Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.
Jennifer M Mundt, Kristi E Pruiksma, Karen R Konkoly, Clair Casiello-Robbins, Michael R Nadorff, Rachel-Clair Franklin, Sunaina Karanth, Nina Byskosh, Daniel J Morris, S Gabriela Torres-Platas, Remington Mallett, Kiran Maski, Ken A Paller
Journal of sleep research June 1, 2025 DOI: 10.1111/jsr.14384 via PubMed
Summary
AI-generated from the abstractA small trial tested cognitive behavioral therapy for nightmares (CBT-N), adapted for people with narcolepsy, with or without targeted lucidity reactivation (TLR) to enhance lucid dreaming. Six adults who had frequent nightmares (at least 3 per week) received seven treatment sessions. Nightmare frequency dropped from an average of 8.38 per week to 2.25 per week, a large improvement. Nightmare severity and symptoms such as sleep paralysis, hallucinations, and dream enactment also improved. The three participants who received TLR all recalled dreams related to their rescripted nightmare. Participants reported reduced shame and anxiety about sleep and nightmares. The findings offer preliminary evidence that CBT-N and TLR may help manage narcolepsy-related nightmares.
Study at a glance
| Characteristics | Multiple baseline single-case experimental design Randomized Pilot study Peer reviewed |
|---|---|
| Sample size | 6 |
| Population | Adults with narcolepsy and frequent nightmares (≥3/week) |
| Interventions | Cognitive Behavioural Therapy for Nightmares (CBT-N) targeted lucidity reactivation (TLR) |
| Duration | 7 treatment sessions; baselines of 2 or 4 weeks |
| Topics | Lucid dreaming |
| Keywords | Hypnagogic hallucinations Hypnopompic hallucinations Imagery rehearsal therapy Parasomnias |
| Citations | 7 |
| Key finding | CBT-N adapted for narcolepsy, with or without TLR, was associated with large reductions in nightmare frequency and severity, and improvements in sleep paralysis, hallucinations, dream enactment, and self-efficacy. |
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.