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

Here are more terror symptoms you should know about:

  • You can sit in bed looking scared

  • You can stare with big eyes during the episode even though you are not really awake

  • You can sweat and breathe faster

  • You may have a faster pulse and a flushed

  • You may be heartbroken

  • You may wake up and have no idea that you were terrified at

This last symptom is particularly noteworthy because when you sleep alone you may have night terrors and not even know it, while someone else may be able to tell you about your night terrors if they sleep in bed with you. Also noteworthy: Many people with night terrors sleepwalk. We believe this is because night terrors and sleepwalking have similar mechanisms in the brain during sleep. Night terrors can also be physically dangerous because of sleepwalking – say, when you get out of bed and end up injuring yourself.

There are a few key differences that set nightmares apart from night terrors.

For starters, nightmares and night terrors typically occur at different times in the sleep cycle. Nightmares occur during Rapid Eye Movement () sleep, the phase of sleep when vivid dreams are most likely to occur, according to the American Sleep Association (ASA). Night terrors typically occur during non- sleep, especially third stage sleep. This phase is also called deep sleep and is when, according to the ASA, extremely slow brain waves occur that are interrupted by faster waves.

Another big difference between nightmares and night terrors is how you react when you wake up. With nightmares, you may wake up easily and still have fear or other negative emotions, but you can ultimately think clearly, says the Mayo Clinic. But when it comes to night terrors, it can be difficult to wake up and be confused when someone manages to wake you up.

What does the nightmare treatment include?

For mild nightmares, I recommend what is known as image rehearsal therapy. It works by desensitizing a particular nightmare to make it less scary. During the day, write down your nightmare and remember the early details. But towards the end of the story, during the most terrifying part, comes a non-scary ending. Visualize this story a few times a day. If the story shows up in your nightmare, the ending may change to be more like the one you created. In my experience, this can erase the nightmare over time.

Image sampling therapy can also help with nightmare disorders, as can options like talk therapy with a mental health expert, says the Mayo Clinic. If it looks like your nightmares are related to an underlying condition (like restless legs syndrome) or a medication you are taking, treatment may include treating these aspects to see if your nightmares subside.

How do you treat night terrors?

When it comes to treating night terrors versus nightmares, I take a different approach to night terrors. I recommend catching the timing of night terrors and setting an alarm before they strike. Part of this will depend on your bed partner, in case you have one, as you may not realize that you are night terrified on your own. Ask them to keep track of the time of your horrors so you know when to set the alarm. Wake up to the alarm clock and go back to sleep. In some cases, I have a patient do an overnight study in a sleep laboratory where we videotape their behavior and monitor their brain waves, breathing, and heart rate. (This can be helpful if you suspect you may have night terrors but don’t sleep with someone who can confirm it for you.)

There are a few other strategies you can try to deal with nightmares and night terrors.

In addition to some of the specific coping strategies mentioned above, there are some lifestyle changes and activities that can help with both nightmares and night terrors.

In either case, the Mayo Clinic recommends doing your best to get adequate sleep – which may seem counterintuitive when nightmares or night terrors are disturbing your sleep, I know. But fatigue can make you more at risk for both, so a consistent and relaxing bedtime is a good place to start. Try calming activities like reading (nothing scary!), Riddling, meditating, relaxing exercises, or cuddling under a weighted blanket. It can also help doing your best to reduce stress in general, not just before bed.

Leave a comment

Your email address will not be published. Required fields are marked *