Night Terrors vs Nightmares & How To Help

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Many children occasionally suffer from nightmares, especially when their body may be overstressed or overtired. Night terrors, though, are different from nightmares. They can be biological in nature or result from particularly stressful periods in a child’s life. This blog will help you identify them and discuss commonly practiced tips for addressing night terrors. At the end of this blog, I’ll also discuss ways to help with addressing nightmares too.

When you have a nightmare it wakes you up out of your sleep. You may be able to recall details of the dream as you try to calm your senses back down. When someone has a night terror they are usually still dreaming when they begin to cry out or sit up in their bed. They can seem to interact with you, but they are generally still in their sleep state. Many times, trying to wake them can cause them to become more confused and agitated. Most children won’t remember any part of their night terror or that they even had one during the night.

In most cases, a night terror is more stressful and scary for the parents than the child

Night terrors are more common in children than adults, affecting around 40% of children. They can be hereditary in nature or they can come during times of stress- both psychologically and physically (growth spurts, sleep changes, illnesses, etc.) They are most commonly seen between the ages of 3-12 (usually peaking around age 8) and they may only happen once or twice or they can come in clusters where they occur occasionally over the span of weeks or months and then disappear for longer lengths of time. Children typically grow out of them by their teens.

During a night terror, a child’s fight-or-flight response can be overactivated while the child is in the deepest stage of non-REM sleep. It can cause a child to partially wake while they are experiencing a nightmare-like dream. This usually occurs in the first portion of their total sleep time or likely within the first 2-3 hours of sleep. The exact causes aren’t certain, but they seem to occur sometime during the transition to deeper sleep. A night terror can be very distressing for parents or caregivers to watch, but it is not actually distressing for the child. The child may scream, shout, mumble, cry hysterically, or engage in sleep walking, but they generally don’t recall those actions in the morning. If you try to wake them and cause more distress though, that may be the sequences that they actually recall in the morning. Sometimes a child can seem to be awake during a night terror, but when you try to engage with them, they won’t typically respond to the actual things you are saying or asking, but instead may just react to the noise of your voice.

Here are some tips to help you address night terrors in the moment as well as ways to help reduce them in the future.

A night terror can typically last 10-15 minutes (which can feel like forever to a caregiver during that time). Your gut instinct will likely be to try to wake them up and help them out of it or hold onto them to comfort them, but you need to remember that they are still asleep and they aren’t aware yet of your presence so your actions may seem more frightening to them in their dream. If you try to wake them they may become more reactive. Instead, make sure they aren’t going to hurt themselves in any way, especially if they’re also sleepwalking. You may talk to them soothingly and briefly, but if it appears to agitate them then stop. You can put on a soft light in the room but refrain from turning on the room lights to wake them. Mostly, you are riding it out with them and then focusing on the steps that can help for the next night. Remember, these episodes will actually be more distressing for you than them. *Note- if you have other children, the volumes that a night terror can escalate to may be a concern, so planning ahead with sound machines in bedrooms may be beneficial during night terror clusters.

Reducing Future Night Terrors

Remember sometimes night terrors are merely hereditary, but these steps can still be an overall benefit to children in those cases as well. Here are some steps to help reduce future night terrors.

1) Build consistent bedtime routines that provide relaxation before bed and that allow for adequate amounts of sleep for your child’s age

Keep tv’s out of children’s rooms or at least don’t let kids fall asleep to them because it can cause sleep disruptions.

2) If your child has night terrors around a similar time, you can plan to briefly wake them 15-30 mins before that typical time and have them use the restroom or sit up for a few minutes. This break may help them with a better transition into deep sleep after they fall back asleep. If there isn’t a consistent time, you can try waking them an hour after they fell asleep. You only need to do this when they are in a night terror cluster- meaning they have been having them more consistently over a period of time. You can follow this routine for a week and then you would stop doing this once the night terrors have gone away for about a week. If they return, you can start again but you don’t want this to become your child’s consistent sleep routine.

3) Focus on stress or anxiety reduction at home on a daily basis. Be sure you are aware of what anxiety reduction actually means though. Helping your child engage in avoidance or withdrawal from natural stressors can actually increase one’s anxiety and cause longer term problems. Seek out a children’s therapist if needed. You can also reference any of my blogs or other therapists’ blogs on anxiety in children. Note though, not all night terrors are from psychological stress, so if there are no other signs of anxiety or high stress, that may not be the current trigger for your child’s night terrors.

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4) When night terrors are chronic, you should check with your doctor about conditions like sleep apnea, restless leg syndrome, or gastrointestinal issues such as reflux that can be disturbing your child’s sleep. Enlarged adenoids or tonsils can cause sleep disturbances like night terrors- as can a stressed digestive tract. Also, it can be more common after changes in some medications (check with your doctor) and after anesthesia.

If your child has a night terror for the first time it can be very alarming for a caregiver if they have not experienced them before. Rest assured that night terrors are not an immediate signal of mental illness or distress. Yes, major or difficult life changes can trigger them, but many can be a temporary result of minor life changes too, as discussed earlier.

Even if it isn’t necessary, it may feel more comforting to you to reach out to your pediatrician with any concerns. Hopefully this blog has helped to alleviate some of your own anxiety though, should you find yourself awoken in the night to a child’s night terror. Night terrors are not harmful to children, but if they are chronic, the disruptions in sleep quality can be impactful. Meet with your doctor about chronic night terrors to determine if there are any underlying physical conditions (Step 4) or with a children’s therapist for any underlying psychological stress (Step 3).