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.

Objective: 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. Methods: 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 35-65, 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, 0-7) and nightmare-related distress (5-point ordinal scale, 0-4). Change was assessed with paired Results: 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 -1.6; 95% CI -2.7 to -0.5; Conclusions: 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.