A recent study has introduced a novel approach for managing nightmares associated with narcolepsy. Researchers from Northwestern Medicine combined cognitive behavioral therapy (CBT) and lucid dreaming techniques in a small clinical trial.
A recent study at Northwestern Medicine has unveiled a new method for addressing nightmares linked to narcolepsy.
The researchers integrated cognitive behavioral therapy (CBT) with lucid dreaming strategies to assist patients in a limited clinical trial.
“We had participants envision a dream they’d prefer instead of a nightmare, similar to creating a script for a movie,” mentioned Jennifer Mundt, the study’s lead author and an assistant professor of neurology (sleep medicine) and psychiatry at Northwestern University Feinberg School of Medicine.
The results showed a notable decrease in both the severity and frequency of nightmares among all six participants. These findings were published on October 23 in the Journal of Sleep Research.
Nightmares: A Common Yet Overlooked Issue
Disturbing and vivid nightmares impact around 30 to 40% of individuals suffering from narcolepsy, a chronic neurological condition that interferes with the brain’s ability to manage sleep and wakefulness. These nightmares can provoke a fear of sleep, resulting in heightened fatigue and depression. Despite their prevalence, nightmares have not garnered sufficient attention in research or clinical treatments related to narcolepsy.
“Nightmares associated with narcolepsy have long been an overlooked symptom of the disorder,” Mundt explained. “Many participants had endured nightmares for years without receiving any treatment for various reasons—some were not asked about their nightmares, while others were unaware that treatments existed or felt embarrassed and chose not to mention them to their healthcare providers.”
Mundt emphasized the importance of directing these patients toward treatment, noting that many are unaware that help is available, and that therapy can dramatically improve their sleep and overall daytime feelings within weeks.
The First Study Utilizing CBT for Narcolepsy-Related Nightmares
While previous studies have shown that cognitive behavioral therapy for nightmares (CBT-N) can effectively treat trauma-associated nightmares, this research marks the first instance applying it to narcolepsy.
All six participants received CBT-N through weekly telehealth sessions, where they learned about nightmares, sleep routines, factors affecting sleep, and techniques to relax and elevate their mood before sleep.
Through CBT-N, participants transformed their nightmares into preferable dreams (a process called rescripting) and rehearsed these new scripts nightly before sleep.
Combining CBT-N with Lucid Dreaming Techniques
Starting in the fifth week of the study, half of the participants also took part in a unique procedure conducted in Dr. Ken Paller’s lab at Northwestern. During their nap, scientists attempted to evoke lucid dreams using a method known as targeted lucidity reactivation (TLR), which had previously shown effectiveness.
A previous study conducted in Paller’s lab demonstrated that individuals in a dream during TLR could engage with scientists in real-time during the REM (rapid eye movement) sleep stage, where most lucid dreams occur. Since people with narcolepsy often experience frequent lucid dreams during REM sleep, this new study modified the TLR technique to leverage this phenomenon.
The researchers monitored brain activity using an electroencephalogram (EEG) to identify when participants entered REM sleep. Upon detection of REM, they softly played sound cues linked to lucidity and the rescripted dreams. These cues were intended to trigger a lucid dream and encourage the participants to engage in their new dream scenarios. For instance, one sound cue was a piano chord that participants associated with their new dream while rehearsing it. Another cue included specific words related to the dream, such as “calm” or “family.”
“This research paves the way for innovative methods to optimize sleep, potentially enhancing its benefits and helping individuals wake up feeling more positive,” said Paller, who oversees the Cognitive Neuroscience Program at Northwestern’s Weinberg College of Arts and Sciences.
Study Results
After treatment, all participants reported a reduction in the severity and frequency of their nightmares. For four out of six participants, the intensity of their nightmares even fell below the threshold for nightmare disorder, Mundt indicated.
One participant from the TLR group did not enter REM sleep and therefore did not receive any sound cues. The other two did enter REM sleep during their nap, with one participant signaling lucidity by moving their eyes as planned. While the other participant did not indicate lucidity, both recalled dreams that closely resembled their rescripted dreams.
“When they discussed their dreams, they noted striking similarities to the scenarios they had reshaped,” Mundt stated. “This is particularly remarkable— post-TLR procedure, they experienced elements of the dreams they had created, a phenomenon not typically witnessed in individuals undergoing CBT-N.”
Due to the small number of participants, researchers did not compare the groups (CBT-N vs. CBT-N plus TLR). Instead, this study serves as a proof-of-concept that TLR can be adapted for treating narcolepsy-related nightmares.
Participants reported feeling less anxious and embarrassed about their nightmares after the therapy.
“This has been an empowering experience for them,” Mundt remarked. “They are often amazed by the effectiveness of this approach. It enhances their confidence in managing their symptoms and they express gratitude for the help they have received. It truly transforms their mental outlook.”
