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Nightmares and night terrors are usually easily identified by an adult experiencing them or by a child’s parent. If the nightmares or night terrors occur frequently or interfere with waking life, professional help may be sought. A physician may examine a patient for underlying physical causes. In some cases, patients who experience frequent nightmares or night terrors may be referred to a mental health professional for further evaluation.

Patients may be asked to describe the episode to help determine whether they are experiencing nightmares or night terrors. Some questions that a patient may be asked include:

• How long after falling asleep do the episodes occur?
• Do they scream, cry or yell upon wakening?
• Do they recall the episode after waking?
• Do they experience daytime dysfunction due to episodes?
• Have they experienced any physical or emotional stress lately?

For most children, nightmares and night terrors do not require further investigation. Adult patients may be referred to a sleep center where sleep patterns are analyzed in depth by health professionals who specialize in sleep disorders. At the sleep center, a polysomnogram (sleep study) will typically be performed. This painless test is conducted overnight while patients are sleeping. Electrodes are placed on the face and scalp before sleep. The test monitors electrical activity of the brain (electroencephalogram) and heart (electrocardiogram), movements of the muscles (electromyogram) and eye movements (electro-oculogram). These are measured as patients move through the different stages of sleep.

Mental health professionals have created specific criteria for determining whether patients experience occasional nightmares or night terrors or have chronic disorders. To meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for diagnosis of nightmare disorder, a patient must:

• Have multiple frightening dreams that lead to awakening
  
  
• Become fully alert after waking up
  
  
• Experience social or occupational dysfunction or significant distress as a result of frightening dreams
  
  
• Not experience frightening dreams as a result of a mental disorder, substance abuse or medication

To be diagnosed with night terror disorder, a patient must:

• Have multiple abrupt awakenings usually beginning with screaming or crying
  
  
• Exhibit signs of intense fear, such as rapid heart rate and breathing
  
  
• Be difficult to awaken or comfort during an episode
  
  
• Have scant or no recollection of the episode
  
  
• Experience significant distress or impairment in social, occupational or other areas of functioning