I'm not a veteran (though I went through 1.5 year of mandatory service back in my country) but I constantly have nightmares for as long as I could remember. There are nights where I don't want to go to sleep because the night before I had a particularly disturbing nightmare. Remarkably scary dreams.

I'm healthy, exercise nearly ever day. I avoid eating several hours before bedtime.

I was diagnosed with GAD (general anxiety disorder) but I don't take any meds. I'm slowly coming to the realization that my baseline anxiety level is way higher than of the average person. For no apparent reason.

It's frustrating but I'm trying my best to figure out a long term solution.

edit: grammar

Complex PTSD can be a condition that involves significant to total amnesia of the events causing it, while seeming to appear as constant hypervigilance in the present day. Just a note, even parental emotional neglect (which we tend to develop a blind eye to purely for survival's sake) is enough to cause c-PTSD to form (as defined in the most recent ICD).

I'm not necessarily DX'ing but I wish someone had pointed me at some resources when I was just starting to ask the inkling of the same questions. I'm getting to do the work at a much younger age that I see not many people doing until the end of their lives, though it is sort of hell being young and all.

Pete Walker's book on Complex PTSD is an amazing read regardless for anyone in the community, I'd say without diagnosing that as a potential avenue -- take a read of a few snippets, see if they resonate with you (or trigger massive denial/distraction chains), and just work your way through the book slowly if so. The techniques in there can help anyone with even "just" an internal (or otherwise) critic. :)

Hope this helps, the brain is an interesting place and we've only gotten some really good resources for misc conditions that don't externally seem to fit a particular mold. I'm starting to believe that every trauma reaction variant is some exemplar mode of some superset of possible adaptive coping mechanisms, and that in reality the dx and treatment of these things can be much more on point than the diagnosis of "anxiety" or "depression", which I'm viewing more and more as exceptionally frivolous and misleading as a standalone diagnosis (instead of as a descriptor, or a modifier), and is oftentimes as effective as diagnosing someone with "a fever" or "chills and aches". Doing so would alienate the person (in my eyes) and would take a place in a/the diagnosis "slot" that could hold something more informative to their actual base condition (instead of being a rather shallow observation with practically zero actionable value.... And we wonder why a variety of treatments for depression, for example, have low-30's success ratings across multiple stages of trying different treatments! I can't remember the exact numbers but the 4-5 stage...STAR study, I think it is, was one of the biggest and rather disappointing. The future seems somewhat promising but still too far away.... ::( )

Knowing _why_ is the very extremely hard part. :))))

> Complex PTSD can be a condition that involves significant to total amnesia of the events causing it

I have a high baseline anxiety and pretty much no memory of anything pre 8 (except for very small fragments). When I’ve come across amnesia part while reading “Body keeps scores”, it frankly frightened me (and still does) of what might be lurking in my past.

That is a really good book (if triggering for many trauma survivors due to being...rather explicit in specific examples of traumas similar to many readers! D: ). That said, I believe that it really was the seminal one that basically changed a lot of the applied complex trauma field that I see today. IIRC he's been responsible for trying to get cPTSD into the DSM for like... 30 years at this point? Legend. There's even a ton of hit pieces on him on Google when searching for trauma memories/false memories, I'm assuming from the fact that he was court witness over how trauma memories can be extremely accurate due to how the PTSD overspill works. People who have money, no morals, and are in the group that would do things to their children that no one should do... I don't have proof but that is quite interesting. Especially as many articles (even one that got published on the NIH website in connection to him negatively) have surprisingly little substance and such.

Anywho.

Don't rush the process please, of whatever it is. Your body and brain are probably right in some way. It's okay to practice breathing and what Pete Walker talks about in his book, or my go-to starter for anyone even near the topic -- Janina Fisher's "Healing the Fragmented Selves of Trauma Survivors". So good, very little triggering too which is excellente by me.

The main book people read on Polyvagal therapy that's really popular and well rated us good too, I think the author may have been a Susan? That's a good follow-up but more a rider-on/adjunct to me of a very specific "okay how do we get the body in a more continuous kind of safe state. :D :)"

Selective childhood amnesia occurs in most people and is not necessarily an indication of any trauma: https://en.m.wikipedia.org/wiki/Childhood_amnesia

I also have other worrying symptoms I’d rather not disclose here but it’s more assuring to hear that it’s more common than I thought. Cheers.

After studying this topic intensely for my own sake, I'd say it is more common than you thought because childhood trauma is more common than you think.

It can even be minor, little things that can cause memory splits in children for survival sake. These splits set the ground for future splits.

https://www.goodreads.com/book/show/48655845-who-am-i-in-a-t...

I think it can be very strange that the people who are not broken stand out as weird (and maybe even aloof) in a very broken emotional society.

As I've been healing more and growing as a person, my extended and close family, which unfortunately are extremely dysfunctional, have pushed me away more and more. It seems like most people have a story like that, which is why I do have hopes that journeywork and related spiritualism, or at least some kind of vehicle, social or otherwise, with that kind of strong effect comes forward in the coming years.

Thanks for putting the book down too, now I'm really interested to read it. :D :))))

Just finished Pete Walker's book, also recommend. One of the most helpful things I've come across for dealing with the neglect I and my siblings experienced growing up. It's hard to know what you don't know... until you know it!

I honestly would like to find effective avenues to raise awareness of this. I have a pretty interesting mental health history and story (in my judgement) along these lines that I think could help people. But at the baseline, just advocating for it is really good so far.

Really glad you liked Pete's book. Janina Fisher's "Healing the Fragmented Selves of Trauma Survivors" is my other greatest of all time book in the area that I recommend. It's my first go-to over "The Body Keeps the Score" just because somehow Dr. Fisher has a method that works palatably with someone from even "low-grade" trauma to even what I think would be some polyfragmented DID systems, in some kind of Jedi-mind trick set of tools that works really well while dodging most of the myriad of situational triggers that are unique to each trauma survivor. I highly recommend it if you're interested, it adds a flip side of compassion and self-team building that I think Walker's book can go a bit harshly on as it seems to be more centric on the part of the brain experiencing daily life as the reference for others to be compared to. Both books are fantastic and balance each other out, I just started my second read on Fisher's book and am trying to wrap up Walker's. Give that one a go if you're interested, the audiobook is the cheapest!

Happy to chat about the topic, I love and am passionate about this field as you can guess. :D :)

What are the differences between Complex PTSD and GAD?

There's a lot, I'd encourage you to pursue a few different definitions. I'd argue that anxiety is a symptom, effectively, and C-PTSD is a condition.

C-PTSD actually requires a lot of work to properly diagnose, whereas GAD tends to be "Anxiety: The Condition", which allows a clinician to diagnose in an insurance company and report friendly way. It can help a person start their journey but is a shallow diagnosis.

Generally C-PTSD is a plethora of things -- internal fragmentation (~1 in 12 or so people are diagnosably plural afaik from the studies I found [i.e. osdd, which no one seems to really know about, to did], though most plurals will never find out about their plurality as it is exceptionally stealthy. Also it's a spectrum meant to hide itself from the brain's "user", as it were, so the subtlety of spectrum disorders adds to the mix), difficulty in relationships (it is in the trifecta of "social stuff trouble conditions" of ADHD, autism, and, well, cPTSD), generally at least occasionally unstable emotional state (which can be entirely internal) which oftentimes is hypersensitive to environmental triggers, and a need for control of relationships and environment (not necessarily evil top hat villain manipulation, this can even be just using a fawn trauma response in constantly giving up self to an extraordinary amount to keep the peace, keep relationships, etc).

Everything seems to be on a co-spectrum, cPTSD is just a map marker for a family I'd contest. It has a ton of overlaps with BPD, for example. cPTSD is differentiated from DID in that the different parts of the brain in cPTSD are not considered especially distinct, but there's also some tricky DID business people's brains can play to stuff certain nearly independent parts of a person away so they'd look more like a low-level cPTSD kind of automatic trauma triggered/autonomic response, etc.

I'm not a clinician, etc, etc, hope that helps from a technical perspective some. Feel free to ask any questions you might have. :)

Complex PTSD has more to do with a person's concept of self, ability to have intimate relationships, etc. But there's probably no fine line between them.

I suffered for a couple of decades: anxiety, random panic. I was able to address them by following the following:

1. Have things to look forward to.

2. Pay attention to nutrition, health, rest, breathing, exercise.

3. Meditate. Socialize.

4. Occasionally when anxiety grows, breathe, visualize yourself performing a repetitive yet fun activity (like swimming laps, chopping vegetables.. whatever takes focus). Your heart rate will drop and things will calm down.

Sometimes when your heart is racing, it's possible you just have pent up energy and you need to crank out some pushups and squats at 3am. Such is life.

4. is underrated and mysterious. I've dealt with periods of anxiety by playing an online competitive card game, something that "should" be stressful, but having played it hundreds of times before, the steady stream of familiar choices that ultimately don't matter, is soothing.

When I'm spun up I try to avoid additional physical exercise as I don't want to have a stroke or a heart attack or something. I'm physically fit and my resting heart rate is in the 48-51bpm region day to day.

Am I completely overthinking this?

I’m not familiar with the medical evidence, but… why would exercise instigate a cardiac event when anxious? Perhaps if having a panic attack it would be unwise, but I feel like exercise can serve as a distraction or outlet to anxiety and be beneficial on the whole.

Please explain what you mean by spun up.

If we are talking about emotional stress coupled with a slight increase in heart rate, I would not be concerned about doing exercise. Quite the opposite -- I think a quick jog around the block can do wonders.

The key is to be able to do the exercise without bringing additional stress.

The key element in my personal experience is to make peace with how things are in that moment. That something triggered this unpleasant emotional state/disturbance, that it is totally okay, and not to push it away but instead give it gentle, loving awareness. The trick that works for me is to think of someone who I love, or someone who loves me, imagine that we look each other in the eyes or gently touch the part of the body that feels unpleasant, feel the "warmth of love" developing in me, and then switch from using a third party to myself, so both the sender and recipient of love is me. Looking into the mirror helps. And then staying present with the sensations, realizing that I can have a clear and calm mind and the unpleasant sensations at the same time, give them the attention they deserve, passively listening to what kind of memories come up (if any), and just wait and give it time.

Doing something that gives you a good feeling, that you are capable of taking care of yourself in that moment, like sports/healthy food etc, can help to put you into that necessary emotional state, but the key is the emotional state, not the outside activity. Unless you achieve that calm state of mind, activity "on the outside" could be purely a distraction, and while "successfully" disconnecting you from the feeling, that way it only makes it come back a little stronger the next time.

It does not seem to be relevant to figure out what the trigger was, or what the past experience was, or whether the strong emotion relates to something that happened "just now" or in the past. Thinking about that is a distraction of the mind and "serves no purpose". It does help to identify the more specific feeling beyond "anxiety". For example, I might suddenly get hit with a feeling of terrible loneliness or insecurity/threat to my life, even though I am with my partner or among friends in a "rationally safe environment". Instead of telling myself "hey you idiot, listen, you are not alone, stop feeling lonely right now!", or worse finding some element in the present I can project my current feelings onto ("that guy is a complete arsehole, that's why I am feeling rage right now"), I instead tell myself "this is a memory of a moment where I really was left alone, where there was really a threat to my life. poor me. thank you for reminding me of that past horrible moment, now that i am fully capable of giving it the loving attention that it deserved back then, but didn't get until now. I am very happy that I can give myself that love now, to fully make up for it.". An image that helps me is "a mother holding her crying baby": Gentle, loving, not pushing, not asking questions: the baby cannot answer. Both the mother and the baby are me.

Another way to look at it is that I first create an imaginary wall between the mind and the body: The mind can think whatever it wants, race around, keep itself busy, or relaxed or whatever. I don't care. I don't push it outside of my consciousness, still listening to it sometimes, but I leave it alone, and do not allow it to influence the body in any way. The body is given fully to the crying/hurt child/emotion, not fighting it at all: if it wants to kick, I let it kick. Except for my hands, which I give to the soothing mother with healing power, and lightly rest them on some part of the body where the unpleasant sensation is. The soothing mother also gives the same love to the mind, another one of its children. Then, as a final step, "I" separate myself from all these parts, chill and relax, knowing that all relevant work is delegated, everyone is taken care of. Like the manager of an inner kindergarden, or inner playground, where there is a lot going on but at the same time I can take a break from it, knowing everything is running smoothly.

This process takes some effort to learn, and accepting that you are still learning and not already perfect at it is a key part of the practice. But even small moments where it "works" in my experience finally actually resolve stored up emotions, so each time an unpleasant emotion comes up it hits me less and less, and the frequency goes down massively. It is not important to understand exactly what triggered it, or what the past traumatic memory is. Do not ask yourself, just be, and connect both to your heart and the pain at the same time.

There are many different techniques but they all share these core elements. The one I like the most is "Feeding your demons" by Tsultrim Allione.

Another helpful and calming thought that works for me is to "know" that "my system decided" to release that exact level of stored up emotions, because it is confident that I can deal with that amount right in that moment, and that self-regulation will take care not to overwhelm me but always only give me as much as I can handle.

There are lots of therapies available for anxiety disorders -- medication, CBT, talk therapy, biofeedback. Some of the psychedelic therapies that are getting official trials now also show promise for anxiety. I hope you'll find something that works well for you!

Another therapy is a ganglion nerve block.

I'm rather growing to dislike this therapy as it just separates two parts of the brain, effectively, which can provide temporary relief while allowing for the mutual information drift between them to grow, which further can exacerbate the internal fragmentation experienced in trauma survivors. DID already has this kind of soft separation as a coping mechanism, and much of therapy is oriented in stabilizing, then undoing the block.

I guess I'm biased but I very much lean towards methods that force interconnection while providing emotional pain numbing/relief (Ketamine), or more high-flying methods that force the brain to a higher temporary state of functional connectivity and by some of the consequences of massively increased entropy, chip away at the problem.

I guess the other part is that seems to be soft form of the conservation of energy when it comes to the information of grief and grief processing. Unprocessed grief has to go somewhere and oftentimes it's where you'll see people after a few decades completely break down from the overload (and in the years it takes to decompress and manually process the grief -- Pete Walker is one expert that I refer to who's pretty well-respected all around).

I guess it's up to one's belief as to whether the neuron group on the other side of the ganglion nerve block is conscious enough to suffer. I've had enough experience with DID persons to be extraordinarily uncomfortable with any kind of extended "walling off" strategy, no matter how small or seemingly insignificant on the surface that part of the brain may be.

I need this for dealing with undocumented Win32 APIs

I used to have night terrors as a kid and I can relate to that feeling of not wanting to go to bed. I'm not sure if they're genetic or not -- my father grew up during the Algerian revolution, so it's hard to tell if his nightmares are just an artifact of being terrorized by French colonists.

I also had a period of getting panic attacks in my early 20s. One thing that was/has been super helpful for my anxiety and general well being was starting a daily meditation practice. The Tibetan teacher Mingyur Rinpoche also had an anxiety disorder and had panic attacks as a child, and is a very clear teacher, if you're ever looking for someone to explore that with. I had had a lot of meditation experience before starting it, but I found his `Joy of Living` course to be very good (if a little basic at first). [1][2]

[1] https://www.youtube.com/watch?v=m38SwUKZZJw

[2] https://joy.tergar.org/

> [...] my father grew up during the Algerian revolution, so it's hard to tell if his nightmares are just an artifact of being terrorized by French colonists.

Epigenetics in the wild: https://www.scientificamerican.com/article/how-parents-rsquo...

Gabor Maté [0] also discusses this topic often, particularly related to children. You can find quite a few interesting interviews with him online, for example with Joe Rogan [1] or Tim Feriss [2].

---

[0]: https://en.wikipedia.org/wiki/Gabor_Maté

[1]: https://www.youtube.com/watch?v=fkAcJBjutiQ

[2]: https://youtu.be/H9B5mYfBPlY?t=3944

Ha, interesting. I learned about Maté during my previous gig (generative music for psychedelic therapy). Will give it a read, cheers.

Thanks to both of you for the links. I've read some about epigenetics and trauma research, and Maté's research looks like something I'd be very interested in.

I really appreciate Adyashanti's teachings, I've found that he is generally really practical, down to earth, and generally on-the-money (if seemingly nonsensical on some topics...at first. :) ) :)

For what it's worth, though you're clearly not eligible for American VA benefits if you served in a non-American military, the legal definition of a "veteran" in the US is anyone who performed any active-duty military service at all. You don't need to see combat to be considered a veteran. You're obviously less likely to end up with PTSD if you don't see combat, though you'd be surprised. Training can be rough and a fairly high number of people end up being assaulted and/or raped while in garrison, and of course several US military installations have also been the site of mass-shooting events.

Anyway, if this has happened your entire life, I wonder if there is really anything you can do about it. That seems distinct from trauma-induced. This seems to describe my sister. From as early as I can remember, so at least when she was as young as 3, she was waking up in cold sweats pretty regularly having dreams the entire family except her was murdered in the middle of the night. Myself, I can't remember ever having a single nightmare my entire life, and I served in the Army during Iraq and Afghanistan and even outside of the military had a few near-death encounters. Some people are just a lot more predisposed to worry than others. It's not necessarily a bad trait, either. I'm reasonably sure the high number of near-death experiences for me is because I'm way too prone to idiotic risks because I never believe anything bad will happen. And always surviving just reinforces that even though I know rationally I just got lucky. Humanity exists right now because my ancestors were mostly a lot more anxious than I am.

"The child survives the Trauma of Identity by giving up on his healthy identity, his autonomy, in order to have some connection with his mother, without whom he cannot survive. He is forced to identify with his mother's wants and needs, where his wants and needs are ignored, mis-interpreted or used as a means of persecution by the mother. This, then, brings the therapeutic question "Who am I?". And existentially this question is automatically followed by the question "What do I want?", because in order to know what I want I must have a reasonable sense of who I am.

The Trauma of Love happens when the connection that the child does manage to maintain with his mother after the Trauma of Identity is not in effect a clear, loving connection, but rather a connection that is painful, unfulfilling, manipulative and persecutory.

These traumas form the foundation of our life, our ability to grow up with a healthy, stable psyche, or not. All later experiences that constitute a trauma are always, also, a re-stimulation of these early, pre-verbal, pre-memory events."

https://www.vivianbroughton.com/about-iopt/

FWIW, your baseline anxiety level is way higher than mine. My parents tell me stories of when I was a kid and would come to them with nightmares on a couple funny occasions, but it's been decades since I've had what I'd call a nightmare. I have rational concerns about elements of my future that look negative but over which I have limited control - economic, political, ecological, health, and other general concerns - but I don't fixate on them or dream about them. I relish going to sleep, and have either forgettable dreams or pleasant dreams. I enjoy quiet time with my thoughts, going for a jog or bike ride, or just relaxing in the backyard and daydreaming.

I see others here talking about high anxiety, and I hope that you're able to find a solution for your issues, but your baseline anxiety level sounds like it's orders of magnitude higher than mine. I'm not trying to brag, I just want to share in the hopes of getting some idea of "average person" - am I perhaps far less anxious than "normal"?

I'm not actual doctor and there can be better ways to threat your problem, but here are two things that helped me greatly with quality of sleep.

First of all buy yourself high-quality CO2 meter for ~$100 and make sure that CO2 not going over 1000 PPM while you sleeping. Every single time I sleep in closed room with bad ventilation where CO2 getting over 1200-1500 PPM I will wake up in terror. You can't imagine how many people I knew had terrible quality of sleep due to bad ventilaton and never realise it.

Second thing if nothing else works. Try strictly-scientific lucid dreaming practices: record as much of dreams is possible in a diary for several months, do deep breathing before sleep, etc. Looking at your hands every now and then is required and slightly weird, but it totally worth it. Once you get lucid in a dream once and preserve memory of it will become much easier to deal with nightmares.

Lucid dreaming cost nothing even though some REM sleep tracker like one in Apple Watch is useful. Though beware of bullshit.

> You can't imagine how many people I knew had terrible quality of sleep due to bad ventilaton and never realise it.

Try me. How many?

How many tried the intervention you recommended? How many saw a benefit? How many did not?

Like 10 different people so far?

I've been living in both nothern country where people dont tend to open windows because it -10C outside. And I also lived in SEA where expats literally live with windows constantly closed and conditioner on all due to high temperature and humidity.

I guess in US owner of 150+ m2 / $500,000+ house will never have problems like bad ventilation, but people with worse living conditions and small appartments certainly can certainly have such issues.

I found some studies from OSHA (the United States gov't agency) about very high carbon dioxide levels in certain industry settings, such as where dry ice is used. Effects on cognition are significant at high levels.

But understanding the effects of CO2 in more every day situation seems more complicated. It is also hard to find good rules of thumb about guidelines about when to look more deeply and pay to get measurements.

But I haven't found high-quality studies that talk about residential settings. My Google results seem to be populated with companies trying to sell stuff. So based on maybe 30 minutes of research, I remain practically skeptical.

I'm interested in learning more, Starting with the chemistry and airflow (?) properties of CO2, and then working up to biology. Would you mind sharing high-quality resources you recommend?

I would love a source for the theory on CO2 and poor sleep. Sounds interesting despite my skepticism after a Google search.

Just google something like "Acceptable CO2 Levels in Commercial Buildings" or check out UK government website on hazards of CO2. [1]

I personally might be more sensetive than others, but real issues start when PPM going over 2000. Two sleeping people in small room with bad ventilation can easily bring it as high as 2500 in 3-4 hours.

Also if you're cooking on gas in small appartment and have bad ventilation you can easily bring it to 3000-4000 in much shorter period of time.

[1] https://www.hse.gov.uk/carboncapture/carbondioxide.htm

I don't understand how ventilation could cause CO2 to get that imbalanced. Can you cite a source?

ELI5?

- Your normal city air CO2 is 350-500 PPM.

- Humans exhale CO2.

- In closed unventilated bedroom CO2 have nowhere to go.

- Air isn't being mixed when you sleep too.

- In few hours PPM can grow to 2000 or higher.

- Cheap air conditioners either dont have fresh air ventilation at all or dont have sufficient efficiency to compensate for two humans breathing.

You can google actual numbers elsewhere. Solution usually consist to sleeping with open windows or getting proper fresh air ventination system.

I have many friends that use marijuana in the evening, which helps them relax and sleep. Edibles are very effective these days.

As relevant here, it blocks REM sleep and thus dreams. This can have downsides.

That is only in high THC strains. Many people use cannabinoids before bed as a supplement to encourage REM sleep.

It can also have significant upsides.

Pot triggers panic attacks in some people though.

I quit marijuana, but I did use it daily for years. An under appreciated aspect of pot and anxiety is the strain consumed. Broadly speaking pot is put in to two categories: indica and sativa. More indica leaning strains will produce more of a body depressing feeling of relaxation and tiredness. Sativas are more associated with alertness, and as I used pot while doing other things I only consumed pure sativas. However some strains of pure sativa are particularly prone to increasing anxiety. When I encountered those strains I had to stop consuming them and look for something else. Dosage is also very important. I consumed only roughly a pea-sized amount of ground flour in a sitting. High doses of sativa are much more likely to highten anxiety. I think it’s common for people to take a big rip of pot and suffer negative side effects. Very small doses are under appreciated I believe.

That said I quit marijuana early this year. I think overall my anxiety has decreased. I believe I may have been masking emotional problems, and quitting marijuana made it easier for me to process them. However if someone is having nightmares, they may consider smoking indica before bed. It may always depend on the strain, but I believe indica is unlikely to trigger panic attacks.

Particularly if you take too high a dose. If it happens, I recommend reducing the intake.

It happens to me with only the tiniest little green speck in a bowl. Regardless of strain. Sometimes it's because someone took to much, but some people really do just get panic attacks from it.

I used to be a daily smoker, then something in my body just flipped. I have a couple friends where the same thing happened in their early 30s.

I've gotten bad anxiety from smoking too much in the past, but these are different. Full blown panic attacks with heart-attack-like symptoms and crushing fear. (My cardiologist checked me out, it really is just panic attacks).

It did used to be great at preventing nightmares for me (and it was fun). Sure, sleep quality was worse than ideal but I almost never had an ideal night of sleep. But now I've tried too many times to find "the secret" to stop me from having panic attacks, nothing works and it's just made me become anxious at the sight/smell of weed.

Interesting, thanks for sharing. If you haven't tried it, Alprazolam (Xanax) has been a miracle for panic attacks, although these days it's pretty difficult to get from doctors. Modern American society seems to have decided that any medication that can possibly be abused is evil and must not be used even if somebody could really benefit from it. If you get some though, do NOT take it all the time and build a physical dependence. Withdrawing from Benzos is worse than opioids. If you only take it occasionally though you won't have any issues.

My wife had horrible, hours long life-disrupting nightmares every day. Prazosin, a medicine your doctor can prescribe, solved them within a week, they are much less common and much less intense now. Highly recommend to try.

Highly not recommended for men! Prazosin decreases luteinizing hormone (LH), follicle-stimulating hormone (FSH) and ultimately testosterone levels.

Sleep deprivation also lowers testosterone levels[1], and Prazosin is commonly prescribed to men with benign prostate enlargement, so pick your battles?

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445839/

The OP article actually mentions prazosin:

>“There is a medication that a lot of them are on called Prazosin, which is actually a blood pressure drug, but it doesn’t work for many patients, has a lot of side effects, and also decreases your athletic performance. And in the military, athletic performance is very, very important.”

>Robert Guithues knew Prazosin well — after he returned from Afghanistan, it was one of the 30 pills he was taking daily to help with the injuries he sustained while deployed, including PTSD and nightmares. But sleep was still elusive, and he knew there had to be a better solution than the drugs, which he feared were doing more harm to his body than good.

For me, keto helped with depression but anxiety only went away when I cut out veggies as well.

Vitamin B and zinc are known to help with inflamation. Magnesium as well. Deficiency dawned on me when I was much calmer with red bull which is the only energy drink with vitamin b complex and magnesium.

Haven't found much on it apart from: most neurotransmitters are made in the guts, so what we eat does matter.

Some additives in fast food can weaken the blood/brain barrier, so stuff that made it through the gut/blood barrier get in the brain and activate the brain's immune system.

Sleeping with headphones listening to a loop of ocean sounds, or wind in a forest, etc. can be helpful. Exceptionally vivid dreams can get disrupted this way, anecdotally speaking. It seems a little like what this Nightware app is supposed to do. I'd find vivid dreams getting literally washed away by ocean waves using this method, i.e. you might be having a nightmare, and then ocean surf from nowhere sweeps through, and everything gets swept away, and I'd end up in a peaceful dream of floating on the ocean etc.

This doesn't always work. A friend did massage in a small fishing town in Alaska. As soon as she put on the ocean-waves-breaking-on-a-beach sounds, the massageee would usually bolt upright from the table in a total panic attack. Your mileage may vary!

I have a theory that people with anxiety (i.e. myself) have a strong mind -> body connection, but in a negative way.

My anxious thoughts lead directly to physiological changes, increased heart rate, shallow breathing, sweating etc. Based on the people in my life without anxiety, they can have similar thoughts as me, even "anxious" in nature, but they don't seem to have the physiological response that I do, as an anxious person. What do you all think?

anxiety responses include what you are talking about: if there is a grizzly bear threatening you, your heartbeat should go up and you will sweat

the point here is that you are feeling exaggerated anxiety with minimal external triggers, but the nature of the anxiety response is normal

Have you tried seeing a psychoanalyst, or otherwise delving into the meaning of dreams/nightmares? "What you resist persists."

Try sleeping on your side only, or try a snore alarm or breathing aids like nasal strips or decongestant. I find my nightmares and sleep paralysis are linked to snoring. When you snore you are not getting enough oxygen and your heart rate increases to compensate. Then for some weird reason your brain invents dream scenarios to match your racing heart.

Are you able to lucid dream?

If so, you can create impossible illogical situations and force yourself to wake up. Breathing under water, flying so high the overview effect saturates your ability to generate fake ground, jumping and sticking in the air. These are all examples of things you can do that demonstrate to yourself that you’re dreaming.

Prazosin is the one drug on the market approved for PTSD-related nightmares, I've heard that it works well, but it's a blood pressure medication, so it might not be well tolerated based on conditions or other medications taken.

If I may suggest something unorthodox - have you tried psychedelic therapy? And I don't mean just taking a psychedelic, I mean working with a therapist to go on an intentional healing journey.

Might be worth a trip to Oregon :)

I admit, although not medically prescribed or supervised, doing mushrooms has been one of the most rewarding experiences of my life.

Although I still have persistent nightmares it changed my understanding of other people and their perspectives to the point my anxiety in a lot of situations has vanished.

I don't think people should go nuts with them but I do think it's a good idea for some people with anxiety to find a clean pleasant care-free place to try them. Even if it just allows them to spend a few hours immersing themselves in completely different thought patterns and potentially gain something from them.

I recommend to try the free workshops by https://www.identitydevelopmentinstitute.com/ - please report back!

That sounds very frustrating and difficult. I'm really sorry. Do you have good professional care? Are you in a safe place?

i found this truly helpful, thrice a week sauna->cold water plunges.

about an hour of just 10m sauna-> 1m cold water for a few circuits followed by some relaxation in a hottub or steam room lowered my anxiety and has slowed my brain.

also, chill on the caffeinne and reduce alcohol.

I'm a vet with ptsd so i take every fruit of mental wellness i can

Meditation definitely helps. A combination of Metta, Anapanasati, and Vipassana mediation really helped me.

Meditation*

For my anxiety/depression SSRIs helped. I am much better without any side effects.

Read "The body keeps the score" book.

You are not alone. My earliest memories (like from age 3-4) are of very specific nightmares, and they have continued to dog me my entire life. (Also in 1991 I surprised a burglar in my home who took a pot-shot at me with a .38 on his way out the window, and that didn't help.)

FWIW:

1. I think it's genetic. Anxiety seems to run in my family. We are descended from Holocaust survivors. I think it is plausible that that one event produced strong evolutionary selection pressure in favor of paranoia and anxiety.

2. It gets better as you get older (at least it has for me).

3. Anxiety is a self-fulfilling prophecy. If you're afraid of being anxious, that makes you more anxious. Meditation helps. Quiet and/or white noise too.

Good luck.

> 1. I think it's genetic. Anxiety seems to run in my family. We are descended from Holocaust survivors. I think it is plausible that that one event produced strong evolutionary selection pressure in favor of paranoia and anxiety.

It's... interesting genetics.

https://www.theguardian.com/science/neurophilosophy/2011/sep...

> How might the traumatic experiences of a pregnant woman be transmitted to her unborn children? Research published over the past 10 years or so suggests that this probably occurs by epigenetic mechanisms. Epigenetics is the study of heritable changes in gene activity that are not due to changes in DNA sequence. Epigenetics reveals how genes interact with environmental factors, and has been implicated in many normal and abnormal brain functions.

> A key study in this emerging field, published in 2004, showed that the quality of a rat mother's care significantly affects how its offspring behave in adulthood. Michael Meaney of McGill University and his colleagues found that rat pups that had been repeatedly groomed and licked by their mothers during the first week of life were subsequently better at coping with stressful and fearful situations than pups who received little or no contact.

> They further showed that these effects are mediated by epigenetic mechanisms that alter expression of the glucocorticoid receptor, which plays a key role in the body's response to stress. Analysis of the pups' brains at one week old revealed differences in DNA methylation, a process by which DNA is chemically modified. Methylation involves the addition of small molecules called methyl groups, consisting of one carbon and three hydrogen atoms, to specific sites in the DNA sequence encoding a gene.

---

Grandmaternal stress during pregnancy and DNA methylation of the third generation: an epigenome-wide association study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611722/

> Stress during pregnancy may impact subsequent generations, which is demonstrated by an increased susceptibility to childhood and adulthood health problems in the children and grandchildren. Although the importance of the prenatal environment is well reported with regards to future physical and emotional outcomes, little is known about the molecular mechanisms that mediate the long-term consequences of early stress across generations. Recent studies have identified DNA methylation as a possible mediator of the impact of prenatal stress in the offspring. Whether psychosocial stress during pregnancy also affects DNA methylation of the grandchildren is still not known. In the present study we examined the multigenerational hypothesis, that is, grandmaternal exposure to psychosocial stress during pregnancy affecting DNA methylation of the grandchildren. We determined the genome-wide DNA methylation profile in 121 children (65 females and 56 males) and tested for associations with exposure to grandmaternal interpersonal violence during pregnancy. We observed methylation variations of five CpG sites significantly (FDR<0.05) associated with the grandmother’s report of exposure to violence while pregnant with the mothers of the children. The results revealed differential methylation of genes previously shown to be involved in circulatory system processes (FDR<0.05). This study provides support for DNA methylation as a biological mechanism involved in the transmission of stress across generations and motivates further investigations to examine prenatal-dependent DNA methylation as a potential biomarker for health problems.

---

Intergenerational effects of maternal post-traumatic stress disorder on offspring epigenetic patterns and cortisol levels - https://www.futuremedicine.com/doi/10.2217/epi-2021-0015

> Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during pregnancy and offspring DNA methylation and cortisol levels. Materials & methods: Blood genome-wide DNA methylation and cortisol was measured in the youngest child of 117 women who experienced sexual violence/torture during the Kosovo war. Results: Seventy-two percent of women had PTSD symptoms during pregnancy. Their children had higher cortisol levels and differential methylation at candidate genes (NR3C1, HTR3A and BNDF). No methylation differences reached epigenome-wide corrected significance levels. Conclusion: Identifying the biological processes whereby the negative effects of trauma are passed across generations and defining groups at high risk is a key step to breaking the intergenerational transmission of the effects of mental disorders

---

And specifically about Holocaust survivors - Study finds epigenetic changes in children of Holocaust survivors https://www.research.va.gov/currents/1016-3.cfm

> The researchers focused on FKBP5, a stress gene linked to PTSD, depression, and mood and anxiety disorders. The results suggest that Holocaust exposure had an effect on FKBP5 methylation—a mechanism that controls the gene's expression—that was observed in parents exposed to the horrors of the concentration camps, as well as their offspring, many of whom showed signs of depression and anxiety.

> ...

> She says the researchers pursued this study because offspring of Holocaust survivors "said to us in clinic, 'we are casualties of the Holocaust and need treatment.'" Her team tested blood samples of 32 Holocaust survivors and 22 of their adult children for methylation of intron 7, an area in the FKBP5 gene. For a control group, they analyzed Jewish parents who lived outside of Europe during World War II—most were U.S.- or Canadian-born—and their offspring.

> Interestingly, Holocaust survivors and their children showed epigenetic changes at the same site of FKBP5 intron 7 but in the opposite direction. Survivors had a 10 percent higher methylation than the control parents, while the Holocaust children had a 7.7 percent lower methylation than the control children.

If only there was a way to demethylate our DNA!

Of course, more relevant is to keep from methylating new DNA, and there we can actually make choices that matter.

Editing DNA Methylation in the Mammalian Genome - https://pubmed.ncbi.nlm.nih.gov/27662091/

And from there, the related cites and papers.

This is something that is active research as other diseases are also "turned on" by incorrect methylation. DNA methylation in human diseases - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147084/

> I'm slowly coming to the realization that my baseline anxiety level is way higher than of the average person. For no apparent reason.

One book that may be of interest to you:

Born Anxious, by Daniel P. Keating: discusses epigenetics and how methylation can predispose certain individuals to higher baseline levels of stress and anxiety.

Other books which may not be revelant to you, but would perhaps be of interest to others reading these comments:

The Body Keeps the Score, by Bessel van der Kolk: Talks about the imprints trauma leaves on the mind and the body, and shines a light on how ineffective and misguided many of the mainstream, frontline treatments offered to people with histories of trauma are. (Just because you don't meet the criteria for PTSD, doesn't mean you haven't experienced some form of trauma.)

Accessing the Healing Power of the Vagus Nerve, by Stanley Rosenberg: I haven't finished this one yet, but it discusses the three fight/flight, social engagement, and freeze/depression states of the nervous system, as described in the Polyvagal Theory put forward by Stephen Porges. I've been told by a clinician with a career in working with trauma survivors that the Polyvagal Theory is a key piece of the puzzle in treating trauma. Even if you're not dealing with the effects of trauma, I think you may still find this book interesting, as it describes how we can get locked into states of anxiety one the one hand, or lethargy on the other, finding it difficult to simply relax and be present for our lives.

Author Gabor Maté - I'm not sure if he has any books concentrating specifically on anxiety, but his work seems interesting. Episode 1869 of The Joe Rogan Experience, where he was the guest, was quite illuminating.

Molecules of Emotion, by Candace B. Pert: I haven't started this one yet, but it talks about how the body and mind/brain/nervous system aren't as separate as many of us may like to think. It sounds interesting.

Some lifestyle changes that may help with anxiety and other mental health conditions, including depression: (completely anecdotal, I am not a doctor, etc.)

* Regular, vigorous aerobic exercise, e.g. running five kilometres three times per week. Can't run five kilometres? Check out 'Couch to 5K.' I find that vigorous exercise seems to help 'burn off' anxiety and stress and make it easier to relax. (as recommended by Keating in Born Anxious.) Additionally, depression often goes hand-in-hand with anxiety, and "the efficacy of exercise in decreasing symptoms of depression has been well established." (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/)

* Yoga: teaches one to listen to and befriend one's body. When one is constantly anxious and on alert, the body can tend to be constantly tense, ready for action.

* Diet: the so-called Mediterranean diet seems to be quite healthy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536728/ I'm not sure if eating healthy has been shown to help with anxiety, but can it really hurt?

Have you ever had a hair tissue mineral analysis done?

I love a lot of the innovation going on in the healthcare digital space wrt apps, but this NightWare service reminds me of Sleep.io, which has become a nightmare to try to procure.

I've been trying for months to get on Sleep.io as I suffer from chronic insomnia, and it has been one of the most frustrating journeys I've endeavored upon. They only provide their app to insurance customers that partner with them, there is no option to buy a subscription directly. Despite their marketing and outward "shoot us a message and we'll help you out" virtue-signaling, you quickly realize that you're just sending messages into the void. I tried so hard and offered to pay a subscription rate to try the service. Didn't even get a response.

It's the absolute worst of all worlds: being prevented from being able to use an app that I shouldn't need to talk to a doctor about or have the correct insurance for is unbelievably frustrating. Stuff like this terrifies me for our future.

Took a quick look at sleep.io and seems like it might just be CBT-I. There's a free app from the VA (ironically, given the subject of this thread) - https://mobile.va.gov/app/cbt-i-coach. It's a little rough around the edges, but if you have the general idea of CBT-i it's probably good enough.

In case you don't have the general idea, here it is - 1. Decide your desired wake time. Figure out how much sleep you are currently getting.

2. Go to bed late enough that there's only enough time to sleep the amount you are currently sleeping before your desired wake time. When the wake time arrives (or before, if you wake up too early), get out of bed. E.g., If you want to wake up at 7am and you are currently only getting 5h of sleep each night, you should go to bed at 2am.

3. (Be really really tired for a couple of days, oh my god)

4. Once you are finding it easy to fall asleep and stay asleep until your desired wake time, start backing up the bedtime gradually. (* this is where the app will help, can tell you when to do it and by how much)

5. [follow a bunch of other rules about when to go to bed and when to get out of bed and when to exercise, drink alcohol, and coffee]

Not defending sleep.io or your experience here, which does sound very frustrating - just hopefully some help from a fellow insomniac. CBT-i did help me, albeit temporarily. I have to re-do it periodically.

The app we're building features CBT-I content (at the bottom of the main screen, called "lessons") and is currently free: https://apps.apple.com/in/app/chorus-sleep-tracker-sounds/id...

blast them on twitter/fb/whatever

Just pirate it ?

> Available by prescription only, it’s also the first and only digital therapeutic developed specifically to treat nightmares that is cleared by the FDA

Why is this prescription only? I am surprised to see that something as unobtrusive and harmless like this should be locked behind a prescription.

As they're making specific health claims, these claims should be investigated and demonstrated with evidence, but I fail to see why something this important and good would be locked behind a doctor's visit.

If it is prescription they can charge medicare and or the VA, if it was just a gadget or licensable piece of technology the profit margins are likely lower.

PS - Not justifying, just explaining the business model.

Exactly. If you can pay $10 for a subscription, they can’t charge $500 to a healthcare provider.

Absolutely true, but it also means the ability to pay per-user liability insurance rates that a $10 subscription would not cover. Being a medical product is not all upside.

Simply because an Health Plan is willing to pay 10x - 100x more than a consumer is willing to pay.

Sounds like it would be reasonably easy for someone else to reimplement? Are those sensors available to third-party app developers?

Because it's FDA approved. And because it's FDA approved, they can market it as a medical device that treats a disease.

Being cleared by the FDA means that they have demonstrated evidence, which is linked in the original Apple page: https://pubmed.ncbi.nlm.nih.gov/36305584/

Like others have said, it's likely prescription only because being FDA approved as a treatment for a specific disease allows it to be paid by VA or other health insurances.

FDA approval processes and guidelines are notoriously rigid and increasingly antiquated, and likely ended up requiring "the whole system - i.e. watch + app + phone" to be approved together, making the package pretty pricey - and in awesome circular logic now basically require insurance to pick up the tab.

There are some efforts to make "digiceuticals" more streamlined to approve but... the FDA is unfortunately very necessary but painfully in need of reform.

There was a period of time during the COVID lockdown when I had dreams/nightmares about my time in or with the military every night: basic training, deployment, etc. I wish I still had them; my dreams of normal life today are probably too boring and insignificant to remember. Surely there are a lot who suffer from PTSD. I’m not sure, but maybe the same ones that took it over the top down range, or even in training. We were getting shelled on base one night when I was working late by the flight line, and took my time getting into the bunker. Was met with a rifle in my face, screaming, hyperventilating, single-chevron. Yeah, that dude. The 1SGT’s experience in the article, that’s pretty extreme too. For a lot of us though, it was the most significant thing we’ve ever done in the world, whether we agree morally with it or not, and the dreadful reality is that we’ll never be there again, and even if we are, it won’t be the same because we are not the same, now with forced introspection and greater context, no longer passive observers of ourselves in a third-party role. The movies are great when they visit me. I admit that I don’t have nearly as much action or horror in the collection as some, but there is also comedy, drama, coming-of-age, etc.

Probably irrelevant/offensive/etc, but, whatever.

Oh yeah, one more stupid thing about dreams. In my last deployment, I left Stanford and a startup because I wanted to reclaim that feeling of being a warrior, and got assigned to special forces. One of my first nights on the SF base, I had one of my most vivid dreams ever, a childhood friend of mine whom I knew was no good but believed in him anyway, beat a pet cow to death right in front of me, screaming and begging and pleading for him to stop. This bothered me throughout the deployment. I could rationally accept that it was just random neurons firing, but something told me that I had to make sense of it in terms of why I was there and what I was supposed to get out of it. Maybe these things are supposed to torture us. This is the chaos monkey of our conscience and normal pattern of expectation and response, pointing out the weaknesses.

I used to have very vivid nightmares similar to the one you had of your childhood friend. Extremely violent, extremely vivid stuff, especially common when I was a child/teenager. I didn't have an easy life, but nothing really violently traumatic , just the usual fights with my brothers, and the YMCA pickup basketball fights.

I'm just glad I'm not the only one. The violent nightmares actually started to resurface in my early 20s, when I was actively training Muay Thai, but I was also binge drinking- I cut both of those activities- Muay Thai due to headaches, drinking alcohol, just because I stopped enjoying it. I suspect that there's some aspect of physical head trauma that puts our brain into a subconscious fight or flight mode when we dream.

Note that they require you to get a phone and watch through them, its not an app you can drop on your own device. I saw this thing this morning, and got excited as I have friends with service connected PTSD only to find out the only way to get it is to beg the VA.

I should add that this is likely because the FDA approved the whole watch/phone/software as a system and they can't separate them. Its crap, but what are you going to do?

Looks like the FDA has some labeling requirements and a requirement to make this app prescription only, which probably pushed the company down this route.

It is true that prescription (Rx) and over the counter (OTC) devices have different requirements, particularly with respect to the instructions for use, and many companies choose to pursue Rx first before expanding to OTC down the line because of this or for unrelated business and marketing reasons. That a product lands in Rx does not necessarily mean that FDA would not be supportive of OTC. FDA has an FAQ on switching from Rx to OTC here: https://www.fda.gov/medical-devices/products-and-medical-pro...

Yep. I don’t blame NightWare here. Stupid fda

This topic is addressed by Grady Hannah, co-founder and CEO of NightWare, on the June 23 edition of the DTx podcast with Eugene Borukhovich.

FDA posted a PDF summary of its decision on this product here: https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN200033.p...

Samsung Health deployed less-than-reliable blood pressure features in non-US markets while waiting (and in some cases not gettign) FDA clearance. I wonder if NightWatch and Apple may consider releasing the app in laxer markets. People who really need it will then have a gray market way to get access.

The nightmares are part of a (slow and painful) processing of PTSD events. Suppressing them may not be helpful and actually just kick the can down the road. The benefits of an interrupting device would only make sense in an extended longitudinal study crossed against a group who fully grieved, undertook guided introspection, had their stories heard, and received intimate talk-therapy or similar psychological support.

I'm unaware of any evidence for that. To the contrary, people with PTSD can suffer chronic nightmares for the rest of their lives and show no improvement at all.

Recovering from PTSD involves a lot of therapy of the kind you're suggesting. But the idea that diminishing the strength/duration of nightmares would somehow interfere either with that therapeutic process or the self's own healing processes seems entirely unsupported.

Obviously a device like this should be used in conjunction with healing therapy. But healing therapy can take a long time, and continuing to suffer nightmares during that process seems counterproductive.

Do you have any evidence for this viewpoint? Absent some credible evidence, I'm going to file this in the same bucket as "God just wants people to suffer, so if you are suffering and try to improve your situation, you are violating God's will and will burn in hell for eternity."

I'll admit I've only looked at PTSD a little bit, but I haven't seen anything indicating that the severity declines with more nightmares. Have you?

Why do nightmares exist? What other bodily function would you just turn off? I'm sure the body has vestigial processes, but why is it correct to assume nightmares are such a process? Shouldn't you start off with the assumption that they're useful? Shouldn't you be the one who has to prove this is safe?

Why do appendices sometimes burst? Maybe having a burst appendix is a good thing and the horrible pain serves some beneficial purpose???

When to point out a person's username 101: You have nothing useful to say.

Internet 101: Projection

First, it's one stream of reporting among many. Free journaling, free association, recounting, there are so many tools therapists use.

And second, you don't need 1,000 nightmares to gather that reporting. Ten or twenty will be sufficient.

But the idea that nightmares need to be kept ongoing has absolutely no basis.

Well we're not. :)

Your point was that nightmares need to continue in order to heal.

My point is that they don't. There is zero benefit to that, only harm. The 10-20 nightmares I'm referring to can be referenced from the past. They're not about benefit from future ones.

And also you don't need the nightmares at all, because there are plenty of other sources of material.

You're already misrepresenting the utility of nightmares in therapy. Please don't misrepresent me as agreeing with you as well.

> Please don't misrepresent me as agreeing with you as well.

Unfortunately, it seems to me that your comments are in agreement with @nonrandomstring's comments.

You did happen to admit to the efficacy of experiencing nightmares as a means of reflection[0] and are now only trying to argue that 1) it's not necessary for nightmares to be experienced past a certain point[1] and 2) it's possible for this reflection to be done via other means[0]. @nonrandomstring's point[2] has been that experiencing the nightmares is therapeutic as a means of reflection.

To speak to possibly why this miscommunication happened, I can look at their comments and see places where they could use "a" instead of "the" or "can be" instead of "is" but it's worth noting that I can also look at your comments and see similar things.

[0] > First, it's one stream of reporting among many.

[1] > And second, you don't need 1,000 nightmares to gather that reporting. Ten or twenty will be sufficient.

[2] > Suppressing them may not be helpful and actually just kick the can down the road.

You make some fair and useful observations on nuances of language which I'll try to pay more attention to.

I really wish that, had I said;

  "Glad we've established a principle and now we're just arguing over
   some details"

it would have made a difference. But I get the feeling there is underlying hostility toward my reasonable and prudent critique of a technology, and not specifically anything to do with crazygringo's disputation.

Two things make me think that.

One is that immediately I was deluged with low-rent "show us proof" comments, which frankly seem childish because a cursory search on "why we dream" would turn up hundreds of results, many theories and links to experimental evidence that are widely considered common sense today. I subsequently replied with links to some of the lowest hanging fruit in recent psychology literature.

The other is that a simple, sincere question designed to open up a discussion and get to the nub of the matter was immediately and tactically downvoted to -3. Does the question "why do people have nightmares?" strike anyone as provocative, sarcastic, fulminating or in bad faith?

I think what happened here in this thread remains as evidence for coordinated resistance to rational enquiry and supports my case that there are elements of anti-intellectualism here on HN.

Sorry I thought we had a glimmer of common ground there. You seem so very sure of yourself. It doesn't hurt me for you to continue with your beliefs if the only issue is that we disagree. It's just the end of a promising conversation.

I have grown up reading books by people of the opinion you hold, making strong, very easy to believe claims about human mind. None if that is true. All people I know who followed these teachings never really struggled in life but they have a heck of a ton to say about how others should live their life.

Honestly I only think that those who hold opinions like yours (without any factual support) are a cancer, but besides the point: Can you please provide any peer reviewed research to support your opinion?

Is there any proof of this? This is also a strange comment as the article says they’re doing trials to prove efficacy.

> Currently, NightWare is prescribed to 400 patients in the US, 98 percent of whom are active-duty military or veterans. A new study in the peer-reviewed Journal of Clinical Sleep Medicine shows that participants who used NightWare at least 50 percent of the time had significantly better self-reported sleep quality compared to participants not using NightWare. “The results of our first published clinical trial demonstrate NightWare’s efficacy, and Apple technology is a critical part of that,” says Hannah, NightWare’s CEO. “NightWare benefits from so many of the singular features of the Apple ecosystem — the hardware and design of Apple Watch, the quality control standards, the ease of software integration and deployment — it all comes together to create a system that is changing lives.”

I think the deeper point being made here is that while stopping nightmares does effectively stop nightmares, it might not address the trauma producing them — and by suppressing the nightmare you suppress a potential avenue of healing.

I understand these treatments are necessary and let people live when life might otherwise be intolerable. But there’s definitely a wider discussion to be had addressing the extent to which our mental health apparatus is designed to suppress symptoms rather than to become healthier.

Exactly. Though it's sad, to my mind, that this is dubbed "the deeper point".

Is it not extraordinarily obvious that treating the symptoms instead of the cause is bad medicine.

If there is a "deeper" point it is to question why shallow, expedient, temporary symptomatic treatment is valued above long-term root-cause change. I guess that's a question of our age.

>why shallow, expedient, temporary symptomatic treatment is valued above long-term root-cause change.

Treating PTSD is easier than creating a world without trauma.

> Is it not extraordinarily obvious that treating the symptoms instead of the cause is bad medicine.

What if there is no known way to treat the cause?

There is a treatment, but they don't want to use it yet. It is all about Neuronal Nitric Oxide Synthase and Glutamate.

https://link.springer.com/article/10.1007/s00213-022-06212-7

In fact, this may treat most neurological disorders. Increasing nNOS as a treatment has been overlooked for the last two decades.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413191/

https://www.sciencedirect.com/science/article/abs/pii/S01664...

This is how I cured my Schizoaffective Bipolar Disorder: https://onlinelibrary.wiley.com/doi/full/10.1111/gbb.12193

Is it really a deeper point that treating symptoms isn’t the same as a cure?

In particular I find things based on "self-reported" results to be highly suspect, particularly when the comparison is between a relatively expensive technological therapy and simply doing nothing.

There's no blinding and no placebo control and no comparison of measurable results over a long period of study.

Proof of what?

> The nightmares are part of a (slow and painful) processing of PTSD events. Suppressing them may not be helpful and actually just kick the can down the road.

It sounds like you have decided why people have nightmares. I’m curious if you have any evidence to support your conclusion or if you just made it up.

I’m not a psychologist. I’m sure it differs per person depending on many variables.

Yes it's very much an individual experience with many functions and variables. Here's some (see summary [1]);

Functional threat modelling for templating past events onto avoiding future harms, Valli,Revonsuo et al (Centre for Cognitive Neuroscience, University of Turku)

"The threat simulation theory of dreaming (TST) () states that dream consciousness is essentially an ancient biological defence mechanism, evolutionarily selected for its capacity to repeatedly simulate threatening events."

Integration and consolidation of past events. Physiology and psychology of dreams, Alan S Eiser (Department of Neurology, University of Michigan Sleep Disorders Center Ann Arbor)

   "... direct and systematic investigation could be made of such
   topics as the occurrence, qualities, recollection, and childhood
   development of dreaming...neurobiological research, including
   lesion and brain imaging studies, have established a clearer view
   of the functional neuroanatomy of REM sleep and dreaming."

Processing difficult, complicated, unsettling thoughts. Affect integration in dreams and dreaming, Gary Grenell (Faculty, Seattle Psychoanalytic Society and Institute, USA)

  "The processes by which dreaming aids in the ongoing integration of
   affects into the mind are approached here from complementary
   psychoanalytic and nonpsychoanalytic perspectives.  One relevant
   notion is that the dream provides a psychological space wherein
   overwhelming, contradictory, or highly complex affects that under
   waking conditions are subject to dissociation, splitting, or
   disavowal may be brought together for observation by the dreaming
   ego."

[1] https://www.psychologytoday.com/us/blog/sleep-newzzz/201502/...

Does it matter? The question is looking for empiricism on dreams and whether mediating nightmares causes more harm down the line.

Hi Eliza!

Tell me more about Eliza.

That "nightmares are part of a (slow and painful) processing of PTSD events".

PTSD re-processing of events is probably more traumatic than therapeutic. Most trauma treatment is focused on breaking the cycle of repetition in order to move pst the traumatic events.

Correct. Reprocessing is almost always re-traumatising. That is the nature of therapy. It gets worse before it gets better. Breaking the cycle requires causal insight. Breaking the cycle is not the same as suppressing it. One does not move past unprocessed trauma, one moves through it.

Let me offer a different mental model. Instead of a queue that needs to be processed to reach a productive conclusion, what if we view PTSD like more of a stuck process that just sits there taking up a core's resources without doing anything valuable?

Thats a very interesting analogy that moves the discussion beyond "Gods will", "cancerous opinions" and endless bleating for "proof" that occupies some other outbursts.

I think stuckness is a good metaphor. And yes I see where you are going with that - persistent nightmares are taxing, waking up feeling physically drained etc. There seems a strong case for instrumental suppression, much as anti-depressants can help set the necessary conditions for long-term therapy.

But I'd take the metaphor further and suggest the nightmares are processes that are signalling, but those signals are not acted upon. We sometimes need help in interpreting and verbalising those signals so that we can hear them ourselves. My objection would be to blocking those signals as a first recourse (and allowing that to become a normalised response to intrusive reliving as other self-medication is so often with veterans I've had contact with).

Seems like it would be possible (perhaps even easy depending on how complex their algorithm is) to make an free or open source version of this a give it away. It's essentially a zero risk intervention so I imagine it would be possible to test it on oneself if one had these nightmares.

Nightware would likely come after you for patent infringement[0][1]. In 18-years, if this is effective, hopefully it becomes a common feature, and won't even require a doctor's prescription.

[0] https://patents.justia.com/patent/10765831

[1] https://patents.justia.com/assignee/nightware-inc

I think it would be trivial to replace evade their patents. They've phrased all of their claims around using averages (over time windows) of different sensor values.

I can describe the following inventions which would not infringe upon "Traumatic nightmare detection and intervention" (Patent 10765831).

. A method of detecting and intervening in traumatic nightmares, the method comprising:

    monitoring a user by collecting data from at least one of an accelerometer, a gyroscope, or a heartrate sensor of at least one device worn by the user;

    determining the sum of the data values for each of the at least one of the accelerometer, gyroscope, or heartrate sensor over a first period of time and detecting traumatic nightmares or precursors thereof based on a combination of the summed values; and

    causing an intervention based upon detection of a traumatic nightmare or precursor thereof;

    wherein detecting traumatic nightmares or precursors thereof based on a combination of the summed values comprises summing combinations of the summed values over a second period of time greater than the first period of time; and

    wherein summed values for each of the at least one of the accelerometer, gyroscope, or heartrate sensor are determined over a plurality of first periods of time, and the summed values corresponding to the plurality of first periods of time are summed over the second period of time.

A sum cannot be considered an average because it is not representative of the numbers in a list - it is in fact far greater than any number in the list.

Yet, for time windows containing a constant number of values, this should work just as well as the Nightware algorithm. There are plenty of other work-arounds for those patents.

Easy to avoid the letter of the patent, but not easy to avoid getting sued anyway and having to defend yourself.

They'd also have to be able to serve you with the lawsuit, which is far from easy if you post the code anonymously online.

I don't a judge will care much about your argument that a sum is different from an average for patent infringement considerations.

A judge absolutely would care about that. The actual claim language, not the patent description, defines what is patentable. Accidentally including specificity in the claim beyond what is needed to overcome rejections will absolutely kill the enforcability of the patent.

Luckily it's a software patent so someone outside the USA can just copy it and exclude the jurisdictions where software patents are still a thing.

Well it's really a patent for a method which includes both software and hardware (the sensors). It still might be an Art 84 rejection but I don't know enough about the EPO to say. They haven't filed any international patents, though, so it would not at all be enforceable in Europe even if it was patentable subject matter.

The sensors themselves are nothing special, the first patent was filed for a standard Android smartwatch. There is no new hardware, it's just an algorithm for a software system that happens to talk to hardware.

In the USA it's an improvement patent (see 35 U.S.C. 101). Because the algorithm is novel and involves steps that rely on hardware, you can patent the combination of hardware and process. Not sure if Europe views it the same way.

Presumably though if you built a version in Europe they wouldn't have jurisdiction or grounds to sue?

Curious why it seems restricted to veterans, considering nightmares (and night terrors) affect many with PTSD across causal groups. Maybe it’s a regulatory thing right now.

I see it's being prescribed, and to a small-ish number of people (400), so perhaps it's in a trial phase? FDA has 5 phases for medical device development (googled below):

    Step 1: Device Discovery and Concept.
    Step 2: Preclinical Research-Prototype.
    Step 3: Pathway to Approval.
    Step 4: FDA Device Review.
    Step 5: FDA Post-Market Device Safety Monitoring.

They could be on step 3, where they do clinical trials. Maybe working with the VA, or perhaps they advertised at VA hospitals or veteran's groups. I would imagine that's the easiest group to find and recruit into your trial.

I don't think it's restricted to veterans, the website says it's approved for adults 22 or older with a nightmare disorder or nightmares caused by PTSD. You need a prescription, but you don't need to be a veteran.

Veterans have lots of social credit, and this is a marketing piece from Apple.

Much of their target market will feel goodwill toward the Apple brand as a result of Apple developing products that provide help for a group the person so targeted holds in high esteem.

Of course it helps everyone with PTSD, but I assume thay the demographic Apple is targeting with this bit of marketing is more moved by the mention of military veterans than a mention of mental illness in general.

The subheading of the article does say that it is for PTSD without further qualification.

What if it would have worsened it? Or had unwanted side effects? That you call it an "app" doesn't mean it cannot affect your health, to state the obvious. And that's regulated territory, and with good reason.

Why is it ridiculous for a medical device to be reviewed by the governmental agency whose remit includes reviewing medical devices?

Because it's not a medical device, it's a vibrating watch.

This comment is whatever middlebrow dismissal would be, but for basic facts of U.S. law. As per the Food, Drug, and Cosmetics act of 1938, we have 21 U.S. Code §321[1]:

(1) The term “device” (except when used in paragraph (n) of this section and in sections 331(i), 343(f), 352(c), and 362(c) of this title) means an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, which is

> (A) recognized in the official National Formulary, or the United States Pharmacopeia, or any supplement to them,

> (B) intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or

> (C) intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of its primary intended purposes. The term “device” does not include software functions excluded pursuant to section 360j(o) of this title.

The developer of the device themselves clearly understands that this "vibrating watch" qualifies as a medical device.

[1] - https://www.law.cornell.edu/uscode/text/21/321

Apple Watch has so many health features, but the main hinderance for me is its relatively short battery life - I often forget to put it back on after charging it.

Has anyone tried having two apple watches so one can be worn while the other charges?

[edit] Charging it at night is kind of missing the point, as I would like to track both my daily activities and my sleep

> Has anyone tried having two apple watches so one can be worn while the other charges?

It's terrible that it's come to this IMO. The Apple watch has some great features and can't directly compare, but I can't help compare it to Pebble watches almost 10 years ago - weeks worth of battery life. Even when it "died" it would work for days longer as a watch.

I know the Apple watch has different features, constant heart rate and accelerometer monitoring, etc - but how are we supposed to use it for sleep monitoring (my usecase) if we need to charge it at night anyway? I find it's really, really good at it and I want to use it so badly.

Surely this is a stupidly huge flaw if the battery life is so low that people are considering a second watch just for monitoring the second half of their day (sleeping)?

(I still own an apple watch, and I know there's still a large community supporting them but I wish they were still manufactured)

This may be true for older Apple Watches, but it's not true for the latest Apple Watch. I get 3 days of battery life on regular usage, and a full charge only takes about an hour. Throwing it on the charger while I take a shower or wash dishes is enough to keep it topped off.

Admittedly mine is a bit older and I haven't kept _super_ up to date with people's experiences.

Which model do you have? I'm pretty sure the real expensive one (ultra?) has pretty good battery life, I'm not sure about the others

Here is an article that compares charging times on the newest vs somewhat old apple watches: https://www.androidauthority.com/how-long-does-apple-watch-t...

Also Apple introduced a "Low Power Mode" on WatchOS 9 that allows you to potentially get 60 hrs on the Apple watch ultra. This link discussed what is disabled in this mode. Seems like it would work for your use case or at the very least you run low power mode during the day and turn it off at night for better sleep monitoring: https://www.macrumors.com/how-to/enable-low-power-mode-apple...

I have a series 5 and it easily last 24 hours, with the screen on the entire time. It charges pretty fast. Haven't measured it but I never have to think about battery life.

Even older ones are decent. I have a 4 and it's probably got about 2 days of battery life. I put it on the charger for an hour every morning as part of my routine.

The first thing I did was turn-off the always on display, which save a lot of energy.

I also turned off the background processing of most apps, which saves battery. Same thing with location if the app doesn’t require it to function properly.

My friends with the newer watches/chargers say that they throw it on the charger when they get up to hit the shower in the morning and its mostly charged by the time they're ready to head out to work.

I've done that have two apple watches I used to have a series 7 and a se charge. But I've gotten an Ultra and I only have to charge it for a couple minutes to get a whole night worth of tracking.

I usually charge my watch while sleeping and grab it in the morning along with my phone, but I'd assume a second watch would work? It's an expensive route with the watch, but it's a solution in many other spaces. My wireless headset, for example, has a replaceable, rechargeable battery.

For best results, you'd want to use a single charger, and to always put the alternate on immediately.

That said, the watch can notify when charged, which might be a better first step. The settings for that live in the sleep settings, of all places, but might be worth a shot?

It now reminds you to charge before bed. My watch tells me about 8pm.

Once you get in the habit of charging it then and always sleeping with it, easy to form a habit.

I just got the Apple Watch 8, it's my first Apple Watch. The battery life is excellent. Lasts for 3 days from a full charge. Throwing it on the charger for a few minutes every day while I wash dishes is enough to keep it charged indefinitely.

I get a notification on my phone when my watch is fully charged. This is my reminder to put the watch back on.

charge during shower gets me through whole day no issues... and random charging when i'm sitting down working when i noticed it went too low ( < 20% )

What an amazing innovation using a simple trigger!

I’m hesitant. As somehow who suffers from nightmares I’ve been given medicine for this purpose and while the nightmares went away it was weird. Like non-scary dreams that were meant to be scary but replaced with ridiculous mundane things. Because of this I realized I was dreaming instantly and woke up every time which led to less sleep

At least in this case, the watch is monitoring for and gently discouraging the unwanted body/brain states rather than changing them chemically. Plus it (seemingly) does so before the sleeper internalizes anything from the nightmare.

I’ve been waking up my partner from PTSD nightmares for the last three months whenever they make nightmare noises, which I’m used to doing so I don’t remember doing it most of the time, and they don’t remember waking up either.

But when I leave town for a week they start remembering nightmares again, and then when I get back I remember prodding them out of them for a couple nights, and then both of us stop remembering.

I still don’t know whether or how often I’m bothering them out of nightmares at night, but clearly I am doing so, and it’d be nice to have something doing that for them so that they aren’t dependent on someone else for it. I don’t mind at all being helpful, but this still sounds like a huge quality of life improvement for them!

It’s mentioned elsewhere, but Prazosin is commonly prescribed for this and can make a significant difference for some people.

Indeed.

Apple’s fault this can’t be a downloadable watch app. WatchOS doesn’t enable onboard data processing to trigger events (increased heart rate for haptic feedback). So the data has to be sent to HealthKit on the phone. But developers can’t access that data when the phone is locked, like while the user is sleeping. So now the developer has to pre-load a watch and phone and the product becomes much more expensive to include both. Kudos to the company for making it work, just shouldn’t be this hard to deploy software.

Could be very helpful for those of us who suffer from Central Sleep Apneas if the data is there to support that use. Would be nice to have the watch wake me if I'm having a CSA episode.

“Some of the most horrific sights I’ve ever seen kept playing over and over, but when I started using NightWare, they stopped,” says Guithues. “In the morning, the device will tell me it’s intervened 25 or 30 times through the night, and I never woke up once. It’s to the point where I don’t remember any of the old nightmares.”

I hope this works for a lot of veterans and people with PTSD. Could be a game changer for those afflicted.

For those who want to know how it works:

> NightWare uses information from the Apple Watch heart rate sensor, accelerometer, and gyroscope to detect a nightmare and then disrupt it through haptic feedback, generating gentle pulses on the wrist that gradually increase until the user is roused from the nightmare, but not from sleep.

I may be a one off, but my dentist made me get a mouth guard because I was grinding my teeth. Made sense as I always have crazy stressful dreams. But it seems the causality reversed. Now unable to really grind, the dreams are gone. But a single night away, if I forget the mouth guard, they’re immediately back.

So 1,000 grains of salt. But if you’ve tried it all, maybe a mouth guard for your nights.

"The prototype was created by Tyler Skluzacek in 2015, when he was studying computer science at Macalester College in Minnesota. His father had developed PTSD during his two-decade military career, and Skluzacek wanted to see if technology could provide a solution. The concept was based on the way a service dog gently nudges its owner to help stop a nightmare."

I cannot wait to get my hands on this study to rip it apart:

65 patients and NO statistically significant changes???? Both the sham and treated group did better???? But a "post-hoc" analysis said it works great!!!!

What a scam.

https://jcsm.aasm.org/doi/epdf/10.5664/jcsm.10338

Results: Both groups demonstrated statistically significant within-person improvement on all measures. While the Active system was generally associated with stronger magnitude of improvement, none of the comparisons of individual measures across conditions reached statistical significance. However, a post hoc analysis excluding participants with low frequency usage demonstrated significantly better improvement in perceived sleep quality with the Active device than Sham.

More:

https://www.fda.gov/news-events/press-announcements/fda-perm...

Throughout the night, Apple Watch sensors monitor body movement and heart rate during sleep. These data are sent to the Nightware server and, using a proprietary algorithm, the device creates a unique sleep profile for the patient. When Nightware detects that a patient is experiencing a nightmare based on its analysis of heart rate and body movement, the device provides vibrations through the Apple Watch while the product is in use.

This device was studied in a 30-day randomized, sham-controlled trial of 70 patients. A sham therapy is an inactive treatment or procedure that is intended to mimic as closely as possible a therapy in a clinical trial. Patients in the sham group wore the device, but no vibratory stimulation was provided. Safety was assessed using validated measurements of suicidality and sleepiness, and there were no changes in either over the course of the study in either group. Sleep was assessed with two versions of the Pittsburgh Sleep Quality Index scale, the self-rated questionnaire for assessing sleep quality, including a version of that scale that is intended for patients with PTSD. Both the sham and active groups showed improvement on the sleep scales, with the active group showing greater improvement than sham. The evidence demonstrated the probable benefits outweighed the probable risks.

“Some of the most horrific sights I’ve ever seen kept playing over and over, but when I started using NightWare, they stopped,” says Guithues. “In the morning, the device will tell me it’s intervened 25 or 30 times through the night, and I never woke up once. It’s to the point where I don’t remember any of the old nightmares.”

Maybe it's a placebo, but maybe it's the watch.

"Maybe" isn't science and should not be the standard of how the FDA grants prescription power.

But if it is placebo, what it does mean is that what people with PTSD need is someone who gives a shit about them. And that is old news.

From their FAQ [1]:

If I have an Apple Watch® and iPhone®, can I bring them to my doctor to download NightWare apps?

No. NightWare is not an app. When your doctor writes a prescription for NightWare, you will receive an all-inclusive kit including everything you need to receive the digital therapy, including a preprogrammed Apple Watch® and preprogrammed iPhone.®

I'm going to take a wild guess and say the markup charged to insurance companies for these devices are probably insane

[1] https://nightware.com/patient-faq/ edit: added link

if it isn't an app, then is apple giving them OS level permissions or is this a fork of iOS? then would this be getting slower update releases than iOS?

i don't see why they couldn't just do this with an app aside from trying to make more money selling devices w it already installed.

side note: using the term "virbotactile" gives me snake oil salesman vibes(no pun intended).

> if it isn't an app, then is apple giving them OS level permissions or is this a fork of iOS?

Gonna guess it's corporate distribution certs (whatever they're called, I haven't had to mess with that in years—the ones that let you sign & distribute apps outside the app store, mostly intended for letting companies distribute internal apps that wouldn't be suitable for general use on the app store) and you're technically leasing the device. Or something along those lines, maybe Apple has a special program that's very similar for medical device use. Not a custom build of the OS, nor special permissions.

The footer specifically says this is provided as "a dedicated closed-system specially provisioned Apple Watch and iPhone. In this configuration, iPhone and Apple Watch functionality is limited to running the NightWare app."

I wonder if it's possible to extract the totally-not-an-app

My guess is they want to charge an outrageous amount of money for the app, and having it 'prescribed' is part of that. They'll charge insurance companies.

I hope they gibe this to the person the US army electrified in Iraq.

Locking a potentially beneficial treatment behind an insurance-driven paywall seems like the height of evil to me. There's no technical or medical reason that this should require 3rd-party validation to use. If someone is having nightmares that are impacting their life in a negative way, why shouldn't they be able to try NightWare or similar and see if it works for them?

I have no problem with NightWare making a profit. Let people make big-kid decisions, bring their own (already owned!) hardware and see if the solution works for them. The actual worst-case scenario is that nothing happens.

400 veterans at $$$$/head vs potentially [tens of?] million humans with nightmares at $$/head seems like easy math.

Why does this require a prescription? Why isn't this just another iphone/apple-watch app on the App store?

Is PTSD really something only veterans suffer from? I've never seen anyone referencing it in any other context.

Veterans are the most discussed, but women are the largest subpopulation https://www.ptsd.va.gov/understand/common/common_women.asp

I sometimes wonder if my own PTSD is actually PTSD or if it doesn't count because I'm not a veteran or woman and it happened online.

It wasn't abuse; it was just an extremely stressful social and emotional situation that led to the loss of someone who was probably one of my closest friends, although I no longer remember who.

An AI that can provide perfect stimulants during sleep to create perfect dream could be disruptive.

Great. Vets will lose their VA rating for PTSD and just have an app pushed on them. Fucking perfect.

What do you mean they will lose their VA rating?

VA / Disability rating is tied to injuries suffered during service.

If the VA can "successfully" (by their own undisclosed metrics) "cure" the ailment then you can lose a % of your disability rating. The VA is constantly reviewing and attempting to remove ratings all the time. It's a ducked system and no one really cares. American veterans are demonized and mocked by more than half the population. There are 44 Veteran suicides every day.

https://www.va.gov/disability/about-disability-ratings/

An app like this seems like it could be a godsend to people with chronic nightmares.

bit of jacob collier does it for me as well..

Would be incredible if they integrated with 8sleep.

for those with PTSD, I tried EMDR therapy and it worked out great for me. Expensive but great.

An example of capitalism gone wrong when you have to get a prescription and health insurance just to download a vibrator app.

It's way more complicated than "just downloading an app". Considering it's a medical treatment, they currently ship it as an appliance (for various reasons).

You are not getting a prescription for an app, you are getting an MDM'd device that ONLY runs the Nightmare application.

You would know this if you read the article.

Which implies that this thing either has custom hardware for the watch, or it’s an app that anyone could install in theory if they had access. I doubt it’s the former.

On the face of it this sounds like a way to extract more insurance money.

Tetris, too.