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It was a fortuitous opportunity. Stocker began working under Professor Anne Germain, a leading researcher in the study of nightmares and posttraumatic stress disorder (PTSD). Germain is supervising the university's $4 million Department of Defense and National Institutes of Health grant to study how both active-duty service members and veterans can sleep better. "At the DOD, there used to be a mentality--and I think it's still there, but it's shifting--that sleep is a luxury," she told me. "But compromising sleep actually compromises physical, psychological decisionmaking--how well you can aim at a target."
The Pentagon became alert to sleep research partly because of studies by a retired Army colonel, Dr. Charles Hoge, a senior scientist with the Walter Reed Army Institute of Research. In 2007 the American Journal of Psychiatry published an influential paper by Hoge and four colleagues showing that more than 70% of veterans with PTSD symptoms reported trouble sleeping. No other condition--not panic or pain or inability to work--was as common. And because treating people who are constantly tired is often pointless, gaining a better understanding of sleep and dreams became a priority.
The research helped prompt the Pentagon to develop a Warfighter Sleep Kit, which includes a DVD that begins with a screen reading SLEEP IS ESSENTIAL TO SURVIVAL. The DVD says service members should avoid caffeine, nap only when necessary and--whenever they are safe enough to sleep--wear a camouflage mask and earplugs. The kit includes the mask and plugs.
Germain helped develop the sleep kit. Her research project is now exploring two approaches to mitigating nightmares. One involves a drug called prazosin. Developed in the 1960s as a hypertension treatment, prazosin didn't turn out to be especially effective in lowering blood pressure. But for reasons not well understood, those who took it reported that they slept better and had fewer nightmares. Few psychiatrists used prazosin for nightmares until the 2000s, but they made the remarkable discovery that in many patients, prazosin doesn't stop all dreams--just the very bad ones. The drug's usefulness for nightmares suggests that they stem from a brain or circulation disorder.
And yet the other treatment Germain is studying is purely psychological. Coincidentally, in August 2001, the same month that Ryan Stocker went to boot camp, the Journal of the American Medical Association (JAMA) published a seminal paper on a new psychological treatment of nightmares called imagery rehearsal therapy (IRT).
The paper looked at 168 sexual-abuse victims who reported chronic nightmares. The participants were asked to consider the idea that although trauma may induce nightmares, those bad dreams can become a habit--a behavior not unlike daytime panic attacks, which can seem uncontrollable. But, like daytime panic attacks too, those repetitive dreams turned out to be something like a learned behavior, one that can be unlearned through daytime psychotherapy. Freud and others had thought dreams to be immunable to conscious thought, but the JAMA paper demonstrated that the opposite is true.