Learn how to manage and alleviate night terrors and nightmares for more restful sleep. Meri Sehat offers expert guidance for better nights.

Night Terrors And Nightmares

A. JABBAR DENTAL CLINIC

Sadia Khan

Overview

Night terrors and nightmares are <a href="https://merisehat.pk/disease/sleep-disorders-in-adults">sleep disorders</a> wherein the individual wakes up in a terrified state.

<ul>
	<li>Night Terrors &ndash; Also known as sleep terrors; episodes of intense fear and agitation during sleep, usually occurring in the first third of the night during the NREM phase of sleep</li>
	<li>Nightmares &ndash; Vivid and frightening dreams, usually occurring in the early morning during the REM phase of sleep 
	&nbsp;</li>
</ul>

While nightmares are common, they are only considered a mental health condition when they disrupt an individual&rsquo;s daytime life.<a href="#accordion">[6]</a>

Nearly 35-45% of adults have at least one episode of nightmares in a month, and they increase with advancing age. Comparatively, around 75% of kids have at least one nightmare, with a peak between the ages of 6 and 10.

Night terrors are not that common. 1-2% of adults have them at some point in their lives, usually before they turn 25, whereas 56% of kids aged 13 or under reportedly have it. 
&nbsp;

Sign and Symptoms

Night terrors, common in children aged 3-8, can be characterized by:<a href="#accordion">[4]</a>

<ul>
	<li>May talk or move while asleep; eyes may be open in some instances.</li>
	<li>Sudden awakening from sleep with a scream or cry.</li>
	<li>Fear, agitation, confusion and disorientation</li>
	<li>Sweating and rapid heart rate.</li>
	<li>Not responsive to attempts to wake or comfort them.</li>
	<li>Limited or no recollection of the episode upon waking. 
	&nbsp;</li>
</ul>

Nightmares, affecting both children and adults, can be characterized by:

<ul>
	<li>Vivid and frightening dreams</li>
	<li>Intense negative emotions, such as fear, anxiety, or terror</li>
	<li>Waking up feeling scared or anxious</li>
	<li>Can recall the dream upon waking</li>
</ul>

Night terrors usually occur in the early part of the night and last for around 15 minutes. Sometimes, there may be multiple episodes in a single night. On the other hand, nightmares usually happen later in the night. 
&nbsp;

Important!

<ul>
	<li>DO NOT talk or try to wake up someone experiencing night terror unless there is a risk of major injury and intervention is necessary to protect them or others. Stay calm and wait for them to calm down.</li>
	<li>Consult a doctor immediately if you or your child have repetitive nightmares, several episodes of night terrors in a single or during most nights, or multiple episodes that are severe or last longer than 30 minutes.</li>
	<li>Daytime fears, drooling, or jerking are also causes of concern. 
	&nbsp;</li>
</ul>

Causes

The causes of night terrors and nightmares can be multifactorial.<a href="#accordion">[4]</a>

Generally, they may occur when the individual feels tired or unwell. It&rsquo;s also natural to have an episode after watching a scary film or when sleep is disrupted due to external noise or an urgent need to pee. Life events like exam failure and lack of sleep are also known triggers.

Sometimes, nightmares may be due to the child&rsquo;s developmental stages. For instance, toddlers with separation anxiety may have a nightmare about being separated from their parents, while preschoolers have bad dreams about the dark or monsters.

Psychological factors, such as anxiety, depression, and high levels of emotional distress, have been linked to the severity of nightmares.<a href="#accordion">[2]</a>&nbsp;For example, a study on adopted children found that they had difficulties falling asleep, experienced night terrors, and were reluctant to sleep alone.<a href="#accordion">[3]</a> 
&nbsp;

Other causes may include:

<ul>
	<li>Underlying medical conditions that affect mental health or sleep, such as sleep apnea, restless legs syndrome, dementia, post-traumatic stress disorder, or fever</li>
	<li>Certain medicines, such as antidepressants, dopamine agonists, and beta-blockers 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of night terrors and nightmares involves a thorough evaluation of the individual&#39;s symptoms, sleep patterns, and associated underlying conditions.

<ul>
	<li>Clinical interviews help gather information about the frequency, intensity, and impact of night terrors and nightmares on the individual&#39;s daily life.<a href="#accordion">[1]</a></li>
	<li>Sleep studies, such as polysomnography, help monitor brain activity, heart rate, breathing, and other physiological parameters during sleep.</li>
	<li>Psychological assessments help identify underlying mood disorders and psychological factors contributing to sleep disturbances. 
	&nbsp;</li>
</ul>

Treatment

Most cases of nightmares in children resolve on their own after the age of 10. Similarly, only 1-2% of individuals have night terrors by adulthood.<a href="#accordion">[6]</a> 
&nbsp;

Doctors may suggest a combination of approaches, including the following to address underlying psychological factors and promote better sleep hygiene:

<ul>
	<li>Image rehearsal therapy, hypnosis, and counseling</li>
	<li>Medications, such as benzodiazepine<a href="#accordion">[5]</a></li>
	<li>Treatment of underlying medical conditions</li>
	<li>Lifestyle modifications, such as a consistent bedtime routine<a href="#accordion">[1]</a> 
	&nbsp;</li>
</ul>

Night terrors and nightmares can lead to several complications, including:

<ul>
	<li>Disrupted sleep patterns and poor sleep quality, which can impact overall well-being and daytime functioning</li>
	<li>Increased risk of anxiety, depression, and other mood disorders, particularly in individuals experiencing frequent and severe nightmares</li>
	<li>Impaired quality of life and psychological distress due to the emotional impact of recurring night terrors and nightmares<a href="#accordion">[1]</a></li>
</ul>

It is important to note that the impact of nightmares extends beyond sleep disturbances, as research has indicated a potential link between nightmare distress and suicidal ideation.<a href="#accordion">[7]</a> 
&nbsp;

These include:

<ul>
	<li>Genetics &ndash; People with sleep terrors usually have the HLA-DQB1*05:01 allele</li>
	<li>Age &ndash; Mostly affects children, but adults may have them as well</li>
	<li>Sex &ndash; Night terrors are common in preadolescent boys<a href="#accordion">[5]</a></li>
	<li>Family History &ndash; A 96% risk for individuals with family members who sleepwalk or have had night terrors</li>
	<li>Individual Health &ndash; Adults with night terrors have a history of anxiety and depression<a href="#accordion">[6]</a> 
	&nbsp;</li>
</ul>

To reduce the risk of night terrors and nightmares, individuals can consider the following preventive measures:

<ul>
	<li>Keep a sleep diary to identify potential triggers</li>
	<li>Practice stress management techniques to deal with lifestyle or academic load</li>
	<li>Create a comfortable and relaxing sleep environment to support biological rhythm and limit sleep disruptions</li>
	<li>Get enough sleep each night and avoid internet usage and other activities that delay bedtime</li>
	<li>Avoid recreational drugs before bed 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li style="list-style-type: none;">Night terrors are episodes of intense fear and agitation during sleep, often occurring in the first third of the night, while nightmares are vivid and frightening dreams that occur during REM sleep.</li>
	<li>Night terrors and nightmares can be caused by genetic predisposition, psychological factors, underlying medical conditions, and stressful life events.</li>
	<li>Screening and diagnosis of night terrors and nightmares involve comprehensive assessments of sleep patterns, psychological factors, and physiological parameters during sleep.</li>
	<li>Treatment options for night terrors and nightmares may include psychotherapy, medications, addressing underlying medical conditions, and lifestyle modifications promoting better sleep hygiene.</li>
	<li>Complications of night terrors and nightmares include disrupted sleep patterns, increased risk of anxiety and depression, and impaired quality of life.</li>
	<li>Preventive measures for reducing the risk of night terrors and nightmares include practicing stress management techniques to deal with lifestyle or academic load and avoiding internet usage and other activities that delay bedtime.</li>
</ul>

[1] Azad, M., Fraser, K., Rumana, N., Abdullah, A., Shahana, N., Hanly, P., … & Turin, T. (2015). Sleep disturbances among medical students: a global perspective. Journal of Clinical Sleep Medicine, 11(01), 69-74.

[2] Hartman, D., Crisp, A., Sedgwick, P., & Borrow, S. (2001). Is there a dissociative process in sleepwalking and night terrors? Postgraduate Medical Journal, 77(906), 244-249.

[3] Rajaprakash, M., Kerr, E., Friedlander, B., & Weiss, S. (2017). Sleep disorders in a sample of adopted children: a pilot study. Children, 4(9), 77.

[4] Night terrors and nightmares. NHS choices. Accessed December 14, 2023.

[5] Nightmares and night terrors. Johns Hopkins Medicine. November 19, 2019. Accessed December 14, 2023.

[6] Swaim E. What’s the difference between nightmares and night terrors? Healthline. April 7, 2022. Accessed December 14, 2023.

[7] Nadorff MR, Nazem S, Fiske A. Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep. 2011;34(1):93-98. Published 2011 Jan 1. doi:10.1093/sleep/34.1.93