A new pilot study has revealed a promising method for treating nightmares in people with narcolepsy. Researchers at Northwestern Medicine explored a unique combination of therapies to help people overcome the distressing dreams that often accompany this sleep disorder.

About the study

The small clinical trial included six participants, all living with narcolepsy. The study tested a blend of cognitive behavioral therapy for nightmares (CBT-N) and a technique called targeted lucidity reactivation (TLR).

Cognitive behavioral therapy for nightmares

During the first phase of the study, participants attended weekly telehealth sessions focused on CBT-N. These sessions taught them about nightmares, healthy sleep habits and bedtime relaxation techniques. Participants also learned to rescript their nightmares — rewriting them as dreams they’d prefer to have — and practiced visualizing these revised dreams before falling asleep.

Inducing lucid dreams

In the study’s fifth week, researchers introduced TLR to half the participants. TLR aims to induce lucid dreams, where the dreamer is aware they are dreaming and can potentially influence the dream’s content.

To implement TLR, scientists monitored the participants’ brain activity using EEG to identify when they entered REM sleep, the stage of sleep when vivid dreaming occurs. At this point, they played cues, like a piano chord or keywords, associated with the participants’ rescripted dreams. The goal was to guide their dreams toward the positive scenarios they had rehearsed.

Promising findings

The study, published in the Journal of Sleep Research in Oct. 2024, showed encouraging results:

  • Reduction in nightmare severity and frequency: All participants reported fewer and less severe nightmares after treatment.
  • Improved emotional response: Participants felt less anxious and ashamed of their nightmares.
  • Lucid dreaming success: Two participants who underwent TLR recalled dreams similar to their rescripted versions, indicating the technique may help alter the content of nightmares.

This research provided both proof of concept for the use of TLR as well as supporting preliminary evidence for CBT-N in the treatment of narcolepsy-related nightmares.

Understanding narcolepsy and nightmares

What is narcolepsy?

Narcolepsy is a chronic neurological disorder that affects the brain’s ability to regulate sleep-wake cycles. Symptoms include excessive daytime sleepiness, sleep-related hallucinations, sleep paralysis, fragmented sleep and cataplexy (sudden muscle weakness triggered by strong emotions).

The connection between narcolepsy and nightmares

People with narcolepsy often experience vivid, frightening dreams more frequently than the general population. Studies show that the frequency of nightmares in individuals with narcolepsy varies, with 29% to 41.5% experiencing frequent nightmares or nightmare disorder. For instance, a 2022 study found that 39% of those with narcolepsy type 1 and 29% with narcolepsy type 2 reported frequent nightmares, while a 2014 study identified nightmares in one-third of patients.

Lucid dreaming is also more common in this group, which may make them particularly suited to treatments like TLR.

Treating nightmares

Nightmare treatments often include therapy techniques like counseling, imagery rehearsal therapy, systematic desensitization or stress management. These approaches focus on addressing underlying causes, reshaping frightening dream outcomes, reducing emotional responses to distressing content, and lowering stress levels to improve sleep quality.

The combination of CBT-N and TLR could represent a new, non-invasive option for managing nightmares in people with narcolepsy.

Looking ahead

This first-of-its-kind study highlights a potential breakthrough for treating narcolepsy-related nightmares. By blending CBT-N with techniques to induce lucid dreaming, researchers are providing hope for those living with the dual challenge of narcolepsy and frequent nightmares. As this research develops, it may offer a better quality of sleep for many people.

Anyone who has a sleep problem can use the AASM’s sleep center directory to get help from the sleep team at an accredited sleep center.

Medical review by Dionne M. Morgan, MBBS, FCCP

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Authored by: Kate Robards