Using sound to remove the terror from nightmares

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Heart pounding, I sit upright in bed, flushed, sweaty and extremely panicked. My brain snapped me out of a nightmare—a dream so alarming that I woke up.

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

Visions from nightmares can also creep like dark shadows into the light of the next day, interfering with a person’s ability to focus and think. Mood drops and anxiety rises. Days can be filled with an intense fear of falling asleep and triggering another terrifying dream.

Such symptoms can lead to the 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, counselling, gradual desensitization and medication, but the gold standard is imagery training therapy, a form of cognitive behavioral training that teaches people to reimagine their nightmares with positive endings. However, not everyone with nightmare disorder responds to treatment, experts say.

Now, a new study added a twist — playing a sound linked a person’s memory to a more positive outcome during REM (rapid eye movement), or sleep, sleep. The result was fourfold reduction of nightmares compared to the basic therapy itself.

“To my knowledge, this is the first clinical and therapeutic study that uses targeted 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. Adding a well-timed 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 at this time,” said Dr. Timothy Morgenthaler, lead author of the latest American Academy of Sleep Medication Guidelines to nightmares.

“The result needs to be replicated,” said Morgenthaler, who was not involved in the study. “But I was kind of excited about this new opportunity.”

Imagery Rehearsal Therapy 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 to end with a pleasant or empowering solution or resolution.

Now the exercise begins. Reworked sleep must be practiced five to 20 minutes each 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 practicing a new dream right before bed.

In a 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 reframing their nightmares in more positive ways. A control group of 18 people who also had a nightmare disorder did not hear any additional sound while they were reworking their dreams.

All 36 people were given a headband called an actimeter, which they wore at night for two weeks. In addition to monitoring sleep stages, the device emitted sound in a way that would not wake the sleeper – via bone conduction.

“One of the remarkable 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, professor of medicine at the Mayo Clinic School of Medicine.

“Most wearables don’t accurately measure actual REM sleep,” he added. “Of course, further study may reveal that timing is not so critical—but that remains to be determined.”

Sound was delivered to both groups every 10 seconds during the sleep phase for two weeks. In this case, “imagery rehearsal therapy worked for all participants, including the control group,” Perogamvros said.

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

Imagery rehearsal therapy also reduced overall stress, measures of mood and sleep quality in both groups, but the reduction in nightmares occurred faster in the experimental group and was sustained at the 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.

More research is needed to confirm these results and expand the concept, but Perogamvros said he hopes the technique could lead to breakthroughs for the roughly 30% of patients who don’t respond to imagery trial therapy, also called IRT.

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