Nightmares and Night Terrors

What are nightmares and night terrors?

Nightmares are scary dreams filled with monsters or frightening events. Most people have nightmares sometimes, usually in the early morning hours. If they happen once in a while, it is usually not anything to worry about. People with a nightmare disorder have a severe problem with nightmares.

Night terrors are different from nightmares. During a night terror, you may:

• be upset and restless but cannot wake up or be comforted
• sit up, possibly screaming or talking wildly
• not respond even though your eyes are wide open and staring

In the morning, you cannot remember what happened. Night terrors are harmless and each episode will end on its own with deep sleep.

How do they occur?

Nightmares happen frequently in childhood, especially between the ages of 3 and 6. Most children outgrow them. In a few people, they continue into adulthood. Some people dream a different dream every time they have a nightmare, while others may have the same nightmare over and over again. Nightmares may be the result of taking certain medicines such as antidepressants or sleeping pills. They may also be a sign of post-traumatic stress disorder (PTSD) or panic disorder. Females are more likely than males to have nightmares.

Night terrors are not as common as nightmares. Night terrors usually begin between the ages of 3 and 12 in children and are usually outgrown. Adults may start having night terrors in their twenties. Night terrors occur more in young boys than girls, but affect about equal numbers of adult men and women.

While the cause is unknown, night terrors are often related to stress, tension, and conflict. People are more likely to have night terrors if they sleepwalk, or if someone else in their family has had night terrors.

What are the symptoms?

You may have a nightmare disorder if:

• you wake up over and over with nightmares
• the dreams seem to last a long time and are very frightening
• the nightmares are about threats to your life, your security, or your self-image
• you remember the nightmares in detail
• the troubled sleep interferes with work, school, or social activities

With night terrors:

• you may wake up screaming or crying a few hours after going to sleep
• your heart rate and breathing are rapid
• people tell you later that they could not seem to comfort you
• you do not remember the dream
• you will not remember the incident at all, unless other people tell you about it

How are they diagnosed?

Your healthcare provider will ask you about:

• your sleep patterns
• use of caffeine, alcohol, medicine, and other drugs
• eating and exercise habits
• your mental and physical condition
• your medical and mental health history, and your family's history
• sources of stress

After talking with you, your healthcare provider may give you a physical exam. A blood sample may be taken for lab tests.

Your healthcare provider may suggest that you sleep overnight in a sleep center. At the sleep center you may have a continuous, all-night recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves.

How are they treated?

Counseling and therapy often helps people with nightmare disorders. Sometimes medicine such as antidepressants or sleeping pills will help. Some sleeping pills can be addictive. Your provider will work with you to choose the right medicine for short-term or long-term use.

Violent shows or horror movies may cause bedtime fears and nightmares. Avoid these kinds of shows.

Some children will not have a night terror if you purposely wake them (enough to sit up and respond) about an hour after they have been asleep.

For nightmares and night terrors, your healthcare provider may recommend relaxation techniques, changes in diet, and a healthy lifestyle that includes exercise. Talk to your provider for help with strategies for more restful sleep.