Imagery Control Therapy and Lucid Dreaming for REM-Related Symptoms in Narcolepsy

Summary

This randomized controlled trial evaluated the efficacy of a cognitive behavioral intervention based on lucid dreaming training and imagery control therapy for reducing REM-related symptoms in patients with narcolepsy type 1. Specifically, the study examined the impact of the intervention on hypnagogic hallucinations and sleep paralysis, which are common and distressing symptoms associated with REM sleep intrusions in narcolepsy.

Ninety-eight adults with confirmed narcolepsy type 1 were randomly assigned to either an experimental intervention group or a control group receiving standard pharmacological treatment, structured clinical follow-up, and sleep hygiene psychoeducation. The intervention consisted of six weekly 90-minute telehealth sessions integrating psychoeducation, dream awareness training, lucid dreaming induction techniques, imagery rehearsal therapy (IRT), metacognitive strategies, emotional regulation, and relapse prevention.

Primary outcomes included changes in the frequency and distress associated with hypnagogic hallucinations and sleep paralysis. Secondary outcomes included subjective sleep quality, metacognitive dream-related variables, and quality of life. Participants were assessed at baseline, post-treatment, and at 6- and 12-month follow-up evaluations.

The study aimed to determine whether behavioral interventions targeting dream awareness, emotional regulation, and metacognitive control could complement pharmacological treatment and improve REM-related symptoms and sleep-related quality of life in narcolepsy.

Conditions

• Narcolepsy Type 1
• Hypnagogic Hallucinations
• Sleep Paralysis
• REM Sleep Intrusion Symptoms
• Central Disorders of Hypersomnolence

Interventions

BEHAVIORAL

Cognitive Behavioral Therapy for Narcolepsy (CBT-NAR) With Lucid Dreaming and Imagery Control Therapy

A structured six-session behavioral intervention designed for patients with narcolepsy type 1 experiencing REM-related symptoms such as hypnagogic hallucinations and sleep paralysis. The intervention integrated cognitive behavioral therapy for narcolepsy (CBT-NAR), lucid dreaming training, and imagery control techniques. Components included psychoeducation about narcolepsy and REM sleep physiology, dream diary monitoring, dream awareness training, lucid dreaming induction and maintenance strategies, reality testing, metacognitive techniques, imagery rehearsal therapy (IRT), emotional regulation strategies, modification of distressing dream content, relapse prevention, and sleep hygiene education focused on sleep-wake regularity and scheduled nap regulation. Sessions were delivered weekly via synchronous telehealth by trained clinical psychologists specialized in behavioral sleep medicine while participants continued stable pharmacological treatment.

BEHAVIORAL

Sleep Hygiene Education and Structured Clinical Follow-up

Participants received structured clinical follow-up and behavioral sleep hygiene psychoeducation while continuing stable pharmacological treatment for narcolepsy. The intervention included education regarding sleep-wake schedule regularity, scheduled naps, healthy sleep habits, management of daytime sleepiness, and general education about narcolepsy and REM-related symptoms. Sessions were delivered remotely through synchronous telehealth contacts with a frequency comparable to routine clinical follow-up. No lucid dreaming training, imagery control techniques, imagery rehearsal therapy, or metacognitive dream interventions were provided in this comparator arm.

Sponsors & Collaborators

• Institute of Behavioral Sleep Medicine, Colombia

  lead OTHER

Principal Investigators

• IVAN FRANCISCO IF ALVAREZ OROZCO, MD, MS, PhD (c) · Neumocenter, Valledupar, Colombia

• Ulises U Jiménez Correa, MS, PhD · Seep Disorder Clínic, Research Division, Faculty of Medicine, National Autonomous University of Mexico

• HERNAN ANDRES HA MARIN AGUDELO, MS, PhD, Postdoctoral Research · BEHAVIORAL SLEEP MEDICINE INSTITUTE

• JENNY J JURADO HERNANDEZ, MD, MS · HOSPITAL MILITAR CENTRAL BOGOTÁ

• Liliana L Estrada Chaverri, MD, MS · Sleep Med Costa Rica / Sleep Disorders Medical Center

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-03-01

Primary Completion

2025-06-01

Completion

2025-06-15

Countries

• Colombia

Study Locations