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.
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.
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 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.
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.
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!
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]
> [...] 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 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."
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.
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.
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?
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.
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.
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 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
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.
> 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.
> 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.
> 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.
> 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
> 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.
You sound like the perfect candidate for nightware. You should check it out and report back. I’d like to believe the marketing, but it sounds too good to be true.
> 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?
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.
> 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.
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...
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.
The content of nightmares is the reporting that feeds into the
processes of reflection and therapeutic correction. No dreams, no clue
as to what specifically lies at the core of an unresolved traumatic
experience. Unpleasant as they are, they are also useful indicative
tools toward recovery.
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.
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.
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.
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.
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.
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.
Yea - could someone shed some light on this? What would the FDA have to do with an app like this? What risk to the public could an app like this pose?
“We had to get an independent security audit and submit it for FDA clearance”
Security audit is probably a good thing. Maybe they need FDA clearance for doctors to prescribe the usage of an app? That just seems ridiculous to me, but also right up the FDA's alley.
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.
Readit News
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
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. :))))
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.
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.
Am I completely overthinking this?
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.
Dead Comment
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/
Epigenetics in the wild: https://www.scientificamerican.com/article/how-parents-rsquo...
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 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/
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"?
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.
Try me. How many?
How many tried the intervention you recommended? How many saw a benefit? How many did not?
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.
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?
the point here is that you are feeling exaggerated anxiety with minimal external triggers, but the nature of the anxiety response is normal
Deleted Comment
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.
Might be worth a trip to Oregon :)
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.
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
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.
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.
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?
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.
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.
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.
PS - Not justifying, just explaining the business model.
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.
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'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.
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?
FDA posted a PDF summary of its decision on this product here: https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN200033.p...
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.
> 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 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.
There's no blinding and no placebo control and no comparison of measurable results over a long period of study.
[0] https://patents.justia.com/patent/10765831
[1] https://patents.justia.com/assignee/nightware-inc
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:
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.
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.