Night Terrors Vs. Nightmares: Differences, Causes, & How to Cope

What Are Night Terrors?

Night terrors are sleep-related occurrences in which a person may experience physical and verbal reactions due to the distressing visions in the night terror. These happen in non-REM sleep stages and can be very difficult to wake up from.¹ A person in a night terror may appear intensely fearful, screaming and thrashing in their sleep.

Night terrors are undesired episodes during sleep, known as parasomnia. Parasomnia is a type of sleep disorder that leads to abnormal physical movements during sleep, such as sleepwalking. The characteristics of parasomnia can vary dramatically in the frequency and severity of the sleep disorder, but most cause disturbed, restless sleep.

What Are Nightmares?

Nightmares are impactful, realistic, and distressing dreams that differentiate themselves by waking you out of sleep. While a bad dream can also have disturbing content, a nightmare jolts the sleeper awake. Often, upon waking, the dreamer still feels anxious and upset and may even experience physical symptoms, such as a rapid heart rate or sweating.

If you’re having frequent nightmares that disrupt your sleep and affect your daytime functioning, you may have  nightmare disorder.

While nightmares can occur at any point in the sleep cycle, they are more likely to develop during rapid eye movement (REM) sleep. Since REM sleep stages tend to lengthen the longer you sleep, it’s common to experience nightmares in the early morning. An intense nightmare will feel real, and the dreamer may struggle upon first waking to remember it was only a dream.¹

Key Differences: Night Terrors Vs. Nightmares

Despite some similarities, nightmares and night terrors are different experiences. Almost everyone will experience a nightmare at some point in their lives, and while disturbing, they are considered normal. In contrast, night terrors are parasomnia, distressing both the dreamer and those around them.

The key differences between nightmares and night terrors are:

• Wakefulness: People remain asleep during night terrors and wake up from nightmares. Night terrors are very hard to wake up from.
• Memories of the event: People typically don’t recall night terrors, whereas they can often remember details of nightmares. People who get night terrors, however, can have physiological reactions upon waking.
• Occurrence: Night terrors are rare for adults (less than 2%). However, most adults have nightmares at least once.
• Sleep stage: Night terrors occur during slow wave sleep, which is non-REM sleep, while nightmares occur during REM sleep, which is the stage of sleep where memory is processed and when dreams occur.²

What Causes Night Terrors?

While the exact cause of night terrors is unknown, there are several possible causes and contributing factors. Risk factors for night terrors include a family history of sleep disorders, nightmares, and trauma.

Triggers and causes for night terrors include:

• Traumatic experiences: Those who have endured traumatic experiences may experience nightmares and night terrors as a symptom of post-traumatic stress disorder (PTSD). Having both PTSD and night terrors is common. Additionally, childhood trauma may cause night terrors without the other symptoms of PTSD.
• Mood Disorders: Mood disorders, including depression, bipolar disorder, and generalized anxiety disorder, can lead to nightmares. While the connection isn’t completely clear, the extra stress of these conditions may increase the likelihood of experiencing a night terror.
• Stress and anxiety: Stress, emotionally distressing periods, and times of increased anxiety may make you more likely to experience a night terror.
• Medications: Certain medications, including beta blockers, SSRIs, antihistamines, and certain sleep aids, can create more vivid, intense dreams, nightmares, or night terrors.
• Substance abuse: Recreationally abusing drugs and alcohol can impact sleep quality. As a result, the dreamer will experience less REM sleep and be more likely to experience night terrors. Additionally, night terrors are a frequent symptom of those going through alcohol withdrawal.
• Medical conditions: Medical conditions like Parkinson’s disease can increase a patient’s likelihood of experiencing nightmares and parasomnia, including night terrors and sleepwalking.
• Family history of recurring nightmares: Those who have a family history of night terrors or recurring nightmares may be genetically predisposed to experience night terrors.
• Sleep disorders: Sleep disorders disrupt the typical sleep processes, potentially inducing night terrors.³

What Causes Nightmares?

While the definitive cause of nightmares remains unknown, experiences during wakefulness can significantly contribute to nightmares. Many sleep specialists believe dreams help the brain process memories and emotions. Therefore, nightmares may serve as the brain’s way of processing trauma and fear. While experiencing nightmares is normal, certain mental health conditions are associated with nightmares, including post-traumatic stress disorder (PTSD), anxiety, and depression.⁴

Nightmare triggers and causes include:

• Stress: Both everyday stressors and major life changes can lead to nightmares
• Mental health conditions: Mental health conditions that may cause nightmares include depression, anxiety, PTSD, and bipolar disorder
• Medical conditions: Certain medical conditions like Parkinson’s disease, heart disease, or cancer can impact sleep, leaving a person more prone to nightmares
• Medications: Certain antidepressants, blood pressure medications, beta-blockers, and other drugs may trigger nightmares
• Sleep deprivation: Irregular sleep patterns, insomnia, or other disruptions that lead to sleep deprivation may lead to a higher likelihood of experiencing nightmares.
• Sleep disorders: Similarly, sleep disorders like sleep apnea are also linked to nightmares as they disrupt the sleep cycle and may lead to lower quality sleep.⁵

9 Tips for Coping with Night Terrors & Nightmares

Night terrors and nightmares may occur without warning, but basic tips for improving sleep and addressing mental health needs can reduce the frequency of nightmares. Nightmares don’t typically require treatment, but several ways exist to reduce and cope with them.

Practical tips for coping with nightmares include:

1. Keep a regular sleep schedule: A regular bedtime routine gives your body external clues that it’s time to sleep and will wind down accordingly.
2. Manage stress: Employ stress management techniques to keep your daytime stressors from affecting your sleep and causing nightmares.
3. Don’t eat before bed: Most people can benefit from stopping eating two to three hours before bed, as snacking increases metabolism, leading to increased brain activity and possible nightmares.
4. Avoid exciting or scary content before sleep: You should reduce screen time before bed and be careful about the nighttime content you consume. Frightening or upsetting shows, movies, or news viewed right before going to sleep can lead to similar dreams.
5. Use a white noise machine: If you’re uncomfortable with silence, or hear uncontrollable noises during your sleeping hours, then using a white noise machine to drown out unpredictable sounds can improve your sleep.
6. Avoid caffeine/alcohol: Limiting alcohol and caffeine, especially in the afternoon and evening, can improve sleep quality.
7. Practice relaxation techniques: Trying breathwork or progressive muscle relaxation before bedtime can help you quiet your mind and drift into sleep more easily.
8. Try journaling: Journaling for anxiety can allow you to clear any lingering stress or worries from your brain before settling down to sleep.
9. Keep your bedroom comfortable: A cool room temperature can be one of the most significant factors in achieving a good night’s sleep. Keeping the bedroom at around 65 degrees Fahrenheit is considered ideal.

Treatments for Night Terrors & Nightmares

If you still experience frequent night terrors or nightmares, even after making environmental and lifestyle changes, you may be dealing with a sleep disorder or an untreated mental health condition that interferes with sleep. Recurring nightmares or night terrors can affect your mood, and ability to focus, so you may benefit from professional help. If you’ve always struggled with your sleep, knowing when to seek help can be difficult. However, there are options available to improve your sleep quality.⁶

Treatments for nightmares and night terrors include:

• Image Rehearsal Therapy (IRT): IRT works to reduce the quantity and intensity of nightmares. In IRT, after experiencing a nightmare, patients are taught to reframe the story and create a new, less frightening outcome. Then those outcomes are rehearsed to reduce the impact of future nightmares.
• Eye Movement Desensitization and Reprocessing (EMDR) Therapy: EMDR works to help the brain process traumatic memories, effectively desensitizing the brain to trauma symptoms. It’s an especially beneficial treatment for those whose nightmares result from PTSD.
• Hypnotherapy: Hypnotherapy can target negative thought patterns and help reduce stress and anxiety that lead to nightmares. Hypnotherapy is an effective tool for targeting both nightmares and sleepwalking.
• Systematic Desensitization Therapy: Systematic desensitization therapy works to gradually exposes people to their fears, teaching patients to cope and deal with stressors in a safe environment and reducing the intensity of fear that comes with nightmares.
• Cognitive Behavioral Therapy (CBT): CBT can use various methods to target negative thoughts and emotions, allowing those with nightmares to reframe their interpretations of nightmares, reducing the distress they cause.⁶

Connecting with your physician if your sleep impacts your health is essential. Additionally, there are many online therapy options for working through stress, anxiety, and other nightmare and night terror triggers. Searching an online therapist directory is also an excellent way to choose a therapist for your specific needs. Together, you and your medical team can devise a plan to improve your sleep and work through circumstances negatively impacting your sleep.

Final Thoughts

What you are dealing with is unique, but you are not alone. Nightmares and night terrors can be challenging, but there are ways to move forward. Working on home remedies and collaborating with a therapist can be a great way to learn to manage your triggers and symptoms.