Using sound to take the terror out of nightmares

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Heart pounding, I sit up on the bed, flushed, sweaty, and completely terrified. My brain has pulled me out of a nightmare, a dream so disturbing that I wake up.

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

Even nightmare visions can creep into the morning light like dark shadows, disrupting a person’s focus and ability to think. Mood goes down, and anxiety goes up. The days may be filled with an intense fear of falling asleep and trigger another terrifying dream.

Symptoms can lead to a diagnosis of nightmare disorder, a sleep condition that affects about 4 percent of adults, according to the American Academy of Sleep Medicine.

Treatment can include stress reduction, counseling, gradual desensitization, and medication, but the gold standard is imagery rehearsal therapy, a form of cognitive behavioral training that teaches people to reimagine their nightmares with positive outcomes. However, 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 the REM (rapid eye movement) or dream stage of sleep. The result was four reducing nightmares over baseline therapy.

“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, MD, a psychiatrist at the University Hospitals and University Sleep Laboratory in Geneva. Geneva.

“This is a promising development. Adding appropriate sound during REM sleep appears to increase the effect of imagery rehearsal therapy…which is a standard and perhaps one of the most effective non-pharmacological therapies,” said Timothy Morgenthaler, Ph.D., lead author. American Academy of Sleep Medicine latest Medical guidelines for nightmares.

“The result should be replicated,” said Morgenthaler, who was not involved in the research. “But I was excited about this new opportunity.”

Imagery rehearsal therapy has four basic steps that can be taught in just one day, experts say. First, people are asked to write down all the details of their nightmare. Each person then rewrites the nightmare with a positive arc, making sure it ends with a pleasant or empowering solution or resolution.

Now the practice begins. The reworked dream must be rehearsed Five to 20 minutes a day, until it is woven into the brain’s memory circuits. Once that’s in place, 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, the researchers added a twist to the therapy. Eighteen people with nightmare disorder listened to a neutral sound—piano chords—while reimagining their nightmares in a more positive way. A control group of 18 people with nightmare disorder heard no additional sounds while reworking their dreams.

36 people were given a headband called an actimeter to wear at night for two weeks. In addition to monitoring the stages of sleep, the device provided sound in a way that would not wake the sleeper, through bone conduction.

“A significant aspect of this study’s intervention is the use of relatively new technology that can more accurately time the actual REM sleep stimulus,” said Morgenthaler, professor of medicine at the Mayo Clinic School of Medicine.

“Most wearable devices do not accurately measure true REM sleep,” he added. “Of course, further study could show that time is not as critical, but that remains to be determined.”

The sound was given to both groups every 10 seconds during the dream phase of sleep for a period of two weeks. In this case, “trial imagery therapy worked for all participants, including the control group,” Perogamvros said.

“But in the experimental group, where the sound was positively associated, the decline was significantly greater: they had almost four times fewer nightmares,” he added.

Imagery trial therapy also decreased measures of overall distress, mood and sleep quality in both groups, but the reduction in nightmares occurred more quickly in the experimental group and lasted at the three-month follow-up, Perogamvros said. Furthermore, members of the group that heard the sound reported happier dream experiences during their dreams than those in the control group.

More research is needed to confirm those results and expand the concept, but Perogamvros said he hoped the technique could lead to breakthroughs in the roughly 30 percent of patients who don’t respond to imaging trial therapy, also called IRT.

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