Jacquie Baker, a former Air Force engineer, has had nightmares four or five nights a week for nearly a decade. The scenarios vary, but the feeling of helplessness is always the same: she’ll watch someone get murdered, or she’ll forget her pre-flight checklist and the plane she’s riding will crash.
“I started having skin issues, because I was constantly sleeping in my own sweat,” she says. “I had to change my sheets multiple times a night.” After struggling through those nights, Baker would often have to miss the morning or day of work. She was diagnosed with post traumatic stress disorder (PTSD) stemming from her time in the military, as well as anxiety and depression. But no medications or interventions helped her nightmares—until 2021, when she began using Nightware, an Apple Watch-enabled app that helps to interrupt nightmares.
The system—which includes an Apple Watch preloaded with Nightware and locked to only run that app—taps into Baker’s nighttime biorhythms, including her heart rate, breathing, and movements. Using an algorithm, it determines when these metrics escalate enough to indicate a nightmare. The watch then buzzes at her wrist, pulling her out of the dream without necessarily awakening her. The morning after using the device for the first time, she was disappointed because she thought she hadn’t had a nightmare. She hadn’t woken up overnight and felt she had finally gotten a good amount of uninterrupted sleep. “I felt like a liar,” she says. “Then I went back and looked at the report and found I had 12 interventions that night.”
Sam Schultz, a veteran who served in Afghanistan and also uses Nightware after being diagnosed with PTSD, sees similarly high tallies when he’s stressed. “One night, it went off 56 times in the span of eight hours,” he says. “But I very rarely remember ever waking up. Instead, I wake up feeling rested and feeling like I can actually do stuff that day.”
Since using the app, Baker says she’s returned to being the person she was before incessant nightmares hijacked her personality. “I have a seven-year-old son, and for six years of his life, Mommy was bananas; Mommy was grumpy and had no patience,” she says. But no longer. Even though she still physically has nightmares, she doesn’t remember them—and they don’t bother her. “It gave me my life back.”
Nightware was approved by the U.S. Food and Drug Administration in 2020 to reduce sleep problems associated with nightmare disorder and nightmares related to PTSD, and so far has been prescribed primarily to veterans and people in the military. The device is not a treatment or cure for nightmares in the sense that it can eliminate them, but it interrupts the process so the sleeper is spared the stressful, emotionally difficult, and traumatic fallout of the dreams. It’s an important first step. In an October 2022 study involving 65 veterans with PTSD-related nightmares, the device improved sleep among the most compliant users.
Even though Nightware does not treat the cause of nightmare disorder, interrupting the stressful dream has a lot of value, and it could pave the way toward de-escalating and eventually neutralizing nightmares. The use of physical triggers to pull people out of nightmares is not entirely new: Schultz, for instance, has a service dog who is trained to recognize his frantic movements during sleep that could signal a nightmare. But having the dog wake him up out of nightmare comes with some downsides. “When you’re woken up by a 50-pound dog sitting on your chest, that can rattle you a little bit.”
Because it’s still new to the market, there isn’t enough data yet to evaluate what effect Nightware has over the long term, but sleep specialists are eager to see what the data show in coming years. “I’m not sure we know in deep ways whether or not the whole way the brain is functioning during sleep changes a great deal [because of the device],” says Dr. Timothy Morgenthaler, professor of medicine and director of the Mayo Clinic Center for Sleep Medicine. (Morgenthaler is not affiliated with the app.) “Is it reparative or just different? We don’t know.”
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Nightmare disorder is a relatively new entrant to the list of psychiatric conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the latest guidelines issued by the American Society of Sleep Medicine, sleep specialists recommend that doctors treat nightmare disorder with various forms of cognitive or behavioral therapy. These can involve techniques such as image-rehearsal therapy, in which patients are asked to write down the nightmares they experience in as much detail as possible, including the scents, sounds, and feelings they encounter. They are then asked to rewrite the script of these nightmares, redirecting their thoughts to a less threatening scenario, with the goal of training the brain to reroute thoughts from a traumatic experience to a more benign one. Imaging studies involving this approach suggest that strategy can change which parts of the brain are activated during sleep.
Cognitive behavioral therapy (CBT) delves deeper into the triggers and causes of nightmares. Working with therapists, patients unpack the meaning of their nightmares and learn ways to de-escalate or neutralize the threat they feel from them.
These types of therapy have drawbacks. Many people suffering from nightmares don’t have adequate access to mental-health professionals who can work with them, or the time needed to gradually conquer their trauma. And for some, including victims of sexual assault, the process of reliving the nightmare can even be damaging. During the time it takes for CBT to have an impact, for example, patients are still experiencing nightly trauma. And the sleeplessness that results can blunt potentially helpful therapies, or even make them futile.
Nightware can help bring people to a point where they are more receptive to therapy, just by letting them sleep better. “Once I was able to get some sleep…that made my day so much more manageable,” says Baker. “I could see, wow, I am kind of depressed.” Good sleep made her better equipped to “participate more in treatment.”
There’s also the intriguing possibility that over time, the constant interruption of nightmares could eventually extinguish them, or at least the emotional trauma associated with them. “Can the nightmares stop? We don’t have the research to show that,” says Dr. Brian Robertson, chief medical officer at Nightware. “But we do know that [the device] is interrupting nightmares for sure, and I do know of a couple of patients who stopped having them.”
So far, about 400 doctors have prescribed Nightware to service members, according to the company. For active duty military, it’s covered by their insurer Tricare, but not yet covered by the VA or for veterans. (Both Baker and Schultz received their devices from the Semper Fi & America’s Fund, which provides financial support to wounded, ill, and injured service members.) As the device continues to show benefit among people in the military with PTSD, the company plans to expand to other affected populations as well, including first responders and victims of sexual trauma.
For nightmare sufferers like Baker and Schultz, the device has been a life saver. “It’s so crazy how something so simple can quite literally change everything,” says Baker.
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Contributor: Alice Park