- The FDA recently approved an app that claims to stop nightmares.
- The app, NightWare, uses heart rate and movement data to identify nightmares and vibrate users out of their dream states.
- Sleep experts said the vibrations would likely stop a nightmare, but won't address its root cause.
- Visit Insider's homepage for more stories.
Nightmares are almost universally harmless. But for an estimated 3 to 8% of the population, recurrent nightmares are a disturbing problem that can wear down mental health and sleep quality.
The medical device company NightWare created an app meant to help the numerous post-traumatic stress disorder patients who experience traumatizing and persistent nightmares.
The app, which was approved by the FDA this month, uses the Apple Watch's biometric monitoring technology to learn a user's sleep patterns and distinguish a nightmare from regular sleep. Then, it gently vibrates — ideally enough to shake the wearer out of their bad dream, but not enough to wake them up.
"My guess is sometimes it'll wake you up, sometimes it won't wake you up," Michael Grandner, director of the Sleep and Health Research Program at University of Arizona, told Insider. "It's like when you're snoring and someone pokes you to roll over and you don't actually wake all the way up."
NightWare was tested in a randomized controlled trial of 70 people, all veterans who have been diagnosed with PTSD and nightmare disorder, and it was found to improve sleep quality.
The intervention is low risk, high reward, Grandner said, although he'd like to see more efficacy data. Another study of 240 patients is scheduled to be completed in 2021.
Nightmares are just dreams that are strong enough to wake you up
Like all dreams, nightmares occur during the rapid eye movement stage of sleep.
During REM, the brain is hyperactive but the body is paralyzed, with the exception of the eyes and the muscles that control breathing.
Heart rate and breathing are more variable during REM sleep and tend to increase overall during this stage. People may also twitch or mumble in their sleep during a particularly vivid dream, Grandner said. The strongest dreams can even wake you up.
"A nightmare is just a dream that has an emotional content that's so strong it steamrolls over your defenses and breaks through and wakes you up," Grandner said. "The simplest definition of a nightmare is a dream that wakes you up itself."
Michael Nadorff, a nightmare disorder expert at Mississippi State University, said NightWare's vibrations could be a gentler awakening than the alternative. Even if the vibrations briefly wake the user up, it's better than jolting awake in a cold sweat.
But, he said people are more likely to remember the dreams they wake up from, which is not a desired outcome for nightmares. Remembering unpleasant dreams could lead to insomnia if people become wary of sleep, and constant arousals could chip away at sleep quality.
NightWare might cut nightmares short, but it doesn't address their root cause
Compared to other interventions, the NightWare app is a Band-Aid, said Courtney Bolstad, a graduate student who works in Nadorff's lab. While it may provide a short-term fix, it doesn't address the underlying cause of nightmares like other therapies do.
Imagery rehearsal therapy is the current recommended treatment for nightmare disorder. It involves writing down your dreams with re-imagined, non-frightening endings and then rehearsing those replacement dreams with the help of a professional.
Often, in cases of PTSD, nightmares are a normal part of the healing process, Nadorff said. Just like exposure therapy involves working through a traumatic experience, nightmares can kick-start that process during sleep.
"One hypothesis is that's actually what happens with nightmares. It's the body doing that exposure naturally to try to help the person overcome whatever stressful event they experienced," Nadorff said.
However, when nightmares persist for more than a month after the trauma, doctors may recommend IRT or another treatment. Recurrent nightmares can increase the risk of depression, anxiety disorders, and suicide.
The NightWare app is currently available by prescription for people who have nightmares associated with PTSD. It is not meant to be a standalone therapy for PTSD and should be used along with other treatments.
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