adults, if the root cause is an underlying health condition like sleep apnea, bipolar disorder, or other conditions, effective treatment of the condition may help relieve the episodes. Like with children, for some adults anticipatory awakening may help too according to the Mayo Clinic. (8)
Sleep medications are rarely recommended. However, if depression or anxiety is believed to be causing the sleep terrors, antidepressants may be prescribed.
7 Ways to Help Manage Night Terrors
Night terrors in children are a stress- and anxiety-inducing event for parents and children alike. For adults, relationships are often strained and productivity at work may suffer. Finding effective ways to help prevent episodes and effective natural sleep aids are key for getting a good night’s sleep.
1. Avoid caffeine, nicotine and alcohol for six hours before bedtime.
Stimulants such as these can prevent restful sleep. Remember, caffeine is found in sodas, chocolate, certain pain relievers and many types of tea. While alcohol may help you fall asleep, it increases the number of times you awaken during the night, according to Harvard Medical School. (9)
2. Create a peaceful sleep environment.
For children and adults alike, creating a sleep-inducing environment can help improve the quality of sleep. The temperature, lighting, noise level and the quality (and comfort) of the mattress are important for restful sleep. A well-ventilated room with a temperature between 60 degrees and 70 degrees is generally recommended.
Lights from electronics can disrupt sleep; turn off electronics before you retire. If children do homework in their room or if your home office is in your room, consider other options to help keep the bedroom a sanctuary for sleep.
3. Practice good sleep hygiene.
Most children have a good bedtime routine that includes bathing and relaxation activities. Adopting a routine as an adult that helps you transition to sleep may be helpful in reducing night terrors. A shower or bath before bed helps to lower the body temperature, promoting drowsiness. Just be sure to crawl into bed with fresh sleepwear and sheets.
Daily exercise is one of the best ways to encourage a good night’s sleep. This is true for children and adults alike. Exercise helps to reduce stress and anxiety and makes you physically tired. But, it is important to avoid both physical activity and mental activity in the three hours before bedtime as it can promote alertness. (9)
Aerobic type exercises including jogging, tennis, dance classes, riding a bike, martial arts and swimming are great activities for both adults and children. Yoga is an excellent activity for adults, and a recent clinical study in the journal Anxiety Stress & Coping found practicing yoga significantly reduces stress, anxiety and insomnia. (10)
5. Try mindfulness and relaxation training.
Promoting a sense of well-being and relaxation before bedtime can help improve sleep quality, insomnia symptoms and overall quality of life. In a recent pilot study, postmenopausal women underwent eight weeks of training and received significant sleep benefits. (11)
Mind-body practices, including meditation, are becoming more and more common in pediatric care for pain, stress and sleep. Meditation and mindfulness can also be made easier for children and teens with guided meditations written for their specific age group. The Chopra Center offers kid-friendly meditations and even a free guided meditation app specifically written for children eight to 12 years old. (12, 13)
6. Get hypnotized.
Long practiced for stress, addiction, pain, anxiety and PTSD, hypnosis may help reduce the severity and the number of episodes of night terrors according to Harvard Medical, and a landmark clinical study from the early 1990s. The study published in The Journal of Nervous and Mental Disease found that hypnosis was effective in 74 percent of adults studied for reducing or eliminating sleep terrors and sleepwalking. (6, 14)
A more recent study conducted by researchers from Hurley Children’s Hospital at Michigan State University College of Human Medicine and Seattle Children’s Hospital found that clinical hypnosis is an effective tool for children and adolescents in managing pain, anxiety, depression, grief, phobias and sleep disorders. The researchers also note the relationship and similarity of hypnosis to mind-body practices including biofeedback, yoga, guided imagery, meditation and prayer. (15)
7. Use essential oils.
Certain essential oils including lavender oil and frankincense are associated with relaxation and better sleep quality. In a clinical trial published in the journal Complementary Therapies in Clinical Practice aromatherapy improved sleep quality in 64 percent of those in the study. (16)
Safe for adults and children alike, my DIY Sleep Aid recipe features lavender, bergamot, cedarwood and frankincense essential oils. As you are preparing for bedtime, place 10 drops of the blend in a diffuser to encourage restful sleep.
While not considered a serious medical condition, night terrors can lead to the following complications and challenges: (18)
- Excessive daytime sleepiness
- Disturbed sleep
- Relationship problems
- Injury to self or others
- May be a sign of an underlying health condition
- Anxiety and stress
If sleepwalking occurs with sleep terrors, it is important that bunk beds aren’t used. For children and adults, if there are stairs in the home, gates to prevent falling down the stairs are recommended. Keeping windows closed and locked, as well as doors, is also extremely important.
- Night terrors are part of larger sleep disorder group called parasomnias. Also in this group are sleepwalking, sleep eating and sexsomnia.
- Night terrors are not just severe nightmares; the two occur at two different cycles of sleep.
- In a night terror, you don’t remember vivid details like a nightmare,. Instead you experience the physical and emotional trauma of intense fear.
- Night terrors most often occur in children, but they can occur at any life stage.
- Night terrors may be caused by an underlying health condition like sleep apnea, too much caffeine, being overstimulated or from other sleep disorders like restless legs syndrome.
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