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NCT03974503

Understanding Trauma Nightmares Using In-Home Measurement

Completed NA Results posted Last updated 9 April 2026
What this trial tests

NA trial testing Exposure, Relaxation, and Rescripting Therapy in Nightmares in 48 participants. Completed in 7 April 2025.

Timeline
2 December 2019
Primary endpoint
31 March 2025
7 April 2025

Quick facts

Lead sponsorVA Office of Research and Development
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposetreatment
Enrollment48
Start date2 December 2019
Primary completion31 March 2025
Estimated completion7 April 2025
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

VA Office of Research and Development — full company profile →

Who can join

18 and older, any sex, with Nightmares or Stress Disorders, Post-Traumatic. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Actigraphy-derived Sleep Efficiency (SE) Percentage Primary · Week from mattress installation to first treatment session; Week from last treatment session to 1-week post-5-week-treatment assessment

Sleep efficiency will be calculated per night from a mattress actigraphy system and averaged for two time-periods (the week between mattress installation and the first treatment session; the week between the last treatment session to the 1-week post-5-week treatment assessment). Sleep efficiency is defined as the ratio of the aggregate duration of quiescent sleep periods divided by the duration of the total in bed period multiplied by 100 to convert sleep efficiency to percentage points. Lower sleep efficiency indicates more disrupted sleep.

Week from mattress installation to first treatment session
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)74.89± 16.34
Sleep and Nightmare Management69.47± 19.77
Week from last treatment session to 1 week post-5-week-treatment assessment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)66.67± 25.14
Sleep and Nightmare Management71.04± 19.1
Actigraphy-derived Respiratory Sinus Arrhythmia (RSA) Primary · Week from mattress installation to first treatment session; Week from last treatment session to 1-week post-5-week-treatment assessment

Respiratory sinus arrhythmia (RSA) was computed in the 0.15-0.40 Hz band, using median values from high-quality inter-beat-intervals segments, each night. These data were averaged for two time-periods (the week between mattress installation and the first treatment session; the week between the last treatment session to the 1-week post-5-week treatment assessment). Lower RSA indicates more cardiac vagal withdrawal.

Week from mattress installation to first treatment session
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)3.85± 2.12
Sleep and Nightmare Management2.96± 1.53
Week from last treatment session to 1-week post-5-week-treatment assessment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)3.46± 2.05
Sleep and Nightmare Management3.15± 1.52
Change in Nightmare Frequency Primary · Baseline past week; post-5-week-treatment past week; 3-month follow-up past week

This fill-in-the-blank variable assesses the number of nightmares experienced in the past week (range = 0 - X nightmares) at each assessment (baseline, one week following 5-week treatment, and three months following treatment).

Baseline past week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)3.22.2 – 4.6
Sleep and Nightmare Management3.52.4 – 5.0
Post-5-week-treatment past week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)2.91.9 – 4.3
Sleep and Nightmare Management2.71.8 – 4.0
3-month follow-up past week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)2.31.5 – 3.6
Sleep and Nightmare Management2.51.7 – 3.8
Change in Total PTSD Symptom Severity Secondary · Baseline, 1-week post-5-week-treatment, 3-month follow-up

Change in PTSD Symptoms will be assessed using the Clinician-Administered PTSD Scale DSM 5 (CAPS-5). The items on the CAPS-5 are on a 5-point scale (0 - 4), (possible range: 0-80, with higher scores indicating more severe symptoms). A symptom is considered present if the severity is rated 2 or higher. Total scores are comprised of four symptom clusters (reexperiencing/intrusions, avoidance, cognitive/emotional and hyperarousal)

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)3429 – 38.9
Sleep and Nightmare Management34.429.7 – 39.2
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)26.420.5 – 32.3
Sleep and Nightmare Management29.724.3 – 35.2
3 Month Follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)24.617.5 – 31.6
Sleep and Nightmare Management28.622.2 – 34.9
Change in Nightmare Severity Secondary · Baseline past week; post-5-week-treatment past week; 3-month follow-up past week

The variable from the Trauma-Related Nightmare Survey assesses the severity of the nightmares experienced in the past week (range = 0 - 4) at each assessment (baseline, one week following 5-week treatment, and three months following treatment). Higher scores indicate greater nightmare-related severity.

Baseline Past Week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)2.42.0 – 2.8
Sleep and Nightmare Management2.92.5 – 3.3
Post-5-week-treatment past week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)2.01.5 – 2.5
Sleep and Nightmare Management2.31.8 – 2.8
3-month follow-up past week
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)2.01.3 – 2.6
Sleep and Nightmare Management2.31.7 – 2.9
Home-based Overnight Polysomnography - Apnea-Hypopnea Events Per Hour of Sleep Secondary · Baseline

Nox A1 portable polysomnography system (Nox Medical, Reykjavik, Iceland) used to record sleep stage measures and patterns of arousals, to calibrate sleep efficiency derived from the mattress system, and to detect sleep apnea.

GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)5.4± 4.66
Sleep and Nightmare Management9.06± 13.4
Change in Global Sleep Quality Secondary · Baseline; 1-week post-5-week-treatment; 3-month follow-up

Change in sleep Quality will be assessed using the Pittsburgh Sleep Quality Index, a 19-item self-report measure assessing qualities and problems associated with sleep in the past month. A global sleep quality score is obtained by summing seven component scores. Higher scores reflect poorer sleep quality. The global score ranges from 0 to 21, with a cut-off score of 5 as distinguishing "good" sleepers from "poor" sleepers.

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)13.912.3 – 15.5
Sleep and Nightmare Management14.613.1 – 16.1
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)10.98.9 – 12.8
Sleep and Nightmare Management11.38.8 – 13.7
3 Month Follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)11.38.8 – 13.7
Sleep and Nightmare Management12.310.1 – 14.6
Change in Self-report Depression Symptoms Secondary · Baseline, 1-week post-5-week-treatment, 3-month follow-up

The patient health questionnaire (PHQ-9), is a 9-item self-report instrument used to assess depression severity. Items are scored 0 to 3, with the total score being the sum of the 9 items (Total scores range from 0 to 27). Higher scores indicate greater depression severity, with a score of 10 or greater considered major depression, and scores of 20 or more is severe major depression.

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)12.310 – 14.7
Sleep and Nightmare Management15.513.2 – 17.7
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)8.35.7 – 10.8
Sleep and Nightmare Management10.78.3 – 13.2
3 Month follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)9.15.7 – 10.8
Sleep and Nightmare Management10.17.1 – 13.0
Change in Nightmare Effects Secondary · Baseline, 1-week post-5-week-treatment, 3-month follow-up

Change in the impact of nightmares will be assessed using the change in Nightmare Effects Survey, an 11 item Likert-type questionnaire designed to assess the impact of nightmares on 11 areas of life including work, social, and leisure activities. Total scores range from 0 to 44, with higher scores indicating greater level of nightmare-related impairment.

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)23.419.7 – 27.1
Sleep and Nightmare Management28.124.3 – 31.9
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)19.715.4 – 23.9
Sleep and Nightmare Management23.219.1 – 27.3
3 Month Follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)16.811.2 – 22.3
Sleep and Nightmare Management22.717.6 – 27.8
Change in Fear of Sleep Secondary · Baseline, 1-week post-5-week-treatment, 3-month follow-up

Change in fear of sleep will be assessed using the Fear of Sleep Inventory- Short Form, a 13-item self-report measure that assesses trauma-related thoughts and activities associated with sleep and the occurrence of traumas associated with the bedroom or sleep. Total scores range from 0 to 52, with higher scores indicating greater fear of sleep.

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)17.012.0 – 22.1
Sleep and Nightmare Management22.117.1 – 27.1
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)11.56.4 – 16.7
Sleep and Nightmare Management19.114.2 – 24.1
3 Month Follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)12.76.8 – 18.6
Sleep and Nightmare Management16.911.4 – 22.4
Change in Suicidal Ideation Secondary · Baseline, 1-week post-5-week-treatment, 3-month follow-up

Change in suicidal ideation will be assessed using the Depressive Symptom Index: Suicidality Subscale (DSI-SS). The four items of the DSI-SS are scored on a 0-3 scale, with total possible sum scores ranging from 0-12; higher scores indicate greater severity of suicidal ideation.

Baseline
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)0.09± 0.29
Sleep and Nightmare Management1.05± 2.11
1-week post-5-week-treatment
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)0± 0
Sleep and Nightmare Management0.78± 2.05
3 month Follow-up
GroupValue95% CI
Exposure, Relaxation, and Rescripting Therapy (ERRT)0.07± 0.27
Sleep and Nightmare Management0.59± 1.8

Adverse events — posted to ClinicalTrials.gov

Time frame: From enrollment until the 3 month follow-up. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Exposure, Relaxation, and Rescripting Therapy (ERRT)
Serious: 0/23 (0%)
Deaths: 0/23
Sleep and Nightmare Management
Serious: 0/25 (0%)
Deaths: 0/25
Other adverse events (1 terms — click to expand)

ReactionSystemExposure, Relaxation, and …Sleep and Nightmare Manage…
Complaint about the in-home mattress system (odor or electrical issue)Product Issues

Data from ClinicalTrials.gov NCT03974503 adverse events section.

Sponsor's own description

Trauma-related nightmares in Veterans are associated with poor clinical outcomes, greater substance use, and increased risk of suicide. In spite of an urgent need to reduce the burden of trauma-related nightmares, the underlying physiological changes associated with them are poorly understood, and there are no clear evidence-based recommendations for their treatment. Limitations of current assessment procedures represent a barrier to improved care. In-laboratory sleep studies rarely capture nightmares, limiting the knowledge about them and their response to treatment. This study addresses these limitations by using extended, in-home sleep monitoring to capture sleep data associated with nightmare reports in Veterans, and assessing how these features are altered throughout a cognitive-behavioral nightmare treatment. Results from this study will increase understanding of trauma-related nightmares, and advance strategies for personalizing symptom management for Veterans.

Publications & conference data

No peer-reviewed publications indexed yet for this trial. Completed trials usually publish results within 12-18 months.

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