What’s the difference between nightmares and night terrors—and is your fearful sleep a sign of underlying trauma? In this post I’ll break down nightmares and night terrors, including how they relate to PTSD, trauma, and stress. Learn how to recognize the signs of nightmare disorder, and what treatments like Imagery Rehearsal Therapy, trauma-focused therapy, and sleep hygiene can do to help. We also explore night terrors in adults, which are rare but sometimes linked to PTSD. Whether you’re seeking effective treatment for nightmares and night terrors, support for trauma-related sleep issues, or just want to understand why your sleep feels so disturbing, this post offers insight and real tools. If you or a loved one suffer from intense dreams or frightening sleep episodes, you’re not alone—and healing is possible.
Night Terrors and Nightmares: What You Need to Know About Sleep Disturbances
A friend recently described to me a time when she woke up to her toddler’s screams in the middle of the night. She found her daughter standing on her bed, eyes wide open and screaming with fear. As she tried to calm her three-year-old, it quickly became obvious that the child was still asleep. My friend eventually got her daughter to lie back down and peacefully close her eyes, but it was pretty upsetting for them both.
My friend thought her daughter was having a really awful nightmare, but actually, it was a night terror. Both nightmares and night terrors are pretty common in kids. But in adults, they may be a symptom of underlying trauma.
Are Nightmares and Night Terrors a Sign of Trauma?
Nightmares and night terrors are often lumped together, but they’re actually quite different. If you have PTSD or a history of trauma, nightmares can be a really common symptom. But I’ve recently learned that night terrors can also occasionally be a symptom of trauma too. Let’s break down the differences so that you can know what to do about them, whether for yourself or a loved one.
What Are Nightmares?
- You’re probably more familiar with nightmares because you may remember having one. That’s one of the things that differentiates them from night terrors.
- The reason you can remember a nightmare is because it’s a vivid, disturbing dream that happens during REM (rapid eye movement) sleep. This is the last sleep stage and is where most dreaming occurs.
- Nightmares tend to have strong emotional content—fear, anxiety, sadness, even guilt—and they can feel incredibly real.
- The fear that lingers after a nightmare can also make it hard to fall back asleep.
It’s normal to have the occasional nightmare, but when they become chronic or so distressing that you dread going to sleep, that’s when we start looking at nightmare disorder or PTSD. More on that later.
What Are Night Terrors?
Okay, so what are night terrors? Night terrors, which are also called sleep terrors, are intense episodes of fear that occur during deep, non-REM sleep. This is stage 3 deep sleep, and it’s usually in the first few hours of the night, usually in the first or second sleep cycle.
Now these can look really scary because the child or adult might scream, thrash about, they might show intense fear. They might be sweating and have rapid breathing. And they look awake! A lot of times their eyes are open, but they’re confused and they don’t respond to you. Usually you can’t wake them up or comfort them.
Night terrors are a form of parasomnia. This is a type of sleep behavior that includes sleep walking, sleep talking, sleep paralysis, and bed wetting.
These episodes typically resolve on their own, and the person will usually fall back into restful sleep without remembering what happened. (Unlike their partner who will definitely remember the situation and probably have a hard time falling back to sleep).
What Causes Nightmares and Night Terrors?
Nightmares and night terrors are two different states, but let’s take a look at what causes them. Poor sleep, stress, medications and other factors can cause both. Both nightmares and night terrors are more likely in children, and they usually peak between ages 3 to 7.
Between 10-30% of children experience night terrors and 10-50% experience nightmares. This goes down quite a bit for adults. About 1-3% of adults have night terrors and 2-8% of adults have nightmares weekly. But that number completely changes when someone has a history of trauma. Nightmares are a common symptom of PTSD. Research shows that 70-90% of PTSD sufferers have nightmares.
Nightmare Disorder: When Nightmares Become a Problem
When nightmares become frequent, distressing, and interfere with sleep and daily life, it may be a condition called nightmare disorder. Let’s dig into that a little. Here are the signs of nightmare disorder.
Signs of Nightmare Disorder:
- Recurring nightmares at least once a week
- Anxiety about falling asleep due to fear of nightmares
- Fatigue, poor concentration, and mood issues from sleep loss
- Nightmares that significantly impact mental health or daily function
These are nightmares that are so distressing that you can’t stop thinking about them. A lot of times we’ll see behaviors of avoidance around nightmares. Some people will use substances or medications to avoid having nightmares, or just avoid going to sleep, which leads to more sleep deprivation, which causes more problems.
Nightmare disorder is often linked to stress, trauma, anxiety, depression, medication side effects, or poor sleep hygiene.
How to Treat Nightmares and Night Terrors in Adults
Now that we know the difference between night terrors, nightmares, and nightmare disorder, we can tailor the right treatment to the related problem.
The first line treatment for any of these sleep disorders is improving sleep hygiene. So this includes sticking to a sleep schedule, reducing screen time before bed, and creating a relaxing environment and nighttime routine. It’s also important to avoid drugs, caffeine or alcohol as all of those interfere with healthy sleep.
Treating Nightmares & PTSD-Related Nightmare Disorder
There are a few options for treating nightmares and nightmare disorders. The first one in this list is effective for 60% of people with nightmares.
- Imagery Rehearsal Therapy (IRT): I made a video about this so you can learn about it, but I’ll give you the short version. During the daytime, you write out your nightmare, and then you change the ending so that the problem is resolved. You can get really creative about how you re-write the ending. Here’s why this works: One of the reasons your brain makes nightmares is it’s actually trying to process memories and emotions during REM sleep, it’s trying to work through them, but with PTSD the processing system can get overwhelmed and you wake up in the middle of the dream without resolving it. It’s like turning off “The Lion King” right after Mufasa dies—it’s a traumatic ending. Instead, you want to help your brain process to the end of the story, hakuna matata, redeem pride rock, restore balance to the circle of life, etc. When you write the new ending, your brain knows how to finish the dream and it doesn’t have to keep reliving that nightmare over and over.
- Reducing Stress & Anxiety: Relaxation techniques, deep breathing, or therapy can reduce their frequency. You can learn how to regulate your nervous system with my free Grounding Skills course. I’ll link that below. I teach body based skills to turn on the parasympathetic or calming response in your body.
- Addressing Trauma & PTSD: If nightmares stem from past trauma, trauma-focused therapy, like EMDR or CBT, can be highly effective. A good therapist can help you learn the skills to work through the underlying trauma that causes your nightmares. I also have a course in my membership called “How to Process Trauma” with a lot of skills to help you process through and resolve trauma instead of coping with it or avoiding it.
- Medications for severe cases: Some medications, like prazosin, can be used in extreme cases to reduce nightmares, particularly in PTSD. It does come with some side effects, so be sure to work with your doctor when you’re figuring out medications.
Effective Treatments for Night Terrors in Adults
Night terrors usually have nothing to do with PTSD. They’re usually related to growing up or a sleep phase issue—usually; but they can occasionally be caused by trauma. This is especially true for combat veterans or those with childhood trauma. Standard night terrors usually have vague themes, are sporadic, and you don’t remember it. But with trauma-related night terrors it might have violent or aggressive themes, be chronic, and sometimes the person does remember it.
If you have PTSD to work through, trauma-focused therapy may help your night terrors.
However, for most people experiencing night terrors, treatment is all about keeping the person safe in their sleeping environment. Here are 5 things you can do.
- Wait It Out: Since night terrors happen during a deep sleep phase and are not remembered, trying to wake the person can make it worse. It’s usually best to let the episode pass naturally.
- Keep a Regular Sleep Schedule: Sleep deprivation can trigger night terrors, so prioritizing adequate, high-quality sleep can help reduce episodes.
- Scheduled Awakenings: If night terrors occur at the same time each night, gently waking the person up 15-30 minutes before the usual episode can prevent them. This is usually the most effective treatment for night terrors.
- Sleep Safety Precautions: For people who move around or thrash violently, make sure their sleep environment is safe. You might have to remove sharp objects or secure furniture to prevent injuries.
- Sleep Study: If night terrors are chronic, dangerous, or don’t seem to fit the normal pattern, you can do a sleep study or see a sleep specialist to rule out any other conditions that may be contributing.
Overcoming Nightmares and Night Terrors: Final Thoughts
While nightmares and night terrors can be unsettling, they are usually manageable with the right strategies. Nightmares are often tied to emotional stress, or trauma and addressing underlying issues can bring relief. Night terrors, on the other hand, tend to be a phase that children outgrow, though ensuring good sleep hygiene can make a big difference.
If nightmares or night terrors are severely impacting your sleep or ability to function, getting professional help from a therapist or sleep specialist is a great next step. I’ve also made a couple of videos teaching some pretty impactful techniques to decrease nightmares, so make sure to check those videos out (linked below). Sleep is essential to mental and physical health—so it’s worth finding ways to make it as restful as possible.
How to Stop Having Nightmares: 9 Tools for Stopping Nightmares and Bad Dreams
Sleep Hygiene: Train Your Brain to Fall Asleep and Sleep Better
How to Stop Nightmares in Adults w/ PTSD – Rescripting Nightmares with CBT for Nightmares Protocol
