Remote Study of NightWare for PTSD With Nightmares (NWVRCT)

A Remote Randomized Double-Blind Sham-Controlled Clinical Trial of NightWare in Adults With Post-Traumatic Stress Disorder and Co-Morbid Nightmare Disorder

This study will provide measures of safety and efficacy of the NightWare digital therapeutic system (iPhone + Apple watch + proprietary application) for the treatment of nightmare disorder associated with post-traumatic stress disorder (PTSD)-related sleep disturbance and the impact of improved sleep with the NightWare digital therapeutic system. The investigators hypothesize that the NightWare digital therapeutic system will significantly improve sleep quality in participants with PTSD-Related nightmares and poor sleep quality.

Study Overview

• Status: Completed
• Conditions: Sleep Disorder; Sleep Initiation and Maintenance Disorders; Stress Disorder; Combat Disorders; Nightmare; PostTraumatic Stress Disorder; Nightmares, REM-Sleep Type; Nightmares Associated With Chronic Post-Traumatic Stress Disorder
• Intervention / Treatment: Device: NightWare Therapeutic System; Device: NightWare Therapeutic System in Sham Mode

Detailed Description

Nightmares are a common problem affecting 2-8% of the general population and a higher proportion of clinical populations. The negative consequences of untreated nightmares are significant and include impaired quality of life, sleep deprivation (often resulting in an increased intensity of nightmares), insomnia, daytime sleepiness, and fatigue. Untreated nightmares can also exacerbate the symptoms of underlying psychological dysfunction in people with depression and anxiety, leading to poor occupational and or social functioning. Nightmares can be idiopathic or associated with the use (or withdrawal) of certain medications or substances or associated with disorders including PTSD.

NightWare (Minneapolis, MN) has developed a novel approach to the treatment of nightmares. Through the use of a smartwatch-based application that senses physiologic parameters, the participant is aroused from sleep (without awakening the participant) so that the nightmare is interrupted prior to reaching a threshold of severity in which the participant would awaken in distress. Seconds later the participant returns to sleep without having experienced a nightmare. This approach avoids risk from pharmacological treatment, avoids exacerbation of symptoms from image rehearsal therapy and allows for a simple method with easily achieved adherence compared to existing treatments.

The NightWare digital therapeutic system consists of a proprietary software application installed on a smartwatch. The application has been effective in focus groups when used on both Apple smartwatches and Motorola smartwatches. For the purposes of this study, the investigators will be using only the Apple (Cupertino, CA) 3rd generation smartwatch and the Apple iPhone. The NightWare application uses physiological markers obtained via the smartwatch to determine by proprietary algorithm whether a participant is in the early stages of a nightmare, but has not yet awoken in distress. As directed by the algorithm, the smartwatch then applies varying degrees of vibratory stimulation to the wrist over variable lengths of time with the intention of arousing the participant from sleep without eliciting an awakening.

• Study Type: Interventional
• Enrollment (Actual): 81
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Bronx, New York, United States, 10461
      • RationalPsych

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

• Self report of diagnosis with PTSD
• Self-report of PTSD-related repetitive nightmares contributing to disrupted sleep.
• Equal to or older than 18 years of age.
• Proficient in both reading and writing in the English language.
• Pittsburgh Sleep Quality Index (PSQI) score equal to or greater than 10.
• ESS: On question #8 any score above "0" will prompt an additional question:
• Do you drive ("get behind the wheel") when you are drowsy? Answer must be "No" to be enrolled in the study for safety.
• Participant owns or has access to devices appropriate for participation in the study including compatible Apple Watch and Apple iPhone.
• Wireless Internet and two power outlets where they sleep.
• Willingness not to use any other application which collects heart rate data on the phone and watch that is used for NightWare.

Exclusion Criteria

• Circadian rhythm disruption on a regular basis (shift-work)
• Concurrent presence of prohibited medications
• Current use of varenicline
• Current use of beta-blockers (unless ophthalmic solutions)
• Current use of non-dihydropyridines
• Current use of Prazosin for the treatment of nightmares (can include subjects 2 weeks post-taper and discontinuation)
• Concurrent presence of prohibited diagnoses
• Known diagnosis of OSA
• Diagnosis of an active disorder of arousal from non-rapid eye movement sleep
• Diagnosis of rapid eye movement sleep behavior disorder
• Diagnosis of narcolepsy
• Diagnosis of dementia
• Uncontrolled atrial fibrillation
• Use of Alcohol or Drugs as specified:
• Alcohol Use Disorders Inventory Test (AUDIT) (score of 8 or higher)
• Drug Abuse Screening Test-10 (DAST-10) (score greater than 2)
• Suspicion of nightmares being secondary to substance abuse or withdrawal
• Previous or foreseeable legal proceedings involving nightmares or trauma
• Nocturia that causes awakening from sleep
• Known sleep walking
• Acting out of dreams PRIOR to PTSD trauma
• Self reported pregnancy or intent to become pregnant during the course of the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active Treatment Arm; Intervention with the NightWare Therapeutic System every night.	Device: NightWare Therapeutic System; A wearable digital therapeutic system that will measure physiologic data when worn during sleep to deliver a mild vibration via the watch to elicit arousal thereby disrupting nightmares. This detection and stimulation sequence will be performed according to NightWare's proprietary algorithm.
Sham Comparator: Sham Arm; NightWare Therapeutic System every night with interventions not-enabled.	Device: NightWare Therapeutic System in Sham Mode; A wearable digital therapeutic system that will measure physiologic data when worn during sleep that does not deliver interventions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in global score on the Pittsburgh Sleep Quality Index (PSQI) from Day 0 to each subsequent 28 day evaluation period	The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. In scoring the PSQI, seven component scores are derived, each scored 0 (no difficulty) to 3 (severe difficulty). The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality. This outcome is the difference between the global score on the Pittsburgh Sleep Quality Index (PSQI) score at baseline (Day 0) and average global PSQI score across the post-treatment initiation assessments (Days 14, 28 and every 28 days after that).	0-730 days

Collaborators and Investigators

• Sponsor: NightWare
• Collaborators: RationalPsych; Center for International Emergency Medical Services

Study record dates

Study Major Dates

• Study Start (Actual): May 21, 2019
• Primary Completion (Actual): December 15, 2021
• Study Completion (Actual): December 15, 2021

Study Registration Dates

• First Submitted: April 29, 2019
• First Submitted That Met QC Criteria: April 30, 2019
• First Posted (Actual): May 2, 2019

Study Record Updates

• Last Update Posted (Actual): January 28, 2022
• Last Update Submitted That Met QC Criteria: January 27, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: PTSD; Veteran; Nightmares; Post-traumatic stress disorder; Digital therapeutic; Nightmare Disorder; Digital medicine
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Nervous System Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Neurologic Manifestations; Trauma and Stressor Related Disorders; Disease; Sleep Wake Disorders; Sleep Initiation and Maintenance Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Combat Disorders
• Other Study ID Numbers: NW101004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No