Nightmares and night terrors: differences and similarities.

We analyze the basic characteristics and treatment of these childhood sleep disorders.

Sleep disorders and difficulties in falling asleep are very common problems in childhood. Parasomnias" are disorders characterized by abnormal events or behaviors associated with sleep, its specific phases or the transition periods between sleep and wakefulness.

Parasomnias include disorders such as sleepwalking, bruxism, nocturnal enuresis, nightmares and night terrors. Although these last two disorders are often confused, the truth is that nightmares and night terrors are not the same. nightmares and night terrors have as many differences as similarities..

• Article related: "The 7 main disorders of the dream".

What are nightmares?

A nightmare is a dream with terrifying content that gives rise to strong feelings of fear or distress. When the child wakes up after a nightmare, he/she remains in contact with reality and responds appropriately to the environment. Upon awakening, it is common for the child to remember the content of the dream.

Nightmares occur during the REM phases of sleepwhich occur to a greater extent during the second half of the night. REM sleep is characterized by high brain activity, lack of muscle tone, high respiratory rate, rapid eye movements and rapid and irregular pulse. It is precisely in this phase of sleep that most dreams, including nightmares, usually occur.

During night terror episodes, it is common for the child to sit up abruptly in bed and begin to screaming, moaning, babbling or crying with a terrified facial expression.. He/she keeps his/her eyes open without really being awake and shows signs of anxiety with high autonomic activation (tachycardia, hyperventilation, sweating, etc.). In addition, night terror occurs in the deep phase of sleep, when there is no muscle tone.

Factors such as emotional stress, traumatic events, anxiety, fatigue, irregular sleep schedules, fever or the of sleep, fever or taking some medications seem to increase the appearance of these sleep disorders.

Night terrors are usually attributed to the stress suffered by the child during the day; going to sleep agitated increases the probability of an episode occurring. Unpleasant dreams are more frequent when the child is anxious or worried about something and are often based on these worries.

Unlike what happens in nightmares, hereditary factors seem to play a causal role in the presentation of night terrors. About 80% of children who suffer from night terrors have relatives who have also presented these sleep disturbances. This genetic basis is shared with sleepwalking..

Differences between nightmares and night terrors

Fundamentally, the differences between nightmares and night terrors are as follows:

1. The chances of awakening

In contrast to nightmares, in night terrors the child does not usually wake up easily despite the parents' efforts. If he/she wakes up, he/she is confused and disoriented, does not respond adequately to his/her environment and is overcome with a certain sense of fear. The episode usually lasts 10 to 20 minutes and then the child may go back to sleep. Often they do not remember the episode when they wake up the next day, and if they do remember anything it is usually isolated and blurred fragments.

2. The sleep phase

Night terrors, like sleepwalking and unlike nightmares, emerge in deep sleep and not during REM phases. They usually emerge during the first third of the night. During deep sleep, muscle tone is weak and Heart rate and respiratory rate decrease.

How to deal with these episodes?

If our child suffers from nightmares or night terrors, it is best to act in a calm manner, trying to normalize the situation. If children see their parents alarmed or worried, their anxiety will be greater.

Intense light should also be avoided as this could lead the child to develop a phobia of darkness, associating it with fear. It is not a good idea to talk in detail with the child about what has happened because he/she may become more active and this will make it difficult for him/her to go back to sleep.

It is advisable to stay with the child until he/she has calmed down enough to go back to sleep, but calm down sufficiently and can fall asleep again, but they should stay in their own room and sleep in their own bed. If parents convey to their child that every time they have an episode they will be able to sleep with them, they will be reinforcing the sleep disorder and encouraging inappropriate habits.

Treatment of night terrors

Night terrors cause real panic in the parents, more than in the child himself, who as we have seen will normally not remember the episode. In mild cases, parents should remain calm and not try to wake their child up. not try to wake up their child during the terror episode.

Care should be taken to ensure that the child does not fall out of bed or suffer any physical harm during the episode, as he or she is fast asleep and unaware of what is going on around him or her.

These sleep disorders usually disappear with time and do not usually require psychological treatment. do not usually require psychological treatmentThey usually do not require psychological treatment, except in those cases that, due to their frequency or intensity, constitute a problem for the child and it is necessary to consult a health professional.

Pharmacological treatment is not recommended for children, since drugs such as benzodiazepines can produce important side effects and when they are no longer taken their benefits disappear, so in no case do they solve the problem.

An effective psychological technique in parasomnias such as night terrors and somnambulism is the technique of programmed awakeningsThis consists of waking the child before the time when the disorder usually manifests itself. This is done to shorten the sleep cycle and thus prevent the occurrence of the episode.

Treatment of nightmares

Parents should try to reassure children after nightmares and try to get them back to sleep, trying not to be overly worried or anxious. For older children, 7 or 8 years and older, you can talk the next morning about the nightmare, trying to find out if there is something troubling the child that may be responsible for these terrifying dreams.

If appropriate, it is important to encourage proper sleep hygiene, i.e., regular sleep patternsIf appropriate, it is important to encourage proper sleep hygiene, i.e., regular sleep patterns that help the child know that bedtime is approaching.

It may also be convenient to avoid copious dinners and violent or horror programs or movies that stimulate the child's imagination, as well as to modify any habit or inadequate stimulus that may disturb the child's rest.

In some serious and frequent cases of nightmares, when they have existed for a long time or occur very often, are very intense and cause significant discomfort, it may be advisable to consult a psychologist.

There are effective techniques that teach the child to cope successfully with dreams that provoke anxiety, such as Imagination rehearsal therapy, which consists of rewriting and rewriting y rewrite and reimagine the dream so that its content ceases to generate fear.

Bibliographical references:

• Sierra, J. C., Sánchez, A. I., Miró, E. & Buela-Casal, G. (2004). The child with sleep problems. Ediciones Pirámide: Madrid.
• American Sleep Disorders Association (1997). The International Classification of Sleep Disorders, revised: Diagnostic and coding manual (2ª Ed.). Rochester: Minnesota.