Study Objective:In this meta-analysis, we compare the shortterm effi cacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS). Methods: Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment effi cacy. Results: Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not signifi cantly different with type of treatment (psychological vs. pharmacological However, when these frightening dreams occur in a recurrent fashion, the nightmare activity may constitute a disorder. In fact, nightmare disorder is listed in both the DSM-5 and in the ICSD-3 as a distinct disorder whose essential features are the presence of repeated negative dreams that lead to awakening, such that the individual becomes fully alert and aware of his or her surroundings. 2,3Nightmares can have an idiopathic origin or may occur after traumatic events. 4 Along with other sleep disturbances (e.g., insomnia and poor sleep quality), 5 nightmares are a typical symptom of posttraumatic stress disorder (PTSD). 6 Indeed, it has been estimated that around 70% of individuals with PTSD report posttraumatic nightmares. 7,8 Nonetheless, nightmares are not exclusive to PTSD, since they are also associated with anxiety and depression, among other mental health comorbidities. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Imagery rehearsal therapy (IRT) and prazosin are both used for treatment of nightmares in posttraumatic stress. The main aim of this study was a comparative meta-analysis of each treatment on nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms. Study Impact: IRT and prazosin had similar effects for nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms; however, adding cognitive-behavior therapy for insomnia to IRT enhanced its effects for improving sleep quality as well as posttraumatic stress disorder symptoms.

Study objectives: This study tested the ecological validity of actigraphy (ACT) for estimating objective sleep parameters in participants' homes. We also examined how well ACT and polysomnography (PSG) measures discriminated (1) individuals with and without insomnia; and (2) nights participants rated worse, the same as, or better than average. Methods: Thirty-one primary insomnia sufferers and 31 normal sleepers completed up to 3 consecutive monitoring nights with wrist ACT and PSG in their homes. They also rated how each night compared to their "average night's" sleep. ACT and PSG measures of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) were then compared using Bland and Altman correlational procedures and repeated measures ANOVAs. Differences between groups and among nights assigned distinctive ratings were tested via mixed-model ANOVAs. Results: Medium to large between-and within-subject correlations were observed for all measures in the insomnia sufferers sample and for most measures in the normal sleepers sample. Two (ACT vs. PSG) × 3 (nights) repeated measures ANOVAs showed that, in both samples, SOL derived from ACT was consistently lower than SOL derived from PSG across the 3 nights of recording. By contrast, ACT and PSG produced estimates of WASO, TST, and SE that did not differ from each other across nights. Subsequent 2 (insomnia vs. normal sleeper) × 3 (worse, same, better than average) mixed-model ANOVAs showed only ACT SOL discriminated those with and without insomnia and nights assigned distinctive ratings. Among the PSG-derived measures, only SE showed such a pattern. conclusions: ACT provides informative data for insomnia sufferers and normal sleepers in their usual sleep environments. The ACT estimate of SOL seems sensitive to night-to-night differences in subjective sleep ratings. A possible strength of ACT lies in its assessment of nocturnal movement, a parameter different from PSG-based sleep measures.

The use of natural products as sleep aids is a common practice. Often associated with a general health-promoting lifestyle, it may reflect the common perception that natural products are necessarily beneficial for sleep and without risks.