This week on the Savvy Psychologist podcast, Dr. Ellen Hendriksen outlines 4 differences between nightmares and night terrors. Plus, tips on how to get rid of each so you can drift back to dreamland.
But sometimes nightmares aren’t the tip of any iceberg larger than temporary sleep deprivation, transient stress, having watched a scary movie, or an unknown X factor. As frightening as it is, a solitary nightmare is nothing to lose sleep over.
With night terrors, a link to psychopathology depends on age. In kids, night terrors are not linked to mental health disorders and are usually a sign of being overtired or stressed from a big change, like moving or starting a new school. And finally, there’s a heavy genetic component - turns out night terrors run in families.
In adults, night terrors can also be caused by genetics or stress, like divorce or a spouse receiving a life-threatening diagnosis. However, night terrors in adults can also be linked to underlying problems like depression, generalized anxiety disorder (GAD), and PTSD. Notably, heavy drinking can also trigger night terrors.
How to Stop Nightmares
So what to do when nightmares and night terrors go bump in the night?
Let’s start with nightmares. I respectfully disagree with Freudian and Jungian analysts who say nightmares are valuable and can teach you about yourself if you just examine their symbolism. I say they’re scary, and especially if they stem from a trauma, can wreck your nights and, by extension, your days.
Now, big breakthroughs in psychology are rare, but one occurred in 2001 with the publication of a study in the prestigious Journal of the American Medical Association. Dr. Barry Krakow, a sleep medicine physician and founder of a sleep research non-profit hypothesized that while nightmares directly following a trauma may be helpful in processing the event, chronic nightmares are just your brain stuck in a rut.
He developed a therapy called Image Rehearsal Therapy, or IRT. In his study, sexual assault survivors with PTSD deliberately changed the plot and imagery of their nightmares - basically, they got to rewrite the whole script.
Krakow asked participants to write down their disturbing dreams, and then instructed them to “change the nightmare any way you wish.” So for example, an assailant with a knife might become a kitten. Balls of fire might become soap bubbles. Being chased might become a stroll on the beach.
The patients rehearsed the new dream for anywhere from 5-20 minutes a day for 3 weeks while they were awake. What happened? Three months after the start of the study, the number of total nightmares per week, number of nights per week with a nightmare, and overall PTSD symptoms were all significantly reduced, while the participants’ sleep was significantly improved.
A 2009 follow-up by a different group of researchers with a different population - U.S. veterans - achieved the holy grail of data replication. They found IRT worked to reduce the frequency of nightmares, both trauma-related and not, and reduced PTSD symptoms 3 months after the program. It almost seems too easy, but it speaks to the resilience of our brains, even after a major trauma.
How to Stop Night Terrors
As for night terrors, if your child or spouse has a once-in-a-while night terror, you don’t need to intervene other than making sure they don’t accidentally hurt themselves (or you). Don’t try to wake them up - there’s no need. In a few minutes, they’ll settle down on their own.
However, if your child or partner has chronic night terrors (or chronic sleepwalking, a closely related phenomenon), try a treatment known as scheduled awakenings. For a few nights, keep track of approximately how long after they fall asleep the night terror occurs. Thankfully, you probably won’t have to burn the midnight oil, as sleep terrors usually occur in the first half of the night.
Once you can predict roughly when it will happen, aim to briefly wake them about half an hour before the sleep terror - usually anywhere between 1 and 2.5 hours after they fall asleep.
Shake them gently and ask them to wake up until they mumble or open their eyes slightly - no need to turn on the light or blast an air horn. You just need to wake them enough to disrupt the slow wave sleep sleep architecture. In a small 1997 study on chronic sleepwalking (not night terrors, but again, a related phenomenon), parents performed one awakening per night for a month and in each case, completely cured the problem.
One last thing: If your child does experience a night terror, there’s no need to mention it to them the next day. Kids have no memory of the night terror - remember, they’re asleep when it happens - so telling them a dramatic, slightly embarrassing story about themselves that they can’t even remember, much less control, may cause them stress or worry. So refrain from launching into an action-packed description when they show up at breakfast.
For a fascinating long read from The New Yorker on IRT for nightmares, click here.
And, if you can’t get to his clinic in Albuquerque, New Mexico, Dr. Barry Krakow has a self-help manual and CD set of his IRT program available for purchase online. I haven’t personally reviewed it, but if you’re interested, you can check it out here.
Silber, M.H., Ancoli-Israel, S., Bonnet, M.H., Chokroverty, S., Grigg-Damberger, M.M., Hirshkowitz, M. et al. (2007). The visual scoring of sleep in adults. Journal of Clinical Sleep Medicine, 3, 121-31.
Frank, N.C., Spirito, A., Stark, L., & Owens-Stively, J. (1997). The use of scheduled awakenings to eliminate childhood sleepwalking. Journal of Pediatric Psychology, 22, 345-353.
Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T.D., et al. (2001). Image rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA, 286, 537-45.
Lu, M., Wagner, A., Van Male, L., Whitehead, A., & Boehnlein, J. (2009). Imagery rehearsal therapy for posttraumatic nightmares in U.S. veterans. Journal of Traumatic Stress, 22, 236-9.