{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:08:52Z","timestamp":1788952132879,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"\n Objective<\/jats:title>\n Nightmares are a common, distressing condition among individuals with post-traumatic stress disorder (PTSD) and are associated with impaired sleep quality and elevated suicide risk. First responders carry a substantial burden of occupational trauma and PTSD yet are under-represented in nightmare-treatment research. NightWare is an FDA-authorized prescription wearable that monitors heart rate and movement during sleep and delivers vibrotactile feedback intended to interrupt nightmares and improve sleep quality. We evaluated the real-world response to NightWare among San Francisco first responders.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n First responders (law enforcement and fire service) prescribed NightWare in routine clinical care completed structured self-report assessments at Day 0, 30, and 60. First responders were aged 35\u201365, half were male and half were female. They had a PTSD diagnosis and at least 3 nightmares per week. The co-primary endpoints were nightmare frequency (self-reported nights with nightmares per week, 0\u20137) and nightmare-related distress (5-point ordinal scale, 0\u20134). Change was assessed with paired\n t<\/jats:italic>\n -tests (with Cohen's d) and one-way repeated-measures analysis of variance (RM-ANOVA).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 11 first responders who initiated treatment, 10 (91%) completed all assessments. Mean nightmare frequency decreased from 5.2 to 3.6 nights\/week [mean change \u22121.6; 95% CI \u22122.7 to \u22120.5;\n t<\/jats:italic>\n (9)<\/jats:sub>\n = \u22123.21,\n p<\/jats:italic>\n = 0.011;\n d<\/jats:italic>\n = 1.0] and mean distress decreased from 2.9 to 1.3 [mean change \u22121.6; 95% CI \u22122.2 to \u22121.0;\n t<\/jats:italic>\n (9)<\/jats:sub>\n = \u22126.00,\n p<\/jats:italic>\n = 0.0002;\n d<\/jats:italic>\n = 1.9]. RM-ANOVA confirmed a significant decline across the three time points for both endpoints (frequency\n p<\/jats:italic>\n = 0.009; distress\n p<\/jats:italic>\n = 0.003). Seven of ten reduced nightmare frequency and nine of ten improved on distress; no participant worsened on either measure. Self-reported sleep quality and treatment satisfaction improved. The participants in this survey used the NightWare device a mean of 76% of nights (45.6 days of the 60-day survey time period). The range of usage was 55\u2013100% (33\u201360 days) of the study nights.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this small, open-label, real-world pilot, treatment with NightWare was associated with clinically meaningful reductions in nightmare frequency and distress and high patient acceptability among first responders. These findings are hypothesis-generating; controlled studies with validated instruments are warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/frsle.2026.1941077","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:11:55Z","timestamp":1788948715000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world reduction in nightmare frequency and distress among San Francisco first responders treated with a prescription wearable device: a 60-day open-label pilot"],"prefix":"10.3389","volume":"5","author":[{"given":"Brian D.","family":"Robertson","sequence":"first","affiliation":[{"name":"NightWare, Inc., Minneapolis","place":["MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily F.","family":"Wargo","sequence":"additional","affiliation":[{"name":"NightWare, Inc., Minneapolis","place":["MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Fay","sequence":"additional","affiliation":[{"name":"First Responder Support Network","place":["San Rafael, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, 5th edn.","year":"2013"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1007\/s00127-011-0408-2","article-title":"Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers","volume":"47","author":"Berger","year":"2012","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1016\/j.sleep.07011","article-title":"Prevalence of different parasomnias in the general population","volume":"11","author":"Bjorvatn","year":"2010","journal-title":"Sleep Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1002\/jts.20569","article-title":"Imagery rehearsal for posttraumatic nightmares: a randomized controlled trial","volume":"23","author":"Cook","year":"2010","journal-title":"J. Trauma Stress."},{"key":"B5","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1037\/1076-8998.4.2.131","article-title":"Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries","volume":"4","author":"Corneil","year":"1999","journal-title":"J. Occup. 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Sleep."},{"key":"B9","year":"2020","journal-title":"Evaluation of automatic class III designation (De Novo) for NightWare (DEN200033)"},{"key":"B10","unstructured":"\u201cYellow ribbon report\u2014under the helmet: performing an internal size-up,\u201d\n \n Fairfax, VA\n A Proactive Approach to Ensuring Mental Wellness\n \n 2017"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.5664\/jcsm.7178","article-title":"Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper","volume":"14","author":"Morgenthaler","year":"2018","journal-title":"J. Clin. Sleep Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1176\/ajp.155.7.929","article-title":"Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans","volume":"155","author":"Neylan","year":"1998","journal-title":"Am. J. 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Disord."},{"key":"B16","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jad.08007","article-title":"Career prevalence and correlates of suicidal thoughts and behaviors among firefighters","volume":"187","author":"Stanley","year":"2015","journal-title":"J. Affect. Disord."},{"key":"B17","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.cpr.12002","article-title":"A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics","volume":"44","author":"Stanley","year":"2016","journal-title":"Clin. Psychol. Rev."},{"key":"B18","first-page":"844","article-title":"Nightmares as predictors of suicide","volume":"24","author":"Tanskanen","year":"2001","journal-title":"Sleep."},{"key":"B19","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1002\/da.22054","article-title":"Impact of impaired sleep on the development of PTSD symptoms in combat veterans: a prospective longitudinal cohort study","volume":"30","author":"van Liempt","year":"2013","journal-title":"Depress Anxiety"}],"container-title":["Frontiers in Sleep"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2026.1941077\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:12:06Z","timestamp":1788948726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2026.1941077\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":19,"alternative-id":["10.3389\/frsle.2026.1941077"],"URL":"https:\/\/doi.org\/10.3389\/frsle.2026.1941077","relation":{},"ISSN":["2813-2890"],"issn-type":[{"value":"2813-2890","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1941077"}}