Night Terrors vs. Nightmares: Understanding Sleep Parasomnias and Management

This podcast episode, hosted by psychiatrist Dr. Tracey Marks, provides a comprehensive distinction between night terrors, nightmares, and sleepwalking, all categorized as parasomnias. Night terrors, also known as sleep terrors, are characterized as involuntary central nervous system arousals occurring during non-REM deep sleep, typically in the first two to three hours after falling asleep. Individuals abruptly wake from a near-coma state with confusion, disorientation, screaming, sweating, and a racing heart, akin to a panic attack. A crucial point is that night terrors are not triggered by upsetting dreams, differentiating them from conditions like PTSD-related dream disturbances, even though both can co-exist.

In contrast, nightmares occur during REM sleep, a lighter stage of sleep where most dreaming happens, usually in the latter half of the sleep cycle. Waking from a nightmare results in less confusion and the ability to recall parts or most of the dream. Night terrors are common in children, often attributed to brain immaturity, but affect about 3% of adults and can run in families, sharing a relationship with sleepwalking (somnambulism). The episode highlights the potential dangers of night terrors, such as thrashing or walking around without full awareness, emphasizing the need for caution.

Dr. Marks discusses various causes for night terrors in adults, including stress, depression, anxiety, sleep apnea, pain, alcohol consumption, and sleep deprivation. She offers practical advice for managing these conditions, starting with fundamental good sleep hygiene practices like maintaining a regular bedtime and limiting food and drink before sleep. A specific intervention, "scheduled awakenings," is introduced for frequent night terrors that occur around the same time each night, involving waking up about 30 minutes beforehand to interrupt the pattern.

The episode also delves into sleepwalking, another non-REM parasomnia that can co-occur with night terrors. Sleepwalking involves arousal during deep sleep where individuals perform basic actions with open eyes but without full awareness or memory of the event (amnestic). Dr. Marks advises against attempting to fully wake someone experiencing a night terror or sleepwalking episode unless they are at risk of harming themselves, as intervention can lead to agitation. For persistent or regular episodes in adults, particularly sleepwalking, seeking medical evaluation is recommended to identify and treat underlying causes, such as medication side effects.

Night terrors are different from nightmares.

Night terrors occur during non-rem sleep usually in the deep phase of sleep when you're in deep sleep you have slower brain waves...

It's like going from a near coma to being shaken awake.

This is a central nervous system arousal that is involuntary it's not a bad reaction to a dream.

You can have both conditions but the night terrors are not triggered by having an upsetting dream.

Night terrors can be dangerous because you can do things like thrash in the bed or walk around and do things without being fully aware of what you're doing.

Nightmares occur during REM sleep and this is a lighter stage of sleep where you do most of your dreaming.

If you have frequent night terrors and they occur around the same time each night you can have someone wake you up or set your alarm to wake up about 30 minutes beforehand to break the pattern.

Sleepwalking is an amnestic event so you don't remember what you were doing in the morning.

Unless the person is at risk of harming themselves it's best to leave them alone and let the episode pass on its own.