Night terror or nightmare?

The difference matters, doctors say


Merry Mayer


The first time it happened, my son was about 2. He was screaming in the middle of the night. His eyes were open and he was sitting up in his bed, pointing to the corner of the room, terrified. My husband and I looked, but there was nothing there. We held him and spoke to him, hoping to wake him out of his nightmare.

But it wasn’t a nightmare. It was a night terror.

“Parents need to understand that they are two completely different events,” says Dr. Barbara W. Huggins, professor and chair of the Department of Pediatrics at the University of Texas Health Center at Tyler, speaking for the American Academy of Pediatrics.

It’s important to understand what night terrors are and how they differ from nightmares, doctors say, so parents know how to handle these frightening episodes—and prevent them. Because although night terrors don’t affect a child psychologically, in severe cases they can interrupt a child’s sleep patterns, which may impact behavior and school performance, says Dr. Kenneth S. Polin from Town & Country Pediatrics, a practice with offices in Chicago and Glenview.

Night terror vs. nightmare

So what is a night terror?

“[Night] terrors are partial arousals from sleep, when both the sleep system and wake system are turned on at once,” explains Dr. Stephen H. Sheldon, director of the Sleep Medicine Center at Children’s Memorial Hospital in Chicago. “It may look like the child is terrified, but [he or she is] very deeply asleep.”

It sounds strange because children also often appear to be awake. “Children are deeply asleep, but their movements are [as though they are] awake, their eyes are opened and dilated, they’re sweating,” says Sheldon.

“It’s an example of the lights are on and nobody’s at home,” Polin adds.

During night terrors, you also tend to see a rapid heart rate in the person experiencing it, sometimes triple the normal rate, says Huggins.

Night terrors are believed to affect about 5 percent of children between the ages of 3 and 5, Huggins says, and occur within the first hour of going to sleep. Episodes can last anywhere from 10 to 40 minutes.

And although most kids outgrow night terrors by the time they are 8 or 9 years old, Polin says some older children and even adults have night terrors.

So how do you distinguish between night terrors and nightmares? Not only do they look different, but they happen during different parts of the sleep cycle and have distinct triggers, doctors say.

Unlike nightmares, which occur during REM sleep, night terrors usually happen in stage 4 sleep — the last deep sleep stage before REM — as do other sleep disturbances such as sleep walking, sleep talking and bedwetting, says Polin. These disturbances are all genetically linked. In 95 percent of families where one of these sleep disturbances occurs, another family member will have one of these four problems, he says.

While nightmares are psychological events often brought on by things that happened during the day, such as the child seeing a scary movie, night terrors have no psychological trigger.

“Nightmares are a conscious process; they are emotional,” Polin says. “Night terrors may look scarier, but nothing [during the day] can be related [to them].”

And though children experiencing a nightmare often wake up with vivid memories, children experiencing night terrors won’t remember anything the next day, Huggins says.

Reacting to night terrors

For those watching, night terrors can be very eerie.

Although my son’s night terrors probably only lasted 10 to 15 minutes, it seemed much longer because we couldn’t help him. His eyes were open, but he didn’t seem to see or hear us as he screamed. Then, without anything changing, his eyes closed and he fell back into bed, quietly, asleep.

“[Children] sit up and look stunned, look like they are trying to escape, but from what we don’t know,” says Huggins.

When a child has a night terror, a parent’s first reaction is often to wake the child. But that’s exactly what Huggins cautions parents to avoid. “What parents want to do is get there to wake up the child. But shaking them and getting them to wake [from a night terror] is worse,” says Huggins. The best thing parents can do is to hold them gently or even just observe, she says.

Waking a child during a night terror can actually scare the child, since he is mentally asleep while his body is in wake mode and his heart is racing, doctors say.

It’s also important for parents whose children have night terrors to alert babysitters about the problem and remove objects near the bed that could hurt the child if he begins to thrash. Most children with night terrors do not move much, but it’s one extra precaution to take, say doctors.

Like my son, most kids sleep through their night terrors, never remembering them in the morning, says Polin.

“They stop as suddenly as they start,” Sheldon says.

In most cases, that’s true in the long term as well. For the vast majority of kids, night terrors eventually go away, says Huggins. Only in extremely rare cases, after parents have repeatedly tried all prevention methods, are medications ever used to control night terrors, she says. 

Tips to prevent terrors

While the cause of night terrors is not completely understood, there are several steps parents can take to lessen the likelihood of night terrors, doctors agree. Psychosocial stress during the day such as changing daycares or missing a nap can precipitate a night terror, Huggins and Sheldon say.

“Be sure your child gets an afternoon nap if they are used to one and don’t let them get excessively tired,” Huggins says.

“Most important is to be consistent,” Sheldon adds. “Children thrive on consistency. Wake time especially should be consistent, but not rigid.”

If night terrors are frequent and disruptive to the family, though, Sheldon suggests a visit to the pediatrician. “I see [children] when it’s occurring very frequently in the night, many times a night or if it’s happening every night and affecting the family,” he says.

One preventive method both Sheldon and Polin recommend is keeping track of whether the night terrors occur at the same time each night.

If they do, parents should try to lightly wake the child several minutes before the night terror occurs. It’s called anticipatory waking and it works in about 80 to 85 percent of cases, says Polin. Lightly nudge the child awake and then tell them to go back to sleep, he says. Doing this for a week or two should be enough to disrupt the night terror cycle in most children.

(Sheldon also warns that if the child pauses or snorts during sleep or has loud snoring, intense sweating, morning headaches, extreme thirst in the mornings or big tonsils and adenoids, there might be a respiratory ailment. Check with your doctor.)

But in most cases, parents just have to relax and wait until the kids outgrow the night terrors. “It’s kind of like colic,” Huggins says. “It’s going to go away eventually.” 

Merry Mayer is a Chicago writer with two children.


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