IRT-TMR: The Treatment For Your Sleep’s Haunting Beast

TMR cues could help boost IRT treatment to prevent Nightmare Disorder

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By Nada Hameed

You have probably had a nightmare before. Whether as a child or a teen, drifting pleasantly to sleep only to wake up panicked is familiar to many. However, while the majority of the population rarely have disturbing dreams, nearly three to eight percent of the population has nightmares at least once a week. This small percentage suffers from what is called nightmare disorder, which comprises a pattern of continuous, frightening, and vivid dreams.

Nightmares are triggered by everyday stressors like sleep deprivation or past trauma. Almost all individuals who struggle with this disorder have repeated occurrences of nightmares to the point that it routinely disrupts sleep, causes anxiety about sleep, and can even bleed into their daytime behavior. Unlike many people’s nightmares, these individuals’ nightmares may be extreme enough to dictate their life, overtaking their thoughts and worsening underlying mental disorders like depression.

Though people with mental illnesses are more prone to suffer from nightmare disorders, they can affect all types of people. While those affected can use medications like Prazosin or Triazolam to treat nightmare disorders, these medications can have unintended side effects. Instead, individuals generally treat nightmare disorder through imagery rehearsal therapy (IRT).

During a session of IRT, a patient will recount their most recurring type of nightmare. Then, they will discuss possible stress or trauma relating to the dream and brainstorm a different ending to the nightmare. At home, they rehearse this ending for 20 minutes a day. Over time, this method of therapy will reboot the brain to adjust the nightmare into a positive dream. IRT works on nightmares that do not seem to have any causes, like PTSD-related nightmares, and allows a person to take control of their dream, giving an individual power or agency against their unknown fears. IRT is the safest and most effective option to fight nightmare disorder, as there are no adamant side effects.

Yet, for nearly one-third of all participants, IRT is ineffective in preventing these terrifying nightmares. To boost IRT’s strength, neuro-researcher Sophie Schwarts and the University of Geneva proposed a technique called targeted memory reactivation (TMR). Using IRT-TMR therapy, a patient would perform the same steps as they would in an IRT therapy session, but as they focus on altering their nightmares, a short piano chord is played in the background. Then, as the patient sleeps, this sound is played again during REM, the dreaming stage of sleep. The rationale behind this technique is that hearing this specific cue during both IRT therapy and REM sleep will activate the brain's memory storage, thus strengthening the associated memory of the altered nightmare into a positive dream.

In a 2022 study, 36 individuals with nightmare disorder performed an initial IRT session. However, while half of the participants were randomly assigned to rehearse the revised nightmares in silence, the other half rehearsed a short piano chord, a TMR cue, played every 10 seconds for five minutes. As participants slept, they wore a headband with sensors, recording their brain's electrical activity and tracking their sleeping stages. The headbands sounded off every ten seconds during the REM stage, the cue boosting the effectiveness of IRT therapy. Then for two weeks, participants practiced IRT daily and recorded their dreams in a diary. Results showed that those who used TMR had a lower weekly average number of nightmares compared to those who just used a standard IRT treatment.

IRT is versatile and works in many different situations depending on the severity of an individual’s dreams. People may decide to reimagine only part of their nightmare, while others may want to forget about it completely. Despite the positive results, there is still room to improve this research. The experiment only involved young, healthy participants with no history of mental disorders. Perhaps with the success of this study, IRT-TMR research can be explored among varied individuals, like people with psychiatric disorders or older adults, giving people more freedom in their method of treatment. Overall, IRT-TMR therapy seems to be a new development in the study of nightmare disorder, allowing all who suffer from these terrifying dreams to get a good night’s rest.