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Night Terrors and Nightmares: What's the Difference?

Nightmares are bad enough, but you may be having night terrors. Learn what separates these two sleep disorders and how night terrors can be treated.

Joshua Cox-Steib
Joshua Cox-Steib is a sociologist and freelance writer. He lives in Tulsa, Oklahoma, with his wife and their menagerie of pets. Joshua holds a degree in sociology from the University of Tulsa and worked as a behavioral analyst before becoming a professional writer.
Joshua Cox-Steib
4 min read
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Nightmares may be part and parcel of the human experience, at least at times, but have you ever wondered if you're having night terrors? Waking up in the night, covered in sweat, with a beating heart and a mind convinced it's been threatened sounds all too familiar to many of us. Yet, how many of us know the difference between night terrors and nightmares? 

Nightmares are dreams that happen while you're fully asleep. Nightmares generally occur during REM sleep, rarely involve serious movement and can often be remembered, at least in part, upon waking up. Night terrors are different in several ways. 

What are night terrors? 

Night terrors, also called sleep terrors, are a type of sleep disorder that affects roughly 2% of adults and up to 6% of children. But in this guide we'll primarily focus on how night terrors affect adults. Sleep terrors are categorized by episodes of terror that occur during non-rapid eye movement sleep and may involve screaming, thrashing, crying and other movements and outbursts. Unlike nightmares, night terrors are rarely remembered after they end. Symptoms of night terrors can include the following: 

  • Crying 
  • Dilated pupils 
  • Rapid breathing 
  • Rapid heart rate 
  • Screaming 
  • Sweating 
  • Thrashing 

What causes night terrors in adults? 

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There isn't yet a clear consensus on the causes of night terrors in adults. Some believe there may be a genetic predisposition, and research has indicated a correlation between night terrors and fever, illness, excessive physical activity, high caffeine or alcohol consumption, sleep deprivation, exhaustion and emotional distress. Others believe that night terrors in adults are strongly linked to stress disorders, such as post-traumatic stress disorder.  

Are night terrors caused by anxiety? 

Researchers have long known that sleep difficulties are relatively common in those who have anxiety disorders. Indeed, insomnia and nightmares are even rolled into the definitions of some anxiety disorders, such as PTSD. With many of these disorders, successful treatment of anxiety has resulted in better sleep. In general, night terrors appear to be more common when the central nervous system is excessively active during sleep. Both anxiety and stress can result in this heightened activity during sleep. If you've ever had anxiety dreams, you may have some idea of what this is like.

Even those who haven't experienced sleep terrors may know how hard it is to get a good night's sleep when going to bed anxious. When the mind is focused on the sensation of danger, threat or insecurity, it can be difficult for the body to respond to anything else. In some cases, people partially wake up while their body is experiencing strong symptoms of stress, and then these individuals may have night terrors.

Trauma can lead to a combination of anxiety and repression that may result in people having a higher rate of both nightmares and sleep terrors. What we avoid and repress during the day may become somewhat unleashed as we sleep. That may be related to how active the amygdala -- a portion of the brain involving emotions -- tends to be during dreams. But while this can help to explain the causes of nightmares because they happen during REM sleep (when dreams occur), the connection to night terrors may be more tenuous, as night terrors usually occur before the brain enters its dreaming state.  

Treatments for night terror in adults  

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While there's no known singular cause of night terrors in adults, there are several avenues of treatment that medical experts have explored. Depending on the patient and the circumstances, some treatments may work better than others. Always consult your physician or another medical expert before making treatment decisions when dealing with medical issues.  

Medication  

Medications are generally not a preferred treatment for night terrors, but in extreme cases, physicians may prescribe benzodiazepines, selective serotonin reuptake inhibitors or tricyclic antidepressants.  

Cognitive behavioral therapy 

If the night terrors are thought to be linked to stress, anxiety or a similar disorder, then cognitive behavioral therapy might be recommended to help address these underlying problems. CBT can help some individuals reduce the symptoms of stress and anxiety by working to retrain the perspectives and reactions of their minds.  

Hypnosis  

Although still considered controversial by many, studies have uncovered strong evidence that hypnosis can be used to reduce the symptoms of sleep terrors in some individuals successfully.  

Biofeedback therapy 

Also known as neurofeedback, biofeedback therapy is a non-intrusive approach that monitors the brain during sleep to look for abnormal brain activity. This information is then used to help patients and physicians identify areas of the brain that might be brought closer to a natural state to facilitate healthier sleep.  

Relaxation therapy  

Relaxation therapy uses known techniques to encourage the mind and body to be more relaxed. These techniques can be extensive, ranging from breathing exercises to biofeedback-assisted relaxation. Stress reduction practices like yoga, meditation, and massage therapy are often considered relaxation therapy techniques.  

Anticipatory awakening 

Anticipatory awakening is a technique that involves learning the pattern of your sleep terrors and interrupting them before they can begin. The first step is to chart the occurrence of your night terrors to determine when they are most likely to start. Then, using that information, you arrange to wake up around 15 minutes before the night terrors start and stay awake for a little while (sometimes only a few minutes) before going back to sleep. This approach is dependent on the night terrors occurring at regular times.

Bottom line 

Whatever the cause, night terrors can significantly disrupt one's sleep and quality of life. While they have been linked to illness, chemicals, exhaustion and stress, there's no known singular cause of this parasomnia disorder. If you suspect you or a loved one have been experiencing night terrors, speak with your physician to pursue a diagnosis and treatment plan.  

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.