Using sound to take the terror out of nightmares

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Heart pounding, I sit up straight in bed, flushed, sweaty and completely terrified. My brain had pulled me out of a nightmare—a dream so terrifying that I woke up.

I’ve only had one or two such night terrors, but for people with trauma, post-traumatic stress disorder, depression or anxiety, the terrifying dreams come night after night, ruining their sleep and ultimately their health.

Visions from nightmares can creep into the next day’s light like dark shadows, disrupting a person’s ability to focus and think. Mood drops, anxiety increases. Days are filled with intense fear of falling asleep and can trigger another terrifying dream.

Such symptoms may lead to a diagnosis of nightmare disorder, a sleep condition that affects about 4% of adults, according to the American Academy of Sleep Medicine.

Treatment may include stress reduction, counseling, systematic desensitization, and medication, but the gold standard is imagery rehearsal therapy, a cognitive behavioral training that teaches people to reimagine their nightmares with positive endings. However, not everyone with nightmare disorder responds to this treatment, experts say.

Now a new study has added a twist – playing a sound during the REM (rapid eye movement) or dream stage of sleep that a person’s memory is associated with a more positive outcome. The result was fourfold Reduction of nightmares on primary therapy alone.

“As far as I know, this is the first clinical and therapeutic study using target memory activation to speed up and improve therapy,” said lead author Lampros Perogamvros, a psychiatrist at the Geneva University Hospitals and University Sleep Laboratory. Geneva.

Nightmare Disorder is a sleep condition that affects about 4% of adults, according to the American Academy of Sleep Medicine.

“This is a promising development. Adding sound at a good time during REM sleep appears to increase the effect of imagery rehearsal therapy … which is a standard and sometimes non-pharmacological treatment. Latest American Academy of Sleep Medication Guide to Nightmares.

“The results need to be replicated,” said Morgenthaler, who was not involved in the study. “But I was a little excited about this new ability.”

Experts say there are four basic steps of imagery rehearsal therapy that can be taught in one day. First, people are asked to write down every detail of their nightmare. Next, each person rewrites the nightmare with a positive arc, making sure it ends with a pleasant or empowering solution or resolution.

Now the training begins. The rearranged dream must be rehearsed Five to 20 minutes each day until it is woven into the brain’s memory circuits. Once it’s worked out, it’s time to put it into action by rehearsing the new dream before bed.

In the new study, published Thursday in the journal Current Biology, researchers added a twist to the treatment. 18 people with nightmare disorder heard a neutral sound – a piano string – while they reframed their nightmares in a more positive way. A control group of 18 people with nightmare disorder heard no additional noise while reenacting their dreams.

All 36 were given a headband called an actimeter to wear at night for two weeks. In addition to monitoring the stages of sleep, the device delivered sound in a way that did not wake the sleeper – via bone conduction.

“One of the important things about the intervention in this study is the use of relatively new technology that can more precisely time arousal for true REM sleep,” said Morgenthaler, a professor of medicine at the Mayo Clinic School of Medicine.

“Many wearable devices do not accurately measure true REM sleep,” he added. “Of course, further study may find that timing is not so critical—but that remains to be determined.”

Both groups were given sounds every 10 seconds during the dream phase of sleep for two weeks. In this case, “imagery rehearsal therapy worked for all participants, including the control group,” Perogamvros said.

“But in the experimental group, When noise was positively associated, the reduction was significantly greater—they had four times fewer nightmares,” he added.

Imagery therapy also reduced measures of overall distress, mood and sleep quality in both groups, but the reduction in nightmares was faster in the experimental group and persisted at a three-month follow-up, Perogamvros said. In addition, members of the noise group reported happier dream experiences in their dreams than those in the control group.

Additional research is needed to verify these results and expand the concept, but Perogamvros said he hopes the technique will lead to improvement in the 30% of patients who don’t respond to image retraining therapy, also known as IRT.

“The idea underlying the hypothesis that target memory reactivation can enhance the effects of IRT has merit,” Morgenthaler said, “and this elegant test of that hypothesis strengthens that theory.”

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