Terrors of the night

I have received several inquiries on night terrors and nightmares from children, teenagers and adults. Let me first differentiate nightmares from night terrors.

A nightmare is a dream that is quite distressing as to cause a partial awakening. Often the dreamer, upon waking up, will experience some disturbing emotion like guilt, sadness or anger. The theme of one’s nightmare is different from the other. For example, the child survivors of the December 2004 disaster in Infanta, Quezon have recurrent bad dreams of the gushing mud and log slide destroying their homes. Such recurrent bad dreams have a purpose in healing the scars of the victims. Each time the bad dream recurs, the accompanying anxiety becomes less intense. The fact that a person remembers such dreams means that this person may be able to respond creatively and effectively to such a problem.

Nightmares usually occur after several hours of sleep. Screaming or moving about is quite uncommon. Night terrors are different since they usually occur on the first one or two hours of sleep. Loud screaming is very common in night terrors. The sleeper who is having night terror is also very hard to awaken and upon waking up may just be able to relay an overwhelming feeling but cannot give details of his dream. Some people who experience night terrors have also a tendency to sleepwalk and/or bed wet. Night terrors may be associated with stress among the young and adults. For those who experience night terrors frequently, consultation with a physician is advised.

In nightmares, there is at least one episode of sudden awakening from sleep with accompanying intense fear, anxiety and intense feeling of impending doom. There is an immediate recall of the frightening dream in nightmare and the dreamer experiences alertness immediately upon waking up with minimal confusion or disorientation.

Polysomnography (sleep recording) of a nightmare episode will show the following: [1] abrupt awakening after at least 10 minutes of REM sleep; [2] rapid heart beat and rapid breathing during the nightmare episode; and [3] absence of epileptic activity.

So, is there something that we can still do for such nightmares or night terrors? First of all, we have to determine the source of the nightmare or the night terror. Drugs, medications or illness as the possible cause must be ruled out so discussion with a physician is recommended. I usually encourage the young kids to discuss their bad dreams with their parents or with other adults. These kids will generally not require treatment. For children who are already disturbed by their recurrent nightmares, however, the aid of a child psychiatrist or psychotherapist may already be required. Play therapy which will include drawing the nightmare, talking with the frightening characters of the dream or even fantasizing the changes in the dream will help the child feel safer and subsequently less frightened. The nightmares which actually repeat a traumatic episode are reflective of a normal psychological healing process. These repetitive bad dreams will gradually diminish in frequency and in intensity as the child is recovering. If such nightmares persist for more than a month, consultation with a psychiatrist is a must.

For adults, nightmares may give them the chance for self-exploration and understanding. The adult dreamer, with some effort and some practice, can learn to interpret the visual images and the symbols of the dreams and connect them to their life.

Here are some techniques you can try to reduce your nightmares: 1] write or draw your nightmare; 2] talk to the characters that appear in your dreams; 3] imagine a better and more pleasant ending to your nightmare; or 4] recite this ending several times. A faster and easier way to reduce your nightmares or night terrors is through the assistance of a psychotherapist.

Night terrors in children can be a frightening phenomenon with the child getting out of bed and running around. Remember that these terrors are not dangerous. If the night terrors of your child occur frequently or over a long period of time, it is better that you discuss this with your child’s doctor. Remember that shouting and shaking your child who’s having dreams will just agitate her more. Don’t overreact.

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