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Heart pounding, I sit straight in bed, red, sweaty and completely panicked. My brain has grabbed me from a nightmare – a dream so alarming that I wake up.
I’ve only had one or two such nightmares, but for people who suffer from trauma, post-traumatic stress disorder, depression, or anxiety, night after night can come with frightening dreams, ruining their sleep and ultimately their health.
Visions from nightmares can also creep into the next day’s light like dark shadows, interfering with a person’s ability to focus and think. Mood falls and anxiety rises. Days can be filled with an intense fear of falling asleep and recalling another terrifying dream.
Such symptoms can lead to a diagnosis of nightmare disorder, a sleep disorder that affects about 4% of adults, according to the American Academy of Sleep Medicine.
Treatment may include stress relief, counseling, gradual desensitization, and medications, but the gold standard is imagery therapy, a form of cognitive-behavioral training that teaches people to reimagine their nightmares with a positive ending. Still, not everyone with nightmare disorder responds to treatment, experts say.
Now, a new study has added a twist — playing a sound that the person’s memory has associated with a more positive outcome during REM (rapid eye movement), or the dream phase of sleep. The result was a quadruple reduction of nightmares about basic therapy alone.
“To my knowledge, this is the first clinical and therapeutic study using target memory activation to accelerate and improve therapy,” said lead author Dr. Lampros Perogamvros, a psychiatrist at the Sleep Laboratory of the University Hospitals of Geneva and the University of Geneva.
“This is a promising development. It seems that adding a well-timed sound during REM sleep increases the effect of image repetition therapy. the most recent American Academy of Sleep Drug guidelines for nightmares.
“The result needs to be replicated,” said Morgenthaler, who was not involved in the study. “But I was a little excited about this new opportunity.”
Rehearsal therapy with imagination has four basic steps that can be learned in one day, experts say. First, people are asked to write down every detail of their nightmare. Then each person rewrites the nightmare with a positive arc, making sure it ends with a pleasant or reinforcing solution or solution.
Now the practice begins. The reworked dream must be rehearsed five to twenty minutes a day until it’s woven into the brain’s memory circuits. Once that’s in place, it’s time to put it into action by practicing the new dream right before bed.
In the new study, published Thursday in the journal Current Biology, researchers added a twist to the therapy. Eighteen people with nightmare disorder heard a neutral sound — a piano string — while reinventing their nightmares in a more positive way. A control group of 18 people who also had nightmare disorder heard no additional noise while they reworked their dreams.
All 36 people were given a headband, called an actimeter, to wear overnight for two weeks. In addition to monitoring sleep stages, the device delivered sound in a way that wouldn’t wake the sleeper — via bone conduction.
“One of the important things about this study’s intervention is the use of relatively new technology that can more accurately time the stimulus for true REM sleep,” said Morgenthaler, a professor of medicine at the Mayo Clinic School of Medicine.
“Most wearable devices do not accurately measure actual REM sleep,” he added. “Of course, further research could indicate that the timing is not that crucial, but that has yet to be determined.”
The sound was delivered to both groups every 10 seconds during the dream phase of sleep for a period of two weeks. In this case, “imagery exercise therapy worked for all participants, including the control group,” Perogamvros said.
“But in the experimental group, where the noise was positively associated, the decrease was significantly greater — they had nearly four times fewer nightmares,” he added.
Image repetition therapy also reduced overall stress, measures of mood and sleep quality in both groups, but reductions in nightmares occurred more quickly in the experimental group and persisted at a three-month follow-up, Perogamvros said. In addition, members of the group who heard the sound reported more joyful dream experiences during their dreams than those in the control group.
Additional research is needed to verify these results and expand the concept, but Perogamvros said he hoped the technique could lead to breakthroughs for the approximately 30% of patients who fail to respond to imagery therapy, known as IRT.
“The ideas underlying the hypothesis that targeted memory reactivation might enhance the effects of IRT have merit,” Morgenthaler said, “and this elegant test of that hypothesis reinforces that theory.”