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Nightmares are vivid, disturbing dreams that usually wake a person and are often remembered. Night terrors, also called sleep terrors, are parasomnias involving partial arousal from deep non-REM sleep. A person may scream, sit up, thrash, sweat, or appear terrified while remaining largely asleep.
Nightmares generally occur during REM sleep, often later in the night. Night terrors typically arise from deep N3 non-REM sleep earlier in the night. Nightmares are commonly recalled; night terrors usually leave little or no memory.
Frightening dreams, abrupt awakening, fear or anxiety, sweating, rapid heartbeat, difficulty returning to sleep, and daytime fatigue.
Sudden screaming, sweating, thrashing, confusion, sleepwalking, difficulty waking, and little recall afterward.
Triggers may include stress, trauma, sleep deprivation, irregular sleep schedules, fever, certain medications, and alcohol or substance use. Recurrent episodes can also occur with PTSD, anxiety, depression, insomnia, sleep apnea, restless legs syndrome, or other sleep disorders.
Night terrors are more common in children and often improve with age. Nightmares affect both children and adults. Episodes that begin in adulthood, cause injury, involve unusual movements, or produce significant daytime sleepiness should be evaluated.
Nightmare disorder involves recurrent disturbing dreams that cause significant distress or interfere with sleep or daytime functioning. Symptoms may contribute to fear of sleeping, fatigue, concentration problems, or mood changes.
Evaluation may include sleep patterns, episode timing and frequency, medical and psychiatric history, medications, trauma exposure, and daytime effects. Clinicians may also consider other conditions that resemble parasomnias. A sleep study may be considered when another sleep disorder is suspected.
Treatment depends on the cause, severity, safety concerns, and related conditions.
Cognitive behavioral approaches may help with sleep-related distress, anxiety, or insomnia. Trauma-focused therapy may be appropriate for trauma-related symptoms. Imagery rehearsal therapy (IRT) can help recurrent nightmares by creating and rehearsing a less distressing version of the dream while awake.
Medication is not routinely required. When symptoms are severe or linked to another psychiatric condition, a clinician may determine whether medication is appropriate after evaluation.
Consistent sleep times, adequate sleep, a calming bedtime routine, and identifying triggers may help reduce episodes.
Stay calm and prioritize safety. Remove nearby hazards and gently guide the person away from danger. Avoid forcefully waking, shaking, or restraining them unless safety requires it.
Seek evaluation when episodes are frequent, cause injury, repeatedly disrupt sleep, begin in adulthood, or cause significant daytime impairment.
If nightmares or night terrors are affecting sleep, safety, or daily life, schedule an evaluation with Paramount Healthcare Services in Las Vegas, Nevada.
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