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, Susana Gabriela Torres-Platas, Remington Mallett, Kiran Maski, Ken A Paller
Journal of Sleep Research June 1, 2025 DOI: 10.1111/jsr.14384 (opens in new tab)
Study at a glance
AI-extracted from the abstract| 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 Dreaming |
| Keywords | Hypnagogic hallucinations Hypnopompic hallucinations Imagery rehearsal therapy Parasomnias Sleep paralysis |
| Citations | 7 |
| Key findings | 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.