Nightmares and terrors

Published by Bupa’s Health Information Team, December 2010.

Anyone can have a bad dream from time to time – especially in childhood, but are nightmares and night terrors anything to worry about? This article will explore some of the main differences between the two – and what you can do to stop them.

Just a bad dream?

Everyone has probably experienced a nightmare or night terror at some point in their life – but thankfully, most people grow out of them by adulthood. Although anyone can have a nightmare or night terror, they are much more common in young children.

So what exactly is the difference between the two? Nightmares and night terrors are easily confused – but in fact, they are very different. When you sleep, you cycle between phases of rapid eye movement (REM) and non-rapid eye movement (non-REM) sleep (see The science of sleep for more information). Nightmares, like dreams, happen in the REM stage, whereas night terrors occur in non-REM deep sleep. You may wake up while you’re having a nightmare, and be able to recall it vividly. In a night terror, however, you stay in deep sleep – and although it can be shocking for others to see, you will usually not remember a thing about it.

What happens in a nightmare?

A nightmare is a particularly vivid dream that is unpleasant, frightening or unsettling. Anyone can have a nightmare, but they are particularly common in children between the ages of three and six.

Nightmares occur during REM sleep, so are more common in the middle of the night – about three to six hours after going to sleep.

Nightmares may focus on a physical situation, such as being chased, or a psychological scenario, such as being embarrassed in a social setting. You might also conjure up a monster, fierce animal or a frightening person in your imagination during a nightmare.

Someone having a nightmare won’t usually make much noise or movement until they wake up. However, you can wake up quite easily from a nightmare and will probably be able to remember it vividly. This can be very frightening for young children.

What causes nightmares?

In children, nightmares are often caused by frightening experiences, such as watching a violent TV programme or being told a scary story. Children may also be more likely to have nightmares if they are worried about something. As an adult, you are more likely to have nightmares at times of anxiety or upheaval, such as when moving house or starting a new job, or if you have recently gone through a distressing event – such as an accident or a violent attack.

Nightmares can also be a side-effect of various medicines or can start when you stop taking certain medicines.

What happens in a night terror?

Night terrors occur during slow-wave sleep (deep sleep), two to three hours after going to bed. This means someone having a night terror won’t usually wake up, and won’t remember anything about it in the morning. Night terrors are most common in young children aged between the ages of three and eight – and they usually grow out of them before adolescence.

A child having a night terror may sit up suddenly in bed and start screaming. He or she may appear awake and look very frightened – the child may thrash, kick or roll about. Although it may look as if he or she is awake, the child won’t usually respond to your voice or touch.

Although night terrors are frightening for those who witness them, they don’t cause any harm to the person having them, and usually pass within a few minutes. As a parent of a child having a night terror, the best thing you can do is to try to stay calm and sit with your child until the night terror passes. Don’t try to wake your child, as this can make it worse.

What causes night terrors?

Your child may be more likely to have a night terror if he or she is feeling anxious about something. Lack of sleep and change to routine can also set off night terrors, so try to maintain your child’s routine as much as possible.

If your child is regularly having night terrors, it may help to try waking him or her before the terrors usually occur – as this can break the cycle and prevent a night terror from happening.

If the night terrors happen for more than three months, see your GP.

Seeking help for nightmares and night terrors

Sleep problems are very common in young children. They are not usually serious and most children will grow out of them on their own. There are some simple things you can try yourself that may help the situation.

• Talk to your child to find out if there is something worrying them and that may be triggering their nightmares or night terrors.
  
• Make sure you have a consistent, relaxing bedtime routine to help your child wind down for the night. Changes to routine are a common cause of night terrors.

If nightmares or night terrors continue to cause problems, it’s important to seek professional help – as they may start to interfere with your child’s learning and behaviour. Your GP may be able to refer you to a sleep specialist for further investigation.

For sources and links to further information, see Resources.