Nightmare Disorder from Sleep Terrors: How to Differentiate Them
Sleep disturbances come in many forms, and nightmare disorder and sleep terrors are among those that are most misunderstood. While these two conditions are indeed upsetting, they vary in their symptoms, their sleep stage at which events occur, and also in their consequences to the sufferer. Such differences allow the identification and adequate handling of these sleep disorders.
In this blog, we’ll compare nightmare disorder and sleep terrors, highlighting their signs, symptoms, and how they impact sleep quality.
1. What is Nightmare Disorder?
Nightmare disorder includes frequent and intense nightmares that interfere with normal sleep. They are violent dreams that happen in stages of REM sleep, where most dreams take place. Nightmares are a kind of dream that incorporates vivid, story-like narrations that usually express strong negative emotions, including fear, sadness, anger, or disgust.
Key Features of Nightmare Disorder Include:
- It occurs during REM sleep, and since sleep cycles are longer by the latter part of the night, this also is the time most people experience it.
- Clearly elaborated, detailed, and emotionally arousing, nightmares contain a logically constructed plot combined with a more coherent narrative structure.
- Other negative emotions include feelings of fear, anxiety, and turmoil right after they wake up.
- Arousal of the autonomic system: This could be manifested by physical symptoms of having sweated, breathed more quickly, or even palpitations resulting from having had a very emotionally active dream.
- Memory of the dream: Some people are more, if not fully awake to remember all that transpired in the nightmare.
- This is most likely to occur during the latter portion of a sleep episode because REM sleep periods increase in length as we further progress through sleep.
To be considered a nightmare disorder, repeated nightmares must occur that interfere with sleep but do not stop someone from sleeping out of fear of having a nightmare.
2. What are Sleep Terrors?
Other sleep disorders include sleep terrors, otherwise known as night terrors. They occur-like nightmares-during non-REM sleep, but during deeper stages of sleep often referred to as slow-wave sleep. These do not include the vivid dreams or detailed narrations associated with nightmares. Rather they include partial arousals and can be quite frightening because of intense physiological arousal.
Key Features of Sleep Terrors Include:
- Occur in NREM sleep: Sleep terrors are manifestations of stages 3 and 4 NREM sleep, occurring early in the night-usually in the first third of the night or generally within the first 90 minutes.
- Fragmented and indistinct: Opposite to nightmares, the sleep terror is not narrative-driven; it includes only vague, terrifying images, and the person remembers little to nothing about the incident.
- Sudden arousal: This is a key feature of sleep terrors; the person partially arouses while sleeping, may suddenly sit up, scream, or appear panicky-never really awake.
- Amnesia: On awakening, there is usually no recollection of the terror content whereas in nightmares the dream is usually recalled.
- Arousal of the autonomic nervous system involves an intense physiological arousal, similar to a nightmare, consisting of tachycardia, tachypnea, and diaphoresis during a sleep terror.
- Self-limiting solution: While it is an abrupt and violent episode, sleep terror tends to self-dissolve rather quickly; the subject often simply goes back to sleep with no issue.
The attacks mainly happen among children aged between 3-12 years, though the episodes normally reduce as the children grow older. Sleep terrors occur less in adults, whose reactions are less spectacular; these may include agitation but no screaming.
3. Important Differential Diagnosis in Differentiating Nightmare Disorder from Sleep Terrors
Understanding both of these conditions is always better when presented with their key differences:
| Feature | Nightmare Disorder | Sleep Terrors |
|---|---|---|
| Sleep Stage | Occurs during REM sleep | Occurs during non-REM sleep (slow-wave sleep) |
| Time | More frequent during the latter half of the night | More likely to happen during the first third of the night |
| Dream Content | Vivid, story-like, emotional dreams | Vague fragmented images, no coherent storyline |
| Memory | Recalls most or all of the dream | Little or no memory of the event |
| Physical Responses | May include excessive perspiration and labored breathing | Sudden arousal, racing heartbeat, sweating |
| Awaking | The individual is arousable but confused | Partial arousal without full consciousness of environment |
| Age Group | Predisposition, both in children and adults | More common in children; rare in adults |
| Outcome Post-Event | Sleep onset difficulty after awakening | Often settles quickly and easily resettles to sleep |
| Emotional Resonance | Likely to cause fear or distress | Typically resolves without emotional memory |
4. Disorders of Nightmare and Sleep Terrors
Causes of Nightmare Disorder:
- Anxiety and stress: Various daytime concerns or violent emotional moments can be reflected in nightmares.
- Frequent nightmares following traumatic events are common among patients who have a history of posttraumatic stress disorder.
- Medications: Certain drugs are blamed for nightmares, particularly the ones affecting neurotransmitters of the brain.
- It may also be the probable cause of sleep disorder: sleep deprivation.
Causes of Sleep Terrors:
- Sleep deprivation can cause sleep terrors, which is also related to nightmares.
- Stress and anxiety: Though emotional stress may be considered a provocator of sleep terrors, too, once more the connection here is less clearly understood than in nightmares.
- Genetics: There is some evidence to suggest that sleep terrors may run in families.
- Sleep terrors may sometimes be provoked by fever in children.
5. Therapy of Nightmare Disorder and Sleep Terrors
Treatment for Nightmare Disorder:
- CBT therapy: Alters the root cause that could well be due to anxiety or trauma.
- This is a technique whereby the storyline of the recurring nightmare is rewritten into one that no longer contains threat.
- Pharmacotherapy: This may involve the prescription of certain antidepressants, for instance, that could reduce the frequency of nightmares.
- Improvement in sleep hygiene-for example, regularization of sleep, avoidance of stress at night, and providing a pleasant sleep environment-reduces nightmares.
Treatment of Sleep Terrors:
- Comfort and reassurance: Sleep terrors are generally a problem in children, and since they outgrow it, comforting is the main role parents play.
- An improvement in sleeping habits, especially a good night's sleep, can minimize the events of sleep terrors.
- Managing triggers: Avoiding stress and maintaining a regular sleep pattern can prevent sleep terrors. Professional help may be helpful if the sleep terrors happen repeatedly or the child is very upset.
Conclusion: Sleep Terror and Nightmare Disorder Management
Sleep terror and nightmare disorders are indeed provocative in appearance but are very different in symptoms, sleep stage of origin, and emotional resonance. While nightmares leave a more indelible emotional mark, sleep terrors resolve without memory or other emotional aftershocks. Understanding the differences between sleep terror and nightmare disorders would go a long way in pointing to the right kind of support and treatment individuals may need to help them cope with the sleep disruption. They should seek professional help that can help them improve their sleep conditions to generally improve their lives by all means.
Reference:
https://youtu.be/HwTv2uWY8Fg