Sleep disorders and difficulties in falling asleep are very common problems in childhood. Disorders characterized by abnormal events or behaviors associated with sleep, its specific phases or periods of transition between sleep and wakefulness are called “parasomnias”.

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 have as many differences as similarities .

What are nightmares?

A nightmare is a dream with a terrifying content that causes strong feelings of fear or anguish. When a child wakes up from a nightmare, he or she remains in touch with reality and responds appropriately to the environment. Upon waking, it is common for him to remember the contents of the dream.

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

It is one of the most common disorders in childhood and adolescence. According to studies, between 10 and 50% of children aged 3 to 6 years suffer from it . Although nightmares do not usually pose a risk to a child’s health, they may produce a certain fear of going to bed, especially if they are frequent. In these cases the sleep pattern may be altered and excessive sleepiness, irritability, anxiety, etc. may appear secondarily.

What are night terrors?

During night terror episodes it is common for the child to sit up abruptly in bed and start to scream, moan, babble or cry with a terrified facial expression . He keeps his eyes open without really being awake and shows signs of anxiety with great autonomic activation (tachycardia, hyperventilation, sweating, etc.). In addition, night terror occurs in the deep phase of sleep, when there is no muscle tone.

The appearance of this sleep disorder is not ruled out in adulthood but it is in childhood when it is more frequent. Its onset usually occurs between the ages of 4 and 12 and it is estimated that between 1% and 6% of children suffer episodes of night terrors.

Why do they happen?

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

Night terrors are often attributed to stress suffered by the child during the day; going to sleep in agitation increases the likelihood of an episode. Unpleasant dreams are more common when the child is distressed or worried about something and are often based on these concerns.

Unlike nightmares, hereditary factors seem to play a causal role in the occurrence of night terrors. About 80% of children with nightmares have family members who have also experienced 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 possibilities of awakening

Unlike in nightmares, in night terrors the child does not usually wake up easily despite the efforts of the parents. If he does wake up, he is confused and disoriented, does not respond properly to his environment, and is overcome by 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 something it is usually isolated, blurred fragments.

2. The Sleep Phase

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

How to act on 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 to the child developing 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 it could become more active and this would make it difficult for the child to fall asleep again.

It is advisable to stay with the child until he has calmed down enough and can fall asleep again, but he should stay in his room and sleep in his own bed. If parents tell their child that every time he has an episode he 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, rather 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 during the episode of terror.

It is advisable to watch that the child does not fall out of bed or suffer any physical damage during the episode, since he is deeply asleep and is not aware of what is going on around him.

Normally these sleep disorders disappear with time and do not usually require psychological treatment , except in those cases which, 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 with minors, since drugs such as benzodiazepines can produce significant side effects and when they stop being taken their benefits disappear, so they do not solve the problem in any case.

An effective psychological technique in parasomnias such as night terrors and sleepwalking is the technique of programmed awakening , which consists of waking the child before the time in which the disorder usually manifests itself. This is done to shorten the sleep cycle and thus prevent the onset 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 show excessive worry or anxiety. For older children, from the age of 7 or 8, you can talk about the nightmare the next morning, trying to find out if there is anything that worries you that might be responsible for these scary dreams.

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

It may also be advisable to avoid lavish dinners and violent or scary programmes or movies that stimulate the child’s imagination, as well as to modify any inappropriate habits or stimuli that may disturb his or her 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 see a psychologist.

There are effective techniques that teach the child to successfully confront the dreams that cause him/her anxiety, such as Imagination Rehearsal Therapy, which consists of rewriting and reimagining the dream so that its content no longer generates fear.

Bibliographic 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 (2nd Ed.). Rochester: Minnesota.