It’s the middle of the night. You wake up suddenly because you hear your child’s scream from their room. Your heart beats fast as you run down the hall. Is your child calling out because of a bad dream or is this one of those scary night terrors you have heard about?
Either way, it’s a moment that can make any parent feel helpless. We spoke with Daniel Combs, MD, a pediatric sleep specialist with Banner - University Medicine, to learn the difference between nightmares and night terrors, and how to help your child get back to restful sleep.
What are nightmares?
Nightmares are bad dreams that happen during REM sleep, the stage when your brain is most active and dreams occur. They are very common in children, especially between the ages of 3 and 6.
“Children often wake up fully from a nightmare and remember it in detail,” Dr. Combs said. “Usually, a parent wouldn’t find out about the nightmare until the child is awake and tells them.”
Signs your child is having a nightmare
- Wakes up scared and upset
- Can describe the dream afterward
- Usually wants comfort from a parent
- Often goes back to sleep after reassurance
What are night terrors?
Night terrors are very different from nightmares. They happen during non-REM sleep and aren't connected to dreams like nightmares. Night terrors happen less often than nightmares and usually happen to children between 2 and 12 years old.
Children having a night terror might scream, kick, say ‘no’ many times or look awake but still be asleep. Usually they are not harmful, even though they can seem scary.
“Unlike nightmares, children usually don’t remember the event the next day,” Dr. Combs said. “They are typically unresponsive to parents and are difficult to awaken.”
Signs your child is having a night terror
- Screaming, flailing or sitting up in bed
- Eyes open, but no eye contact
- Unable to respond to comfort
- Often occurs in the first few hours of sleep
Why do nightmares and night terrors happen?
Both are forms of parasomnia, or disruptive sleep behaviors, but they have different causes:
Nightmares
- Stress or anxiety
- Certain medications
- Traumatic events
- Irregular sleep schedules
Night terrors
- Sleep disruptions like snoring, sleep apnea or restless sleep
- Broken (fragmented) sleep caused by illness or discomfort
- Family history of sleepwalking or night terrors
- More common in preschool and early elementary ages
Coping with nightmares and night terrors
Coping and managing nightmares and night terrors looks a bit different for each.
How to help after a nightmare
- Stay calm and offer reassurance or a cuddle
- Give them a favorite toy, blanket or “lovie” for comfort
- Encourage your child to go back to sleep in their own bed to maintain routine
- Talk about the dream the next day if your child wants to, helping them process their feelings
- Avoid scary movies or stories before bedtime
“It may take your child a little bit to fall back asleep,” Dr. Combs said. “Bad dreams can create a fight-or-flight response that will take time to calm.”
How to respond during a night terror
- When you enter the room, don’t try to wake them.
- Ensure safety by clearing the floor of toys and, if needed, gently guide them back to bed.
- Do not try to wake them, as it can make the episode worse or longer.
- Night terrors typically resolve on their own within minutes.
- Prepare any babysitters or caretakers on what to do if it happens while you are away.
“Night terrors are very unpleasant for parents, but children usually don’t remember them in the morning,” Dr. Combs said. “The best thing you can do is remain calm and make sure your child is safe.”
Tips for preventing nightmares and night terrors
Dr. Combs shared the following tips:
- Keep a consistent bedtime routine free of screen time or scary content.
- Ensure your child is getting enough sleep for their age.
- Consider returning to a midday nap for younger children if they seem overtired.
- Encourage relaxing activities before bed, such as yoga, stretching or deep breathing.
- If your child has night terrors at the same time each night, gently wake them up 20 to 30 minutes before the usual episode. Then let them fall back asleep.
- For older children who have repeated nightmares, image rehearsal therapy might help.
- Lower stress and anxiety during the day to help improve their sleep at night.
When to seek professional help
Most children outgrow night terrors and occasional nightmares, but talk to a pediatric sleep medicine specialist if:
- Nightmares occur frequently and interfere with daytime function
- Night terrors happen more than twice a week
- Sleep disruption is affecting your child’s overall health
- You notice potential underlying sleep disorders, such as sleep apnea
Keep a sleep log with notes on bedtime, wake times and any nighttime events to help your child’s provider identify patterns and triggers.
“If sleep problems are affecting your child’s daytime function and safety, a sleep specialist can help identify the cause and suggest effective strategies,” Dr. Combs said.
Bottom line
Nightmares and night terrors can be scary, for both your child and you. The good news is that most children experience them rarely and both are a part of growing up.
If you have questions or need support, contact your child’s health care provider or a Banner Health sleep medicine specialist. We can help you and your family get the best sleep possible.
