It can be very alarming to wake up in the night screaming. After all, sleep is supposed to be a peaceful and relaxing experience for you. It’s designed to refresh, heal, and restore your brain and body ready for the next day. Night screaming is bound to affect your quality of sleep, and it will almost certainly be affecting your partner or others in the house.
Nightmares and night terrors are quite common in childhood but are less frequent in adults. But just about everyone has the occasional nightmare from time to time. However, for some people, night terrors and nightmares are an everyday occurrence.
If you’ve only recently begun screaming in the night, you might be wondering what has suddenly brought it on. Today, we’re going to look at both night terrors and nightmares in detail. We’ll examine what they are, their causes, and treatments.
What Are Night Terrors?
If you find yourself frequently screaming yourself awake, you may be experiencing a phenomenon called night terrors. These are also known as sleep terrors, or by their Latin name “pavor nocturnus.”
They are a type of parasomnia, recognized in the Diagnostic and Statistical Manual of Mental Disorders. According to the DSM, night terrors are most common in children between the ages of 3 and 12. Roughly 1 – 6% of children experience them, compared to less than 1% of adults.
Usually, night terrors aren’t standalone experiences; they recur time and time again. Unlike dreams, night terrors don’t occur during REM (rapid eye movement) sleep. Instead, they begin during deep (slow-wave) sleep.
When the night terror starts, the individual will appear to have woken from sleep. Their eyes will usually be open. However, in reality, they are still sleeping. To an observer, they appear to be experiencing extreme fear and cannot be consoled. They might:
- Scream, cry, or shout loudly
- Breathe rapidly or heavily
- Stare wide-eyed
- Sit upright in bed, or get up and run around
- Display aggression if restrained
- Have dilated pupils and a fast heartbeat
It can be distressing to witness someone having night terrors. Fortunately, night terrors are not harmful in themselves. The only danger may come from an activity carried out by the sleeping person, such as falling downstairs.
What Are the Causes of Night Terrors?
Night terrors aren’t always caused by one particular thing. Many different factors might contribute to the likelihood of someone experiencing them.
Let’s examine the other factors which may make night terrors more likely.
- A twin study in the Pediatrics journal found that night terrors can be hereditary. This means that if your mother or father experiences night terrors, you are more likely to.
- Children are far more likely to have night terrors than adults. Though it is not impossible for adults to experience them, most night terror episodes pass by adolescence.
- Sleep deprivation. You are more likely to experience a night terror if you experience a lack of sleep. This may be because the more tired you are, the longer you spend in deep sleep, which is when the night terrors occur.
- Certain medications, especially those that affect the brain, can trigger night terrors.
- Fever and illness can trigger various parasomnias such as sleepwalking, sleep talking, and night terrors, especially in children.
- Stress and anxiety are common triggers for various disorders, including parasomnias. If you’re going through a stressful period, you’re more likely to experience night terrors. They may also be related to past trauma.
- Medical conditions such as sleep apnea, epilepsy, and restless legs syndrome often occur alongside night terrors. Night terrors can also occur alongside mental illnesses such as depression and personality disorders.
However, sometimes night terrors occur for no distinguishable reason at all. Some people are more prone to experiencing them than others, even when none of the above criteria apply.
What Are the Treatments for Night Terrors?
A study in the American Family Physician found that night terrors often subside when practicing good sleep habits. If you train your brain to know when it’s time to sleep, you’re less likely to wake up during the night or experience sleep disorders. Before visiting a professional, try the following:
- Establish a bedtime routine. In the hour before bed, relax your mind by having a warm bath or drinking chamomile tea. Do not use screens, such as mobile phones, as the blue light can trick your brain into thinking it’s daytime.
- Sleep at the same time each night. Regardless of whether it’s a workday or a day off, always go to bed and wake up at the same time. This will help your body learn when it’s time to rest.
- Exercise during the day to tire yourself out enough to sleep well at night. However, be careful not to become overtired as this can make sleep terrors more likely.
- Aim for 7 to 9 hours of sleep per night, if you’re over 18. Adolescents need slightly more sleep – between 8 and 10 hours.
If you believe that your night terrors are associated with a past traumatic event, consult a therapist. They may be able to offer some form of counseling to help you deal with your past. A study in the American Journal of Psychotherapy found that psychotherapy is an effective tool for reducing and eliminating the occurrence of night terrors.
Doctors rarely prescribe medication for night terrors, unless they are severely affecting the patients’ day-to-day life. According to the Canadian Family Physician, benzodiazepines (sleeping pills) can be effective at reducing the frequency of night terrors. However, these should only be used as a last resort, and are not a long-term solution.
What are Nightmares?
If you woke up screaming and terrified, night terrors might not necessarily be to blame. You may be experiencing nightmares, instead. You may have heard the terms “nightmares” and “night terrors” used interchangeably. However, although they can both cause screaming during the night, they are two entirely different things.
So, what are nightmares? Like night terrors, nightmares occur during sleep. However, they are not classified as a sleep disorder or parasomnia. Instead, they are just a type of bad dream. Unlike night terrors, everyone experiences nightmares occasionally. Research in the journal Sleep found that around 40% of adults have a nightmare sometimes.
Nightmares occur during REM (rapid eye movement) sleep. They are unpleasant dreams which provoke strong emotional responses, including fear, anxiety, and sadness. Nightmares usually involve an uncomfortable or frightening scenario which causes the dreamer to panic. Common themes include falling and being chased by someone or something. Someone who is having a nightmare may:
- Thrash or toss and turn in their sleep
- Talk, scream or shout in their sleep (somniloquy)
- Have a concerned or panicked look on their face
- Be sweating, or have a rapid heartbeat
- Wake suddenly in fear
- Be able to describe their nightmare once it’s over
Once the dreamer has awakened, they will be lucid but may find it difficult to go back to sleep.
Though experiencing the occasional nightmare is normal, it isn’t usual to experience them very frequently. If someone experiences nightmares at least weekly, they may be diagnosed with nightmare disorder (recurring nightmares). To be diagnosed, the nightmares must cause significant distress. They must also impact some areas of day-to-day life, such as work or socialization. Around 4% of adults experience frequent nightmares.
What Causes Frequent Nightmares?
If you find yourself waking up screaming from a nightmare often, there could be some underlying factors at play. Like night terrors, frequent nightmares can be triggered by many different things. A study in the journal Sleep identified many factors which could affect nightmare frequency:
- Sex. In adults, women tend to report having nightmares more frequently than men. In children, however, the incidence rate is about the same for both sexes.
- Lifestyle. People who lead a stressful life are more likely to have nightmares. In particular, you may experience more nightmares if you are unemployed, have a lower household income, divorced, or widowed. Nightmares are also associated with lower life satisfaction in general.
- Sleep duration. Nightmares are strongly linked with a lack of sleep. You are most at risk of nightmares if you sleep less than five hours per night, or suffer from insomnia.
- Some medications can trigger nightmares. These include painkillers, sedatives, hypnotics, and antidepressants.
- Medical conditions can impact the frequency of nightmares. For example, high blood pressure, angina, and heart failure tend to elicit frequent nightmares. Having a mental health condition such as depression also puts you at risk of nightmares.
Bear in mind, however, that everyone has the odd nightmare now and then. Infrequent nightmares are often spontaneous, with nothing, in particular, causing them. Some people experience nightmares for no reason.
What are the Treatments for Nightmares?
If you only experience nightmares now and then, there probably isn’t any need for treatment. Nightmares are normal, and nothing you do can stop you from ever having nightmares again. If your nightmares are not affecting your daily life in any way, you don’t need to worry about seeking treatment. They are a part of the normal human experience
Fortunately, though, there are treatment options available for individuals who have nightmares more frequently. The first step is to visit your doctor. They will be able to determine whether there is an underlying cause of your nightmares.
Your nightmares may be the result of a psychological condition such as depression, anxiety, or post-traumatic stress disorder (PTSD). If this is the case, therapy could be beneficial. A particularly useful form of therapy is called cognitive-behavioral therapy (CBT). A study in Cognitive Therapy and Research found CBT effective in treating many types of mental illness.
You can also try changing your lifestyle. For example:
- Get enough sleep. For adults, a healthy amount is between 7 – 9 hours per night. Try to go to sleep and wake up at the same time every day. That way, you’ll find it easier to fall asleep in general.
- Address any stressors in your life, such as an unsatisfying job or personal relationship. If there is something in your life making you unhappy, take steps to fix it. Don’t be afraid to seek help from others.
- Practice yoga or meditation to help relieve stress and clarify your mind. Many people also find that regular exercise is a great way to de-stress. As a bonus, it also results in more restful sleep.
Is It a Night Terror or a Nightmare?
So, now you know what night terrors and nightmares are, and what causes them. You also know the potential treatments for both. However, night terrors and nightmares can seem quite similar. So how do you tell them apart, as a non-medical professional?
Night terrors are entirely distinct from nightmares. Although they might sound similar in principle, they are not related at all.
Here’s how to recognize a night terror versus a nightmare:
The Time it Occurs
A study in American Family Physician found that night terrors usually occur early in the night. They are most common between 90 minutes and three hours after falling asleep.
This is because of our sleep stages. When we first fall asleep, we go through a period of light sleep, then transition to deep (slow-wave) sleep. Night terrors usually occur when we start to transition from stage 3 to stage 4 of deep sleep. This often happens quite early in the night.
By contrast, nightmares are more likely to occur later on in the night, usually during the early hours of the morning. If you’re waking up screaming only a couple of hours before your alarm, it’s probably a nightmare.
This is because nightmares are dreams, which are produced during REM (rapid eye movement) sleep. At the start of the night, our REM sleep stages are quite short. As we sleep for longer, our REM stages get longer as well. The longest periods of REM sleep occur after we’ve already been asleep for many hours.
A typical night terror will last around 1 to 2 minutes. The most severe night terrors can last up to 30 minutes. Throughout the duration of a night terror, the person experiencing it is fast asleep, though they appear awake. After an episode, the individual will either return to a peaceful sleep or will wake up.
Nightmares are very different. If someone is having a nightmare, they will appear asleep. They will remain lying down, usually with their eyes closed. They may move around or make noise in their sleep, but not always. Nightmares can vary significantly in duration, lasting from five minutes up to an hour.
According to research by the University of Mannheim, a person having a nightmare will almost always wake up naturally. Unlike a night terror, when they wake, they will be alert and present. They may also have difficulty returning to sleep.
According to research in the Tzu Chi Medical Journal, it is challenging to interrupt a night terror. This is because night terrors occur during the deepest stage of sleep. Someone having a night terror may not recognize the person trying to comfort them, and will not be consoled. Talking to or touching someone having a night terror will not wake them, and may even make it worse. If they do wake, they will be confused and disoriented. They will usually not be aware that they were screaming, or what they were afraid of.
Nightmares, on the other hand, occur during the transition between REM and light sleep. For this reason, it is easy to wake someone up from a nightmare. This can be done, for example, by gently touching their arm or calling their name. They will usually wake up straight away and can be consoled. When they wake, they will be aware that they have had a nightmare. They will also be able to describe the nightmare to some degree.
Because night terrors occur in the deepest sleep stage, they are not dreams. They are merely episodes of spontaneous fear and terror. Though the person having the night terror appears frightened and threatened, they will not remember this later on.
If the individual wakes up after the night terror, they will seem confused and will not understand what has happened. Upon waking up in the morning, they will likely not be able to recall the episode at all. So, if you’re screaming in sleep and not remembering it later, it may be a night terror.
By contrast, nightmares are almost always remembered because they are a form of a dream. Nightmares are usually very vivid and occur in one of the lighter sleep stages. When a person wakes up from a nightmare, they can almost always explain what they were dreaming about. In the morning, they will usually remember that they experienced a nightmare during the night. Some of the details may be forgotten, however.
How to Help Someone Having a Nightmare or Night Terror
Now that you know the differences, you should know whether you are dealing with night terrors or nightmares.
If your loved one experiences nightmares or night terrors, you may be wondering how best to help them through it. If you’re the one screaming in your sleep, you can also give the following advice to your partner or family member. That way, they’ll know what to do next time.
For Night Terrors:
- Don’t try to wake the person. It’s almost impossible to wake someone who is having a night terror, and the attempt may confuse or distress them.
- Don’t try to talk to them, or touch them. Talking and touching won’t soothe or reassure them. It may even make the night terror worse, and last longer.
- Don’t try to restrain them from moving, unless they are endangering themselves. It could result in aggression.
- Do sit near them until their night terror has passed, to make sure they don’t hurt themselves.
- Do reassure them if they wake up on their own. They may not understand what happened.
- Do reassure the person, by softly talking to or touching them. It’s safe to wake someone having a nightmare, and they may be appreciative of it.
- Do comfort and reassure them when they wake. People are often distressed after waking up from a nightmare. Explain that it was all a dream and that they’re safe.
- Do talk with them afterward, to take their mind off of it. They may find it helpful to tell you about their nightmare, or to talk about something unrelated.
When Should I Seek Medical Help?
Most of the time, both nightmares and night terrors don’t require any medical intervention. They go away on their own and don’t affect your waking life. They usually don’t cause any long-term mental or physical harm.
However, when they begin to affect aspects of your normal functioning, it may be worth visiting a doctor.
For example, it may be a wise decision to visit a medical professional if:
- Your nightmares or night terrors occur very frequently, such as every night, and prevent you from sleeping adequately
- They are affecting your emotions during the day, such as making you afraid or angry
- You notice any other symptoms, such as headaches or behavioral changes
- Your night terrors or nightmares came on very suddenly, with no previous history of them
- You suspect they are related to trauma in your past, which you would like to address with a professional
Your doctor will ask you questions about your life and your experiences with nightmares or night terrors. They may also offer to conduct a sleep study on you, to better understand your issues. Your doctor may offer you medication or therapy, and recommend lifestyle changes that may help.