How to end a nightmare using ocular distress signaling

Nightmares trap people in a unique state of helplessness. Whereas fear during wake can be resolved with downregulation strategies, fear during sleep typically coincides with a reduction in the cognitive and social routes to implement them. Here, we report a case in which a dreamer and a technician together overcame both limitations, ending a nightmare in real time. A participant experiencing frequent nightmares was enrolled in a protocol designed to induce lucid dreams (restoring cognition during REM sleep) and enable communication from the dream via eye movements (restoring a social connection). During a nightmare, they gained awareness and used the eye signal as a mayday to request extraction from the dream, all while in polysomnography-verified REM sleep. They were awakened by the technician 34 seconds after the help request and reported immediate relief. At 2- and 4-week follow-ups, lucid dream frequency increased relative to baseline, with lucidity reducing the distress of a subsequent nightmare. Together, these results suggest that real-time dream communication might offer an in somno approach to treating nightmares, a core symptom of PTSD and other psychiatric disorders.