Nightmares and Night Terrors

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KEY POINTS

• Nightmares are bad dreams that cause strong feelings of fear or distress. During a night terror, you may be very active and upset, and sit up with your eyes open, even though you are still asleep.
• Treatment may include relaxation techniques, medicine to help you sleep, or counseling to help with anxiety or stress.
• To help prevent nightmares and night terrors, it may help to avoid violent shows or horror movies, and find ways to take your mind off your troubles.

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What are nightmares and night terrors?

Nightmares are bad dreams that cause strong feelings of fear or distress. Most people have had nightmares at times, usually in the early morning hours. Usually people wake up from a nightmare and remember what the nightmare was about. If nightmares happen once in a while, it is usually not anything to worry about. If you have a nightmare disorder, you have repeated nightmares that interfere with your ability to work and relate to others.

Night terrors are different from nightmares. During a night terror, you may be very active and upset, and sit up with your eyes open, even though you are still asleep. Night terrors usually happen in the first hour after you fall asleep. In the morning, you cannot remember what happened. Night terrors may look alarming to others, but are harmless and each episode will end on its own with deep sleep.

Having nightmares or night terrors sometimes is normal. However, if you keep having them, they keep you from getting enough sleep, or you fear going to sleep because of them, see your healthcare provider.

What is the cause?

The exact cause of nightmares is not known. Nightmares happen often in childhood, especially between the ages of 3 and 6. Most children outgrow them. In some people, they continue into adulthood. In adults, nightmares may be the result of:

• Taking certain medicines such as antidepressants or sleeping pills
• Post-traumatic stress disorder (PTSD)
• Panic disorder
• Sleep apnea, which means that you stop breathing many times while you sleep
• Severe lack of sleep
• Using alcohol or drugs
• Watching scary movies or reading scary books

Females are more likely than males to have nightmares. Some people have different nightmares, while others may have the same nightmare over and over again.

Night terrors are not as common as nightmares. Night terrors usually start between the ages of 3 and 12. Most children outgrow them, but adults may start having night terrors in their twenties. Night terrors may be related to stress, tension, conflict, fever, or lack of sleep. You are more likely to have night terrors if you sleepwalk, or if someone else in your family has had night terrors.

What are the symptoms?

You may have a nightmare disorder if:

• You wake up over and over with nightmares.
• The dreams seem to last a long time and are very frightening.
• The nightmares are about threats to your life, your security, or your self-image.
• You remember the nightmares in detail.
• The troubled sleep interferes with work, school, or social activities.

Symptoms of night terrors include:

• You may abruptly sit up in bed screaming, crying, or thrashing about a few hours after going to sleep.
• Your heart rate and breathing are very fast.
• You may get out of bed and run around your home.
• People tell you later that they could not seem to comfort you and that you were hard to awaken.
• You do not remember the night terrors at all, unless other people tell you about it.

How are they diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms. You may have tests or scans to help make a diagnosis.

Your healthcare provider may suggest that you sleep overnight in a sleep center. At the sleep center you may have a continuous, all-night recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves.

How are they treated?

If a medical problem is causing nightmares or night terrors, treating the medical problem will help.

In some cases, your healthcare provider may prescribe medicine to help you sleep. Do not take any sleep medicine for more than 2 weeks in a row without your healthcare provider’s approval. This includes nonprescription sleeping pills. You may become dependent on them or build up your tolerance to them so that they no longer work as well.

Your healthcare provider may recommend relaxation techniques, changes in diet, cutting out caffeine, and a healthy lifestyle that includes exercise. Your provider may discuss good sleep habits and a regular sleep routine.

Counseling may help you deal with anxiety or other problems, or help you manage stress. Imagery Rehearsal Therapy (IRT) can be helpful if you have a nightmare disorder. With IRT, you:

• Write down the details of the nightmare.
• Change what the dream is about or how it ends.
• Rehearse the rewritten dream for 10 to 20 minutes per day while you are awake.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent nightmares and night terrors?

Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know what you can do to help prevent problems.

• Stick to a routine of going to bed and getting up at the same time each day.
• Be active early in the day. Exercise regularly, but not too close to bedtime.
• Before you go to bed, write down all the things you are worrying about. Then write down what you can do tomorrow. Mark the other things as things to do later in the week. This may help clear your mind of worry.
• Read something light or entertaining just before you go to bed, to get your mind off the day's troubles.
• Don’t watch violent shows or horror movies because they may cause nightmares.
• Avoid drinking a lot of fluids before bedtime. Don’t drink alcohol within 6 hours of bedtime. Avoid caffeine late in the day.