Imagery Rehearsal Therapy for Nightmares in Narcolepsy

(DAWN Trial)

Overseen By Jennifer Mundt, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Disqualifiers: Psychotherapy, Previous treatment, Sleep apnea, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 9 weeks

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a non-medication treatment called Imagery Rehearsal Therapy can reduce nightmares in people with narcolepsy, a sleep disorder that causes excessive daytime sleepiness and sudden sleep attacks. Participants will undergo assessments; some will start the therapy immediately, while others will begin after a short wait. Those with narcolepsy who experience weekly nightmares, along with their partners, may qualify to join. Partners will complete assessments but will not participate in the therapy. As an unphased trial, this study offers participants the chance to contribute to innovative research that may improve the quality of life for those with narcolepsy.

Will I have to stop taking my current medications?

No, you won't have to stop taking your current medications. However, your sleep and psychiatric medications need to be stable for at least one month before the study and remain stable during the study.

What prior data suggests that Imagery Rehearsal Therapy is safe for reducing nightmares in adults with narcolepsy?

Research shows that Imagery Rehearsal Therapy (IRT) is generally safe for treating nightmares. Studies have found that it can significantly reduce nightmare frequency and improve sleep quality. In these studies, patients reported no serious side effects from the therapy.

For some people, the therapy may not work as well, with about 30% of patients not seeing improvement. However, no evidence suggests that trying the therapy is harmful.

Overall, IRT is well-tolerated and shows promise in reducing nightmares without causing negative effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Imagery Rehearsal Therapy (IRT) for nightmares in narcolepsy because it offers a novel, non-drug approach to addressing a common and distressing symptom of the condition. Unlike typical treatments for narcolepsy-related nightmares, which often involve medications like sodium oxybate or antidepressants, IRT uses a cognitive-behavioral technique to help patients consciously change their disturbing dreams. This method empowers patients to take control of their nightmares by mentally rehearsing new, more positive dream scenarios, potentially reducing the frequency and intensity of nightmares without the side effects associated with medication. This innovative approach could significantly improve the quality of life for individuals living with narcolepsy.

What evidence suggests that Imagery Rehearsal Therapy is effective for reducing nightmares in narcolepsy?

Research shows that Imagery Rehearsal Therapy (IRT) can help reduce nightmares. Studies have found that IRT lowers the frequency of nightmares, improves sleep quality, and eases stress or trauma symptoms. One study, in particular, noted a significant drop in both the number of nightmares and the distress they cause after using this therapy. IRT involves imagining nightmares with positive changes, making them less upsetting. Although specific data on nightmares related to narcolepsy is limited, IRT's success with other types of nightmares is encouraging. Participants in this trial will receive the IRT intervention either immediately or after a waiting period, allowing for a comparison of its effects on nightmares in individuals with narcolepsy. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

Adults over 18 with narcolepsy type 1 or type 2, experiencing at least one nightmare per week, living in the U.S., and who have had stable sleep and medication patterns for a month. Participants must speak English. Romantic partners of participants can also join for assessments.

Inclusion Criteria

I experience nightmares at least once a week.

I live in the United States.

I can speak, read, and write in English.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the behavioral treatment for nightmares. Half of the participants receive the treatment immediately after the first assessment, and the other half after the second assessment.

9 weeks

3 assessments (baseline, 10 weeks, 19 weeks)

Follow-up

Participants are monitored for safety and effectiveness after treatment through assessments.

9 weeks

1 assessment (19 weeks)

What Are the Treatments Tested in This Trial?

Interventions

• Imagery Rehearsal Therapy

Trial Overview The trial is testing Imagery Rehearsal Therapy (IRT) to see if it helps reduce nightmares in adults with narcolepsy. Everyone gets the therapy but at different times: half start after the first assessment, half after the second.

How Is the Trial Designed?

Group I: Waitlist Experimental Treatment 1 Intervention

The Waitlist arm will undergo a waiting period following the first assessment and then will receive the treatment after the second assessment.

Group II: Treatment Experimental Treatment 1 Intervention

The Treatment arm will receive the intervention immediately following the first assessment.

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12012161/

Treating narcolepsy‐related nightmares with cognitive ... This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT‐N), adapted for narcolepsy, in a small group of adults.

2. jcsm.aasm.org jcsm.aasm.org/doi/10.5664/jcsm.7178

Position Paper for the Treatment of Nightmare Disorder in Adults IRT is a modified cognitive behavioral therapy technique which involves altering the content of a nightmare by creating a new set of positive ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0013700623000210

The effectiveness of lucid dreaming therapy in patients with ... Most of the included studies found LDT effective in reducing nightmare frequency among adults with chronic and recurring nightmares.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4120639/

A Meta-analysis of Imagery Rehearsal for Post-trauma ... Results indicate that imagery rehearsal had large effects on nightmare frequency, sleep quality, and PTSD symptoms. These effects were sustained through 6 to 12 ...

5. researchgate.net researchgate.net/publication/8130147_Impact_of_Imagery_Rehearsal_Treatment_on_Distressing_Dreams_Psychological_Distress_and_Sleep_Parameters_in_Nightmare_Patients

Impact of Imagery Rehearsal Treatment on Distressing ... Post-treatment, significant reductions were observed in retrospective nightmare frequency (d = 1.06, p = .007), prospective bad dream frequency ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9013762/

Nightmare Rescripting: Using Imagery Techniques to Treat ... However, during follow-up evaluations (at 3 and 6 months), the patients reported that the frequency and number of their nightmares were significantly reduced, ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S0960982222014774

Enhancing imagery rehearsal therapy for nightmares with ... Although IRT appears to be effective in the management of nightmares, approximately 30% of patients are unresponsive to this treatment.

8. medrxiv.org medrxiv.org/content/10.1101/2022.02.17.22270256v1.full

Combined treatment of nightmares with targeted memory ... Results We found that the patients of the TMR group had less frequent nightmares (p=.026, Cohen's d=1.05) and more positive dream emotions (p=.

9. sciencedirect.com sciencedirect.com/science/article/pii/S0022395624007465

Imagery rehearsal therapy for the treatment of nightmares ... Nightmare symptoms. In both participant and clinician ratings, impairment through nightmares decreased significantly during treatment (participants: F(14,3) = ...