Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.
Journal of sleep research – June 01, 2025
Source: PubMed
Summary
Nightmare frequency significantly decreased from an average of 8.38 to 2.25 per week in adults with narcolepsy after undergoing Cognitive Behavioural Therapy for Nightmares (CBT-N), with a large effect size of -0.97. The addition of targeted lucidity reactivation (TLR) enhanced lucid dreaming experiences among participants, leading to improved dream control. Participants also reported reductions in sleep paralysis and hypnagogic hallucinations. Overall, the treatment resulted in heightened self-efficacy in managing symptoms and decreased anxiety surrounding nightmares, suggesting promising therapeutic strategies for narcolepsy-related disturbances.
Abstract
Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.