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Targeted Lucidity Reactivation May Help Ease Narcolepsy-Related Nightmares
Results from a pilot study of patients with narcolepsy provide proof-of-concept evidence that a procedure called targeted lucidity reactivation can be adapted for narcolepsy-related nightmares, a common but often overlooked symptom of the neurological disorder.
Researchers published the findings in the Journal of Sleep Research.
The study included 6 adult patients with a decades-long history of frequent narcolepsy-related nightmares who received cognitive behavioral therapy for nightmares (CBT-N) adapted for narcolepsy via weekly telehealth sessions. In addition to learning about nightmares, sleep habits, and mood and relaxation improvement before bedtime, participants learned “rescripting”: how to rewrite nightmares into more preferable dreams and rehearse the scripts before falling asleep.
“We had them imagine what they’d like to dream instead of their nightmare, almost like they’re writing a movie script,” said corresponding author Jennifer Mundt, PhD, of the Center for Circadian and Sleep Medicine at the Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Half the participants received 7 CBT-N sessions, and half received 6 CBT-N sessions plus a single session of targeted lucidity reactivation. The latter is informed by previous research suggesting individuals can interact with researchers during rapid eye movement (REM) sleep. For this study, the team used electroencephalogram to determine when participants entered REM sleep and then softly played sound cues, such as a piano chord or the words “calm” or “family,” that patients associated with lucidity and rescripted dreams.
Because of the small number of participants, researchers did not compare the 2 treatment groups. However, they found all patients rated their nightmares as less frequent and less severe after treatment. Nightmare severity fell below the cutoff for nightmare disorder for 4 participants.
In the targeted lucidity reactivation group, 1 patient did not enter into REM sleep and consequently did not receive any sound cues. Another patient signaled being lucid by moving their eyes back and forth as planned during REM sleep, while the third did not signal at all. However, both participants recalled dreams similar to their rescripted dreams.
“This is really unique — that after the targeted lucidity reactivation procedure they experienced aspects of the dream ideas they concocted — since people undergoing CBT-N don’t usually experience their rescripted dream,” said Dr Mundt.
Study participants also reported decreased shame and anxiety about their nightmares after treatment.
“It’s empowering for them,” Dr Mundt said. “They’re so surprised this works. It increases self-efficacy for managing their symptoms, and they describe how glad they are that this helped. It’s really a game-changer, mentally.”
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