Could Nightly app cure nightmares?
Background. The DSM Manual, edition IV-TR, defines nightmare as an extremely frightening dream from which a person wakes up directly. At least one nightmare per week is often used as a criterion for nightmare disorder as this frequency seems to cause clinically significant distress. Nightmares are associated with disturbed sleep and low well-being. They also affect daytime mood and behavior. Between 8 and 29% of adults report recurring nightmares. Our study assumptions are based on the latest research revealing that meaningful external stimuli can be incorporated into dream content, much more than previously assumed. This intervention could be used in the treatment of sleep disorders, especially in the case of nightmares, as a use of positive tone stimuli can change the dream content and improve patient’s quality of sleep. Given the implications, we developed Nightly, an iOS app aimed at preventing nightmares and improving sleep quality. Nightly was used as a source of positive video and audio stimuli and tested as a preventive tool for patients with frequent nightmares. Method. The study was conducted over the period of six weeks, being split in two-week long series. During this time the total number of 39 participants were enrolled. The participants were chosen based on an online questionnaire they filled in. Selection criteria were as follows: both male and female, minimum 18 years old, having declared suffering from severe nightmares. During the study participants were given access to the Nightly app with eight carefully designed video themes. Videos with positive tone stimuli were shown to the study participants before sleep. During the night Nightly played specific sounds at precise moments estimated by the app algorithm. After each night participants filled in a questionnaire referring to their well-being, level of regeneration after sleep, mood, remembering dreams and their description. They also declared (by choosing true or false) whether their sleep was disturbed by any sounds from the application. Results. During the study, the Nightly app was used 180 times: 71 times during the first series, 39 during the second and 70 during the third. Preliminary results show that using the Nightly app reduces nightmares in 89.6% of cases. Blind trials were performed parallel to the rest of the study. Conclusion. The study presented in this paper shows that in the future, applications like Nightly could be used as a preventive tool by people with frequent nightmares. However, further research is required to assess and improve its effectiveness. Furthermore, large-scale studies with wider assessment of sleep apps like Nightly may be a useful addition to future preventive research studies. It also shows a potential that applications alike could become an innovative element of emerging personalized medicine.