Hello everybody!  I’m writing this brief entry tonight to address something a lot of people, particularly parents of young children, can be confused about:  the difference between nightmares and night terrors.  I’ve heard people use these terms interchangeably, but they represent entirely different clinical entities.  Herein I provide a simple distinction between the two.

Night terrors–also known as “sleep terrors” or “pavor nocturnus“–are very memorable for parents.  Here’s a typical scenario.  Your child goes to bed the way she usually does at night.  Later that night, suddenly, from her bedroom comes a loud, blood-curdling scream that scares the hell out of you.  You jump out of bed and run to your daughter’s bedroom.  You find her sitting up in bed, appearing awake and dazed, eyes wide open in fear.  She may or may not respond to you.  She appears distressed and freaked out, sweating and breathing hard; she may move her arms and legs nonspecifically but frenetically as well, compounding your concern as you observe her.  She seems panicked and inconsolable, almost possessed.  After several minutes, though, she calms down, lies down again, and returns to sleep.  The next morning, when you ask her about the event, she tells  you she has no idea what you’re talking about:  she recalls nothing of what happened.

Here’s a nightmare.  You hear your child crying or crying out for you in the middle of the night.  You enter his room.  He’s clearly awake and clear-headed, and answers your questions appropriately and quickly.  He may hug you for comfort.  You ask him what happened.  He tells you he had a terrible dream; a monster was out to get him, for example, or he was about to be pushed off a cliff by someone mean.  He has good recollection of what he was dreaming about.  After some reassurance, he eventually feels comfortable enough to return to bed, and the following morning he may or may not recall the full details of the disturbing dream, but he does remember that he had a terrible dream that caused him substantial distress.

The reason why it’s important to recognize the difference between these two clinical entities is because both can concern and frighten parents, particularly night terrors.  As frightening as they may be to watch, however, they are in and of themselves generally benign in nature and prognosis.

Night terrors represent a type of parasomnia (sleep-related unusual movements or behaviors) typically occurring out of deep non-REM sleep.  As such, dreams are not recalled, and the child is usually completely amnestic of the event.  Though some adults may experience night terrors, they are by far most common in children 3-12 years of age.  As scary as these events are for parents, they are usually not indicative of an underlying abnormality or medical problem, and children with night terrors usually outgrow them over time.  In some children, sleep deprivation or other reasons for going to bed particularly fatigued or sleepy may play a role in the likelihood of night terrors occurring, so make sure that your child gets proper amounts of sleep and sleeps in reasonably predictable, regular schedules night after night.

Nightmares are simply particularly unpleasant and/or frightening dreams.  They occur out of rapid eye movement (REM) sleep, and are usually recalled–and often recalled well–upon abrupt awakening from dream sleep.  For whatever reason, 2/3 – 3/4 of human dreaming is emotionally negative in nature (I had a distinctly negative dream early this morning, for example, though I wouldn’t classify it as a nightmare; hence I’m writing this entry today!).  Most people don’t need specific treatments for nightmares, and how to treat recurring nightmares is controversial.

I think I’ll write a little about recurring nightmares some time soon.  It might be cathartic for me.

Have a good evening, everybody.  I hope your dreams tonight are positive and pleasant.