- About 4% of adults have more than 1 nightmare per week.
- Imagery rehearsal therapy is a common treatment for nightmare disorder.
- Targeted memory reactivation may enhance the effectiveness of imagery rehearsal therapy.
“It was only a dream.”
It’s a common enough expression to be a cliché, but to those living with nightmare disorder, the phrase brings little comfort.
Nightmare disorder is characterized by frequent nightmares that cause distress or impair your ability to function during everyday activities such as work or social situations.
And even if you don’t have this disorder, you’re likely familiar with the occasional bad dream. A nightmare might cause you to wake up and they often leave you with a lasting feeling of fear or stress.
Imagery rehearsal therapy (IRT) is one commonly used treatment method for nightmare disorder.
Researchers in Switzerland recently published a study in the journal Current Biology in which they combined IRT with targeted memory reactivation (TMR). The results might have you sleeping easier.
Let’s take a look at what they found and how you might be able to put those bad dreams to bed.
First, we need to understand IRT, which is already used as a way to reduce nightmare frequency and intensity.
“[You] write down the bad dream in a very detailed version and then create endings for nightmares that are nonfrightening.,” Dr. Thomas M. Kilkenny, MS, DO, FAASM, FCCP, the director of the Institute of Sleep Medicine at Staten Island University Hospital in New York, told Healthline.
“They are written down and rehearsed over and over as one would rehearse an act in a play. In essence, the patient is writing a new ‘ending to the script’ of the nightmare, thereby making it a more pleasant outcome,” Kilkenny explained.
The goal is that, with practice, your unconscious mind learns to follow the new script to its happier ending after a nightmare has begun.
In this newly published study, the 36 participants were split into 2 equal-sized groups.
Both groups practiced IRT, but the second group additionally used TMR.
Dr. Alex Dimitriu, the founder of Menlo Park Psychiatry & Sleep Medicine in California and BrainfoodMD, told Healthline that TMR works by associating a stimulus — such as a specific sound — with a specific thought while you’re awake.
“Then when the same sound is played during sleep, the brain re-activates this memory. In the case of nightmares, if a tone can be associated with a positive ending to the nightmare, playing that sound while the person is dreaming should help reactivate the positive memory that was rehearsed while awake,” explained Dimitriu.
Participants in the TMR group of this study listened to a sound while they imagined the better ending to their dream during IRT.
Participants in both groups wore a special headband at night that played the same sound when they entered the rapid eye movement (REM) stage of sleep associated with dreaming.
After two weeks, those who had listened to the sound during waking IRT experienced fewer nightmares per week. They also had more dreams with positive emotions like joy.
The experts had favorable reactions to how the study was performed and the results it produced.
“I’m delighted to see such a relatively gentle intervention yield such a positive result,” said Dimitriu.
Of particular interest was that when participants were surveyed 3 months later, they all reported fewer nightmares per week.
Those in the TMR group had more pronounced results than those in the IRT-only group.
“The study demonstrates again that IRT alone works to improve nightmare disorder, but the new twist is that the addition of TMR to IRT not only improves [nightmare disorder] but also increases the amount of positive dream experiences,” said Kilkenny.
While the results of this study are encouraging, it might be difficult to implement them on your own.
If you’re experiencing frequent or intense nightmares, it may be helpful to first address your sleeping habits.
“Anyone struggling with nightmares should check a few basic biological systems,” said Dimitriu.
There are five things he recommends investigating:
- Find out if you might have sleep apnea or restless legs syndrome.
- Make sure you are getting enough sleep with regular bed and wake times.
- No caffeine past noon, and no alcohol within 3-4 hours of bedtime. No late dinners.
- Make sure there is no real-world source of the nightmare.
- Seek professional help if you’re experiencing anxiety, depression, or have a history of trauma.
If you’re interested in TMR but don’t have a headband with a built-in electroencephalogram, you might be able to use other sound triggers, such as a fan or a white noise machine.
“The important point is to have the external stimuli be able to be associated with the thoughts one wishes to remember,” said Kilkenny.
“The other therapy that has been proven to work on nightmares in PTSD (post-traumatic stress disorder) is the medication prazosin. Other behavioral therapies that may be considered for treatment of PTSD-associated nightmares based on low-level evidence include Exposure, Relaxation, and Rescripting Therapy, Sleep Dynamic Therapy; Hypnosis, Eye-Movement Desensitization and Reprocessing, and the Testimony Method,” said Kilkenny.
The experts recommend that if you need help managing your nightmares, consult with a primary care physician, sleep specialist, or mental health professional.