Nightmare or night terror: how to tell the difference

Children start having dreams at a very young age and sometimes wake or become agitated during the night as a result. Not all waking or agitation is due to dreaming, though. Night terrors can also cause significant night-time distress but are managed differently. Here’s the scoop on some differences.

Timing: Nightmares tend to occur long after the child has gone to sleep. Children and adults alike go through several sleep cycles before dreaming begins and as such, children aren’t going to be having a nightmare until they’ve been asleep for 4 hours or more. Night terrors on the other hand are a result of disordered sleep and entry into REM sleep way too soon. The timing for night terrors is within the first few hours of sleep.

Appearance: With nightmares, the child is often groggy but awake despite being very upset and scared, and  can be calmed and reassured by a parent. Night terrors on the other hand are “wakeful dreaming” states and the child is actually not awake at all despite having his eyes open, moaning, crying, or even walking around. The child can’t be reasoned with or verbally directed. The child gets no consolation from the parent’s presence and although the child can be led back to bed if walking about, they aren’t aware of what’s going on. Children with night terrors can often have racing hearts or be sweating while they move about in an agitated way and seem in great distress.

Duration: Nightmare distress lasts several minutes but once the parent is there and calms the child, things improve. Night terrors tend to last much longer, up to 20 minutes or more. The night terror burns itself out and the child returns to sleep. Sometimes a parent can awaken a child during a night terror to end it sooner but often it is difficult to wake the child up.

Recollection in the morning: Nightmares can sometimes be remembered in the morning – perhaps not the content of the dream, but the fact that the child awoke and needed to be consoled. Children who have night terrors do not remember anything about them in the morning.

Triggers: Nightmares can often be linked to something during the day. It may seem innocuous to the parent but something like a story, image, or distressing event at school can trigger it. Night terrors are usually the result of mild sleep deprivation, so children who have been up later than usual or who are not napping as well as usual are more likely to have them.

Management: Children who have had nightmares need parental reassurance and avoidance of triggers (if you can figure out what the trigger was). Sometimes children get in patterns of nightmares night after night and need other empowering strategies at bedtime including helping the child understand that he can control his dreams; practice changing scary thoughts into happy ones while awake will help him at night. Children who are having night terrors need to get more sleep in general, so putting the child down a half hour earlier may help. In addition, purposely waking the child an hour or so after having gone to sleep may help “reset” the sleep cycle and prevent the disorder REM sleep from appearing.

Long-term outcome: Most children have nightmares at one time or another and weather them well with parental support and empowering strategies. If your child is in a weeks-long cycle of nightly nightmares, though, talking to your pediatrician or a child psychologist may be in order. Night terrors often persist as sleep walking or sleep talking later in childhood, and children with a history of night terrors need to be more vigilant to ensure they get enough sleep to prevent them.