For more than 30 years, retired combat Marine veteran Tim Bahr would have his sleep interrupted by a dozen or so nightmares every night. He clearly recalls the morning of August 5, 2017 because that was the first time in decades that he woke up from a full night of sleep and could not recall a single nightmare. Bahr was testing an early version of NightWare and has become a strong advocate for this new nightmare treatment.
Nightware, is a ‘breakthrough’ system that uses an Apple watch and iPhone to help reduce nightmares and their related distress. As you begin to have a nightmare, a gentle vibration from the watch wakes the wearer just enough to change the dream state, allowing the person to sleep on more peacefully. Bahr said the sleep data shows he is still having nightmares but the device ‘breaks’ them before they get to the most intense places, so he is blissfully unaware of them. He also says this does not replace therapy but it does enable him to work through his PTSD with a well-rested body and a clear mind. “I now wake up without that fog.”
Granted FDA approval in November 2020, Nightware is now available on a limited basis by prescription to those who suffer from nightmare disorder or nightmares related to post-traumatic stress disorder (PTSD). This is new order of nightmare treatment was granted ‘breakthrough device’ designation that allowed it to fast-track through the FDA approval process.
Recurrent, realistic nightmares that replicate traumatic events are a cardinal feature of PTSD. They cause considerable distress and impair sleep, and for many, these distressing dreams do not simply go away with time. There have been several effective nightmare treatments developed that involve some variant of nightmare rescripting – in which the dreamer invents and rehearses a new ending to their nightmare. Imagery Rehearsal Therapy (IRT) has the most supportive evidence, and many other, similar psychotherapy-based interventions have been developed over the past 20 years. Medications are often prescribed as well, most often Prasozin, but it was recently downgraded because in a recent study, it did not perform better than placebo. However, NightWare is a new and different kind of treatment that can augment other ways of helping reduce nightmare suffering.
The beauty of Nightware is that this wearable device poses minimal risk and has no side effects. When we have a nightmare, our body reacts as though the terrifying event is really happening – so our heart rate increases, our breath becomes rapid, and we can tend to thrash around a lot more. The Apple watch can detect heart rate and movement. Over the first week or so of wearing the device, the patented Nightware software creates a personalized sleep profile to enable it to detect when a person is likely to be having a nightmare. It will then send a signal to create a gentle vibration in the watch, enough to cause a shift in the dream state, but not enough to wake the wearer up… or if the signal is too strong and does wake the wearer, the watch will adjust the signal and make it softer.
NightWare was tested in 30-day clinical trial with 70 patients who were randomly assigned with the working app, or a placebo app that did not create vibrations. Both groups reported improved sleep quality, but those with the Nightware app reported greater benefit. A larger controlled clinical trial is under way in several Department of Veterans Affairs hospital sites. According to NightWare CEO Grady Hannah, the company was founded specifically to support the physical, mental and emotional health of veterans and active duty service members.
There are some caveats. The FDA suggests that Nightware should be used in conjunction with other treatments and under the supervision of a professional. And it’s not recommended for those who tend to sleepwalk, or become violent or act out their dreams because the device may increase this undesirable activity (called REM Behaviour Disorder). It also recommended only for those 22 years of age or older. Nightware is available by prescription only, and is currently limited to veteran and military individuals. To find out more about it, you can do go the company web site at nightware.com.
Dr. Leslie Ellis is an author, researcher and therapist who specializes in PTSD nightmare treatment. If you are interested in learning more about nightmares and their treatment, check out my Short Focused Course on Nightmare Treatment. Or go HERE for a free PDF for clients on ‘What You Can Do About Your Nightmares.’