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.
Comparable studies
Other experimental studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lucid Dreaming Verified by Volitional Communication during Rem Sleep Selected subjects proficient in lucid dreaming | 1981 | Experimental study | n = 5 |
| Incorporation of concern- and nonconcern-related verbal stimuli into dream content. Seven male subjects studied during sleep Stages 2 and REM | 1981 | Experimental study | n = 7 |
| Lucid Dreaming and Alpha Activity: A Preliminary Report Good dream recallers | 1982 | Experimental study | n = 10 |
| Lucid dreaming during NREM sleep: Two case reports | 2012 | Sleep laboratory study | |
| The Dream Catcher experiment: blinded analyses failed to detect markers of dreaming consciousness in EEG spectral power. Human participants during sleep | 2020 | Experimental study with blinded classification | n = 9 |
Citations in the library
Cited by 4
- The clinical neuroscience of lucid dreaming. Neuroscience & Biobehavioral Reviews January 14, 2025
- Investigating dreams by strategically presenting sounds during REM sleep to reactivate waking experiences. Neuropsychologia October 10, 2025
- The Future of Parasomnias. Journal of Sleep Research October 1, 2025
- Sleep Paralysis: Pathogenesis, Clinical Manifestations, and Treatment Strategies. Journal of Integrative Neuroscience August 25, 2025
Cites 17
- Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Sleep 2011
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Sleep June 1, 2010
- Real-time dialogue between experimenters and dreamers during REM sleep. Current Biology April 12, 2021
- Lucid Dreaming in Narcolepsy Sleep February 27, 2015
and 12 more in the library