For people with clinically diagnosed "nightmare disorder," learning to redirect disturbing dreams to more positive ones is usually the return ticket to sleep.
But for nearly one-third of people, that method — called imagery rehearsal therapy — isn't effective.
A new study shows that listening to positive sounds while sleeping reduces the frequency of nightmares.
"This is a promising development. It does appear that adding a well-timed sound during REM sleep augments the effect of image rehearsal therapy…which is a standard and perhaps one of the most effective non-pharmacologic therapies at this time," said Timothy Morgenthaler, MD, in an interview with CNN.
Morgenthaler, who was not involved in this latest study, is lead author of the American Academy of Sleep Medicine's current guidelines on nightmares.
For the new research, nightmares were defined as "the experience of strong negative emotions occurring usually during rapid eye movement (REM) sleep. They involve images and thoughts of aggression, interpersonal conflict, and failure, and emotions like fear, anger, and sadness." Nightmare disorder is characterized as having such dreams so frequently that they cause "significant distress or impairment in social, occupational, or other important areas of functioning."
Left untreated, nightmare disorder can persist for decades, the authors said.
The study, conducted in Switzerland, enrolled 36 participants with nightmare disorder. All 36 participated in a daytime lesson of imagery rehearsal therapy that taught them to redirect their nightmares to positive dreams. Participants were taught to recall a nightmare, change the negative story line toward a more positive one, and then rehearse the so-called "rewritten dream" during the day.
Half of the participants also had a special sound played while they practiced reimagining their new positive dreams. At night for the following two weeks while they slept, the sound was played during their REM cycles.
Those who heard the sound reported significantly fewer nightmares.
"This difference displayed a medium to large effect size and was sustainable at the 3-month follow-up," the authors reported.
They did note that both groups showed improvement, likely because the lesson to reimagine nightmares into positive dreams is known to be effective. However, the authors allowed that other factors may have contributed in ways their study design could not control.
"The result should be replicated," Morgenthaler said. "But I was a bit excited at this new possibility."
Current Biology: "Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation."
CNN: "New treatment for nightmares holds promise, study finds."
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Cite this: Positive Sounds During REM Sleep May Help Nightmares - Medscape - Oct 31, 2022.