Nightmares are a common occurrence from young to old, but what about night terrors? What makes night terrors different — and could frequent night terrors be a sign of a more serious issue?  

Nightmares and night terrors are both types of parasomnias — sleep disorders that occur as the brain transitions from stages of wakefulness to sleep, says Dr. Daniel Barone, a neurologist and sleep medicine expert at NewYork-Presbyterian/Weill Cornell Medical Center. “A nightmare is an upsetting or frightening dream that happens during a phase of sleep when the brain becomes active and produces dreams,” explains Dr. Barone. “A night terror, in contrast, is a sleep event in which someone experiences intense panic or fear and may even scream and thrash around — but it occurs when a person’s brain activity, breathing, and heart rate slow down, so they usually do not remember it.”

While night terrors most commonly affect children (about 30%), approximately 2.2% of adults also experience them. And contrary to how they may appear, night terrors tend to be more upsetting for someone witnessing the episode, rather than the person actually experiencing it.

“Nightmares and night terrors aren’t automatically worrisome, but they can be markers of more serious mental health and sleep disorders,” says Dr. Warren Ng, a psychiatrist at New York Presbyterian and Columbia, and the Community Health Director for New York Presbyterian’s Center for Youth Mental Health.

Health Matters spoke with Dr. Ng and Dr. Barone to learn more about the difference between nightmares vs. night terrors, potential underlying causes of both, and strategies to help manage them.

What causes night terrors vs. nightmares?

Dr. Barone: Our sleep cycle can be broken into two main phases: rapid eye movement sleep, or REM sleep for short, and non-REM sleep.

REM sleep is when most of our dreaming occurs, and, as the name suggests, our eyes quickly dart around under our eyelids. Non-REM sleep is when we get deeper, more restorative sleep, while our brain activity, breathing, and heart rate slow down.

While we don’t know exactly why night terrors happen, we do know that certain disturbances to your regular sleep cycle can contribute, such as drinking alcohol, fever, sleep deprivation, and stress.

It’s very common for children to experience night terrors, since they get mostly non-REM sleep. People who experience night terrors may also have a family history of sleepwalking or night terrors.

Dr. Ng: It’s normal to experience the occasional nightmare, but if they are frequent or very disturbing, it may indicate an underlying mental health condition, such as anxiety or depression. Both night terrors and nightmares can be signs of post-traumatic stress disorder (PTSD).

Frequent nightmares (especially dreams in which you feel like you are drowning or struggling to breathe) may also be a symptom of a medical condition, such as obstructive sleep apnea.

What should you do if someone is experiencing a night terror?

Dr. Barone: If you witness someone screaming and thrashing in their sleep, your first instinct might be to jolt them awake. However, you shouldn’t wake someone who is having a night terror, as it can disorient them, prolong the night terror, and can even be dangerous for both parties. In their state of half sleep, they may view the person waking them as a threat and try to defend themselves, and that’s when someone can get hurt.

Remember: while in the moment they appear to be distressed, they most likely will not remember it the next day.

How are night terrors and frequent nightmares treated?

Dr. Barone: When patients experience night terrors and frequent nightmares, I usually recommend that they get evaluated via a sleep study to detect any underlying conditions, such as sleep apnea.

For the most part, treatment isn’t necessary for night terrors, especially if they are infrequent. If there is an underlying condition, however, such as PTSD or sleep apnea, it’s important to treat the root cause.

For parents with very young children, it can help to wake your child who experiences night terrors about 15 minutes before they typically experience an episode (since the timing can often be predictable) and keeping them awake for a few minutes before they fall back to sleep. This strategy is called “anticipatory waking” and may successfully prevent the night terror from occurring until the child grows out of it.

Dr. Ng: When it comes to frequent nightmares, the proper treatment depends on the root cause.

If they are caused by underlying mental health conditions, stress reduction techniques, mental health assessments, and related psychotherapy can help.

Nightmares caused by PTSD can be treated with psychotherapy, medication, or a combination of the two. Imagery rehearsal therapy (IRT) can be especially helpful in reducing the frequency and intensity of the nightmares. This involves rewriting the ending of your remembered nightmare so that it has a more positive outcome, and then rehearsing the new ending while you’re awake.

I also recommend maintaining healthy sleep habits, including going to bed and waking up at regular times, creating a relaxing bedtime routine such as taking a bath or listening to calm music, avoiding caffeine and alcohol before bed, and limiting screentime before bed.

What is your advice to parents with kids who experience night terrors or recurrent nightmares?

Dr. Ng: Night terrors most commonly affect children between ages 3 to 7, and they usually subside by age 10. Even though it can be upsetting to see your child experiencing a night terror, try not to react in fear; if you remain calm, your child will be more likely to remain calm and be able to go back to sleep.  

If your child is experiencing nightmares, you should always reassure them that nightmares are not real and can’t hurt them. You may have to play detective a bit. Ask about the dream, what made it scary, and try to find out what may have caused it.

Did they watch a scary movie? Did something stressful happen at school? You want to make sure that your child is not experiencing nightmares in response to more serious trauma, which is when getting a mental health expert’s help would be necessary.

It’s also important that your child has a regular sleep routine, which can help minimize night terrors and nightmares. For younger kids, it may help to give them a stuffed animal or a night light to help make their bedroom a comforting space.