Nightmares and night terrors: differences and similarities

Sleep disorders and difficulties falling asleep are very common problems in childhood. It is called "parasomnias" to those disorders characterized by events or behaviors abnormalities associated with sleep, its specific phases or the transition periods between sleep and vigil.

Parasomnias include disorders such as somnambulism, the bruxism, the nocturnal enuresis, nightmares and night terrors. Although these last two alterations are often confused, the truth is that the nightmares and night terrors have as many differences as similarities.

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What are nightmares?

A nightmare is a dream with terrifying content that causes strong feelings of fear or anguish. When the child wakes up after a nightmare, he remains in contact with reality and responds appropriately to the environment. When waking up, it is usual to remember the content of the dream.

The nigthmares happen during REM phases of sleep, which occur to a greater extent during the second half of the night. REM sleep is characterized by high brain activity, lack of muscle tone, high respiratory rate, rapid eye movements, and a rapid, irregular pulse. It is precisely in this phase of sleep that most dreams usually occur, including nightmares.

It is one of the most frequent disorders in childhood and adolescence. According to studies, between 10 and 50% of children aged 3 to 6 suffer from them. Although nightmares do not usually pose a risk to the health of the child, they can cause a certain fear of going to bed, especially if they are frequent. In these cases, the sleep pattern can be altered and excessive drowsiness, irritability, anxiety, etc. may appear secondarily.

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What are night terrors?

During episodes of night terror it is common for the child to sit up abruptly in bed and begin to screaming, moaning, babbling, or crying with a terrified facial expression. Keeps eyes open without being really awake and shows signs of anxiety with great autonomic activation (tachycardia, hyperventilation, sweating, etc.). In addition, night terror occurs in the deep phase of sleep, when there is no muscle tone.

The appearance of this sleep disorder in adulthood is not ruled out, but it is in childhood when they are most frequent. Its onset usually takes place between 4 and 12 years of age and it is estimated that between 1% and 6% of children experience episodes of night terrors.

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Why do they occur?

Factors such as emotional stress, traumatic events, anxiety, fatigue, irregular hours sleep, fever or taking some medications seem to increase the appearance of these sleep disorders.

Night terrors are usually attributed to the stress suffered by the little one during the day; going to sleep agitated increases the probability of an episode occurring. Unpleasant dreams are more frequent when the child is distressed or worried about something and are often based on these worries.

Unlike what happens in nightmares, hereditary factors seem to play a causal role in the presentation of night terrors. About 80% of children who suffer from them have relatives who have also presented these sleep disorders. Is genetic basis is shared with sleepwalking.

Differences between nightmares and night terrors

Fundamentally, the differences between nightmares and night terrors are as follows:

1. The chances of awakening

Unlike what happens in nightmares, in night terrors the child does not usually wake up easily despite the efforts of the parents. If you wake up, you are confused and disoriented, you do not respond appropriately to your surroundings and a certain sense of fear invades you. The episode usually lasts 10 to 20 minutes, and then you can go back to sleep. The episode is often not remembered when they wake up the next day, and if they do remember something it is usually isolated and blurred fragments.

2. The sleep phase

Night terrors, like sleepwalking and unlike nightmares, arise in deep sleep and not during REM phases. They usually emerge during the first third of the night. During deep sleep, muscle tone is weak and heart and respiratory rates decrease.

How to act before these episodes?

If our child suffers from nightmares or night terrors, it is best to act in a calm way, trying to normalize the situation. If children see their parents alarmed or worried, their anxiety will be greater.

It is also necessary to avoid intense light as this could lead the child to develop a phobia of darkness, by associating it with fear. It is not a good idea to talk in detail with the child about what has happened because it could become more activated and this would make it difficult for her to fall asleep again.

It is advisable stay with the child until she has calmed down long enough and he can fall asleep again, but he must stay in her room and sleep in his own bed. If parents convey to their child that every time she has an episode she will be able to sleep with them, they are reinforcing the sleep disorder and promoting inappropriate habits.

Treatment of night terrors

Night terrors cause real panic in parents, more than in the child himself, who as we have seen usually will not remember the episode. In mild cases, parents should keep calm and do not try to wake your child during the horror episode.

It is convenient to ensure that the child does not fall out of bed or suffer any physical damage during the episode, as he is fast asleep and unaware of what is happening to his around.

These sleep disorders usually go away over time and do not usually require psychological treatment, except in those cases that, due to their frequency or intensity, constitute a problem for the child and it is necessary to consult a health professional.

Pharmacological treatment is not recommended with minors, since drugs such as benzodiazepines They can produce important side effects and when they are stopped their benefits disappear, so they do not solve the problem in any case.

An effective psychological technique in parasomnias such as night terrors and sleepwalking is the technique of programmed awakenings, which consists of waking the child before the time in which the disorder usually manifests itself. This is done to shorten the sleep cycle and thereby prevent the occurrence of the episode.

Treatment of nightmares

Parents should try to reassure children after nightmares and try to get them back to sleep, trying not to be excessively worried or anxious. For older children, ages 7 to 8, you can talk the next morning about the nightmare, trying to find out if there is something that worries you that may be responsible for these dreams terrifying.

If applicable, it is important promote proper sleep hygiene, that is, regular sleep patterns that help the child know that the time to sleep is approaching.

It may also be wise to avoid large dinners and violent or horror shows or movies that stimulate the child's imagination, as well as modifying any inappropriate habits or stimuli that may disturb their break.

In some severe and frequent cases of nightmares, when they exist for a long time or occur very often, they are very intense and cause significant discomfort, it may be advisable to go to a psychologist.

There are effective techniques that teach children to cope successfully with anxiety-provoking dreams, such as Rehearsal therapy in imagination, consisting of rewriting y reimagine the dream so that its content stops generating fear.

Bibliographic references:

• Sierra, J. C., Sánchez, A. I., Miró, E. & Buela-Casal, G. (2004). The child with sleep problems. Pyramid Editions: Madrid.
• American Sleep Disorders Association (1997). The International Classification of Sleep Disorders, revised: Diagnostic and coding manual (2nd Ed.). Rochester: Minnesota.