The brainchild of a Macalester College graduate to help his father overcome combat-related nightmares has turned into a promising — but still experimental — medical app that is being tested by the Minneapolis Veterans Medical Center.
Called NightWare, the app is loaded onto an Apple watch, where it learns to track the pulse rates and biometric readings of wearers when they have nightmares. Once trained, the app instructs the watch to buzz lightly, rousing sleepers from their nightmares without fully waking them.
While dreams and even nightmares can play legitimate roles in physical and mental health, they can become "pathological" and "disruptive" to people who suffer from post-traumatic stress disorder, said Grady Hannah, chief executive of NightWare, a Minneapolis med-tech firm that is developing the app as a medical device.
"These people, when they're having nightmares due to PTSD, they're reliving the worst experiences in their life," he said. "They're in dysphoric states. They're generally miserable."
PTSD, a condition in which sufferers relive past emotional traumas, has been found at higher rates in soldiers and military veterans, including members of the Minnesota National Guard who served prolonged tours in Iraq and Afghanistan after the 9/11 terrorist bombings. Screenings immediately after deployments found PTSD symptoms in nearly 5% of active-duty soldiers but nearly 13% of National Guard and reserve unit soldiers.
Treatment typically involves intensive therapy — including exposure sessions that try to get sufferers to recall traumas without feeling the pain of those moments — but there has been little specifically designed to treat PTSD-associated nightmares. Hannah said that's a significant gap, considering that disrupted sleep has been linked to a variety of health problems and increased risk of suicide attempts.
That treatment gap prompted the U.S. Food and Drug Administration to grant special "breakthrough" status to NightWare last month to hasten it through the approval process and to the marketplace.
This month the Minneapolis Veterans Medical Center reported that 31 veterans had tried the device, and 85% reported improved sleep within one month. Now VA researchers are starting a trial that will compare veterans who receive buzzes from the watch when they are having nightmares with veterans whose watches simply silently track their pulse and sleep data.
Buzzing and alarm technology has already been used in commercial products to address sleep-related problems, including bed-wetting for children, and in products that didn't receive FDA approval as medical devices.
Hannah said the FDA deemed NightWare a medical device requiring research and approval, to prove that it is effective and safe, which will ultimately increase trust in the system and make it eligible for coverage by health insurance.
"There have been lots of companies that have tried to create consumer treatments that never made it, because marketing direct to consumers takes a lot of money," Hannah said. "And you can't make any medical claims" without research and federal approval to back them up.
NightWare was originally created at a 2015 hackathon technology innovation contest in Washington D.C., by a 21-year-old Macalester student named by Tyler Skluzacek.
Skluzacek had come to learn about PTSD because of his father's struggles after his overseas deployment in 2006.
"He just hit absolute rock bottom," Skluzacek told the Star Tribune in 2015. "He was just depressed and angry and every emotion you can think of that has nothing to do with happy."
Hannah, an entrepreneur and Silicon Valley veteran, read the Star Tribune account and contacted Skluzacek, who now attends graduate school at the University of Chicago, to begin developing the app for use as a medical device.
Hannah is guarded about discussing the benefits of NightWare until the VA research data comes in, but some early test users have called it life-changing.
Justin Miller suffered PTSD after returning home to South Carolina from two deployments in Iraq as part of a sniper team. He had constant nightmares evoking memories of being injured by an explosive device, seeing soldiers die, or being left by his unit in a building and having to fight his way out to avoid capture.
Miller said he would wake in a sweat with a racing pulse. Sometimes he would be flailing about and elbowing his wife. He rarely slept more than four hours per night, he said.
After trying the app in January, Miller said he started sleeping through the night almost immediately. He's had about a dozen nightmares since then, on the nights when he left the watch off his wrist and on the charging station.
Miller said he's drastically reduced his consumption of energy drinks, melatonin to help with sleep, and even his antidepressant dosage.
"Once I started sleeping, it's amazing how much the rest of my life changed," he said. "I have more patience with people. I am able to keep my cool, most of the time.
"I didn't know [sleep] was possible for me anymore. It hadn't happened in 12 to 13 years."