Nightmares Vs Sleep Terrors - What's the Difference and How to Help

Sleep professional, Ellie, shares her guide to help you unpick the terms "Nightmares" and "Sleep Terrors" are often used interchangeably but there is a difference and it's useful to be able to tell which is which, to help your child in the most effective way possible.

Here is my guide to help you unpick what is really going on with your child's sleep...

Nightmares

• Nightmares are vivid and terrifying dreams that often cause children to wake up feeling scared.
• We have all had nightmares at some time in our life. These occur in Rapid Eye Movement (REM) sleep - the "dreaming" stage.
• Unlike night terrors, when we are in REM our muscles are paralysed (so we do not "act out" our dreams - something I always find fascinating!)
• Nightmares typically happen during the second half of the night.
• Children will wake easily and orientate quickly from a nightmare. As a result, we can often remember our nightmares (but not always).

What to do:

• If your child wakes from their sleep upset, provide plenty of comfort and reassurance.
• Many children become anxious around bedtime where they have memories of vivid nightmares. If your child tells you about their nightmare, help them to turn it into a funny story e.g. "a bear was chasing me" could become "that bear was running because he needed a wee...you both then sat down and ate raspberry jelly". It can't be scary if it's silly!
• Check that your child's sleeping environment is calm and be prepared to move furniture around if it helps remove large shadows. Experience of nightmares plus a vivid imagination makes for an anxious / reluctant sleeper.
• If you decide to put a nightlight in your child's bedroom, ensure that it is of a red/orange colour as blue light is known to interfere with melatonin (the sleep hormone that helps us settle into sleep).

Sleep Terrors (Night Terrors)

• Sleep terrors are episodes where children appear to suddenly wake from sleep with an "explosive" energy, often screaming or crying inconsolably, appearing distressed and confused. They are, however, not awake and may appear to be acting out a dream.
• Some children may get up out of bed and run around the room as if terrified.
• They typically occur in the early part of the night, during the non-REM phase of sleep, around 1-2 hours after sleep onset.
• Unlike a nightmare, the period of distress can last up to 30 minutes.
• They tend to happen from around two years old, and can be hereditary (if a parent experienced Sleep Terrors, their child is almost 10 times more likely to develop this).
• Sleep terrors are thought by some to be caused by chronic tiredness.
• Anyone who has experienced their child during a Sleep Terror will appreciate just how harrowing it can feel. Rest assured however, your child should have no recollection of this happening.

What to do:

• Firstly, ask yourself whether your child is safe? If your child runs around whilst in a confused state...is a stair gate necessary to prevent a fall? Consider whether windows present a risk, or does a front door need locking?
• During a terror, simply be there for your child. Use your voice to gently reassure such as "everything is ok, you are safe, mummy / daddy is here" The aim is to use your voice to reassure without waking your child.
• If sleep terrors are frequent, start keeping a note of the times these happen. You can try to gently rouse (but not fully wake) your child 20-30 minutes before you expect a terror. If you decide to take this approach, it is recommended that you consistently carry this out every night for at least three weeks. The science behind this strategy is not completely understood, but it is widely considered to be effective with no adverse consequences.
• But do be aware that waking your child is more likely to distress them. If you do accidentally wake them whilst trying to gently rouse, provide reassurance, comfort and resettle them in your usual way.
• To avoid your child becoming over-tired and therefore potentially more susceptible to sleep terrors, consider whether you could create a calmer bedtime routine for your child, if they are going to bed at a consistent time and whether their room is free of distractions?
• If the description of sleep terrors here does not fit with your child's experience, i.e. if your child has more than one per night or appears to have a terror immediately after falling asleep, do take a video and show this to your GP to rule out any underlying medical condition.

Even as a sleep professional, when my own daughter had sleep terrors I found it extremely tough, so I really do empathise with parents who witness these. As hard as it can be to witness please be assured that these will and do get better over time.

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Ellie Hunt, BathSleepClinic