Health

Night Terrors vs. Nightmares: What’s the Difference?

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.

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