Mental Imagery and Targeted Memory Reactivation in Insomnia

In this clinical trial, the investigators test whether mental Imagery Rescripting (IR), a technique where the individual is instructed to transform a negative memory or image into a positive one, and olfactory Targeted Memory Reactivation (TMR), a technique used to strengthen memories, can reduce hyperarousal and insomnia severity in patients with Insomnia Disorder (ID).

Patients with ID will be randomized into four groups: in the first group (SH group), patients will have 4 weekly sessions (1 session/week) of a minimal intervention for insomnia (sleep hygiene information) in the presence of an odorless diffuser, which will be also used during the night. In the second group (IR group), patients will use IR during wakefulness to induce a state of relaxation and positive emotionality. More specifically, during 4 weekly sessions of IR, patients will imagine a negative scenario related to their pre-sleep images or current concerns (e.g., social interactions, self-image, sleep problem, nightmares) and transform it into a positive script. They will then perform IR every day for 4 weeks at home in the presence of an odorless diffuser, which will be also used during the night. In the third group, patients will undergo the same 4 weekly IR sessions and an odor will be paired to the positive imagery and will be diffused during the night (TMR group). Patients from this group will also perform IR every day for 4 weeks at home. Finally, the fourth group (OA group) will receive 4 weekly sessions of sleep hygiene instructions in the presence of an odor, which will be also used during the night.

Clinical evaluation of insomnia severity before and after the intervention will take place using the Insomnia Severity Index (ISI, primary outcome measure).

At the end of these interventions, patients with persistent symptoms will benefit from an alternative experimental treatment ("rocking bed") in which they will be cradled for one night.

The investigators hypothesize that patients treated with IR will have significantly reduced insomnia severity compared to participants who received a minimal intervention. They also hypothesize that patients of the TMR group, will have more reduced ID severity compared to participants performing IR and with an odorless diffuser, therefore without an association (IR group). Finally, they hypothesize that one night of sleeping in a rocking bed will improve objective measures of sleep in ID compared to a stationary condition.

Study Overview

• Status: Recruiting
• Conditions: Insomnia Disorder
• Intervention / Treatment: Behavioral: Sleep Hygiene; Other: "Rocking bed" if patients still have insomnia complaints (ISI >10) after the 4 weeks of the intervention; Behavioral: Imagery Rescripting (IR); Behavioral: Imagery Rescripting (IR) and Targeted Memory Reactivation (TMR) during sleep; Behavioral: Sleep Hygiene + Odor

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lampros Perogamvros; Phone Number: +41223729946; Email: Lampros.Perogamvros@hcuge.ch
• Study Contact Backup: Name: Kevin Mammeri; Phone Number: +33627694534; Email: Kevin.Mammeri@unige.ch

Study Locations

• Switzerland
  • Geneva, Switzerland
    • Recruiting
    • Center for Sleep Medicine
    • Contact: Lampros Perogamvros; Phone Number: +41223729946; Email: Lampros.Perogamvros@hcuge.ch
    • Principal Investigator: Lampros Perogamvros

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and 45 years
• Insomnia disorder according to the International Classification of Diseases 3 (ICSD-3)
• ISI > 10
• PSQI > 5
• No other current treatment for Insomnia

Exclusion Criteria:

• patients with another psychiatric disorder requiring acute treatment according to DSM-5
• patients with medical (e.g. neurological disorders) or other disorders explaining the predominant complaint of insomnia (e.g., sleep apneas with ODI>15/h, restless legs syndrome, periodic limb movements with PLM>15, chronic pain)
• patients with significant substance use/withdrawal
• patients with heavy smoking
• known pregnancy
• patients suffering from anosmia, olfactory related issues and respiratory pathology

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Sleep Hygiene (SH); Participants will receive 4 weekly individual sessions of standardized instructions on sleep hygiene, that they will be asked to apply every day for 4 weeks. Each session will consist of providing patients with advice to help their sleep without any CBT-I or other complementary medicine components. They will also have an odorless diffuser being diffused at the end of each weekly individual session and during the night.	Behavioral: Sleep Hygiene; Sleep hygiene education includes modifications in the behavior (e.g., exercise, coffee, alcohol intake) and environment (e.g., light, noise, temperature conditions) that offer to the individual the foundation for healthy sleep. Sleep hygiene is an important component in treating ID, but insufficient and less effective than CBT-I when offered alone.; Other: "Rocking bed" if patients still have insomnia complaints (ISI >10) after the 4 weeks of the intervention; Rocking stimulation boosts brain oscillations in deep sleep (i.e., sleep spindles and slow oscillations) into a rhythmic appearance supporting a neurophysiological mechanism whereby continuous rocking entrains endogenous thalamo-cortical sleep oscillations. The beneficial effects of rocking strengthening the continuity of sleep might have clinical applications and it will be of interest to evaluate if such non-pharmacological could improve sleep and reduce such features of hyperarousal in ID patients.
Experimental: Imagery Rescripting (IR); Participants will receive 4 weekly individual sessions of IR. The IR technique consists of imagining a negative memory or image as vividly as possible, and of transforming it into a positive one. An odorless diffuser will be presented while imagining the positive imagery generated during IR. During 4 weeks, patients of this group will practice IR at home, every day in bed and have the same odorless diffuser being diffused during the night.	Other: "Rocking bed" if patients still have insomnia complaints (ISI >10) after the 4 weeks of the intervention; Rocking stimulation boosts brain oscillations in deep sleep (i.e., sleep spindles and slow oscillations) into a rhythmic appearance supporting a neurophysiological mechanism whereby continuous rocking entrains endogenous thalamo-cortical sleep oscillations. The beneficial effects of rocking strengthening the continuity of sleep might have clinical applications and it will be of interest to evaluate if such non-pharmacological could improve sleep and reduce such features of hyperarousal in ID patients.; Behavioral: Imagery Rescripting (IR); Imagery rescripting (IR) is a technique where the individual is instructed to imagine a negative memory or image as vividly as possible, and to change it in a direction that he/she desires. IR seems particularly efficient because it is based on the experienced emotions during perceptual information processing, thereby eliciting stronger emotional responses than verbal processing.
Experimental: Targeted Memory Reactivation (TMR); Participants will receive 4 weekly individual sessions of IR, at the end of which, a chosen odor will be presented while imagining the positive imagery generated during IR. During 4 weeks, patients of this group will practice IR at home every day in bed and have the same odor being diffused during the night.	Other: "Rocking bed" if patients still have insomnia complaints (ISI >10) after the 4 weeks of the intervention; Rocking stimulation boosts brain oscillations in deep sleep (i.e., sleep spindles and slow oscillations) into a rhythmic appearance supporting a neurophysiological mechanism whereby continuous rocking entrains endogenous thalamo-cortical sleep oscillations. The beneficial effects of rocking strengthening the continuity of sleep might have clinical applications and it will be of interest to evaluate if such non-pharmacological could improve sleep and reduce such features of hyperarousal in ID patients.; Behavioral: Imagery Rescripting (IR) and Targeted Memory Reactivation (TMR) during sleep; Targeted Memory Reactivation (TMR) is a technique used to strengthen a memory trace during sleep. TMR is used to modify memory formation through the application of cues during sleep. In this TMR protocol, an olfactory cue is associated with the imagery rescripting (IR) during the day, and then administered during sleep. In that way, the replay of the associated memory and its corresponding neural representation in memory networks are artificially promoted, a procedure which usually strengthens memory consolidation. Previous studies have shown that TMR in sleep reduces emotional arousal, making it a promising technique for insomnia.
Active Comparator: Odor Alone (OA); Participants will have a chosen odor diffused during the night for 4 weeks and will receive 4 weekly individual sessions of standardized instructions on sleep hygiene, that they will be asked to apply every day for 4 weeks. The chosen odor will be diffused at the end of each weekly individual session.	Other: "Rocking bed" if patients still have insomnia complaints (ISI >10) after the 4 weeks of the intervention; Rocking stimulation boosts brain oscillations in deep sleep (i.e., sleep spindles and slow oscillations) into a rhythmic appearance supporting a neurophysiological mechanism whereby continuous rocking entrains endogenous thalamo-cortical sleep oscillations. The beneficial effects of rocking strengthening the continuity of sleep might have clinical applications and it will be of interest to evaluate if such non-pharmacological could improve sleep and reduce such features of hyperarousal in ID patients.; Behavioral: Sleep Hygiene + Odor; Sleep hygiene instructions will be applied in the presence of an odor, which will be also used during the night.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Insomnia Severity Index (ISI)	Standardized questionnaire that measures ID severity, the score ranges from 0-28, zero indicating no symptom severity and 28 indicating the higher symptom severity.	Baseline, 5 Weeks and 3 Months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh sleep quality index (PSQI)	Validated self-report scale to assess the quality of sleep, the score ranges from 0-21, zero indicating no symptom severity and 21 indicating the higher symptom severity.	Baseline, 5 Weeks and 3 Months
Total Sleep Time (TST)	Time from sleep onset to sleep offset. This outcome is measured both subjectively and objectively.	Baseline and 5 Weeks
Wake After Sleep Onset (WASO)	Number of awakenings during the night. This outcome is measured both subjectively and objectively.	Baseline and 5 Weeks
Beck Depression Inventory II (BDI-II)	Validated self-report scale to assess depressive symptoms, the score ranges from 0-63, zero indicating no symptom severity and 63 indicating the higher symptom severity.	Baseline, 5 Weeks and 3 Months
State Trait Anxiety Inventory (STAI)	Validated self-report scale to assess anxiety, the score ranges from 20-80, 20 indicating no symptom severity and 80 indicating the higher symptom severity.	Baseline, 5 Weeks and 3 Months
Sleep efficiency (SE)	Ratio between total time spent in bed and total sleep time. This outcome is measured both subjectively and objectively.	Baseline and 5 Weeks
Micro-arousals	Objective measure of micro-awakenings during the night.	Baseline and 5 Weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Temperament and Character Inventory	A 240-item self-administered questionnaire designed to measure 4 temperament and 3 character scales.	Baseline and 5 Weeks
Pre-sleep Arousal Scale (PSAS)	A 16-item self-reported questionnaire designed to measure pre-sleep arousability, the score ranges from 16-80, 16 indicating no symptom severity and 80 indicating the higher symptom severity.	Baseline and 5 Weeks
Arousal Predisposition Scale (APS)	A 12-item self-reported questionnaire designed to measure arousability	Baseline and 5 Weeks
Digit Span Task	A working memory task, asking the participant to repeat a string of numbers which are displayed verbally, exactly as given, for "digits forward," and in reverse order for "digits backward"	Baseline and 5 Weeks
Psychomotor Vigilance Task (PVT)	A sustained-attention, reaction-timed task that measures the speed with which subjects respond to a visual stimulus.	Baseline and 5 Weeks
Declarative word paired-associate learning task	Subjects will be instructed to learn 46 word-pairs with an immediate (pre-sleep) and a delayed one (post-sleep) to assess overnight improvement	Baseline and 5 Weeks
Attachment Style Questionnaire (ASQ)	A 40-item self-reported questionnaire designed to measure attachment style.	Baseline and 5 Weeks

Collaborators and Investigators

• Sponsor: University Hospital, Geneva
• Collaborators: University of Geneva, Switzerland

Study record dates

Study Major Dates

• Study Start (Actual): April 22, 2024
• Primary Completion (Estimated): May 31, 2027
• Study Completion (Estimated): August 31, 2027

Study Registration Dates

• First Submitted: March 21, 2024
• First Submitted That Met QC Criteria: March 21, 2024
• First Posted (Actual): March 28, 2024

Study Record Updates

• Last Update Posted (Actual): April 23, 2024
• Last Update Submitted That Met QC Criteria: April 22, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Insomnia; Imagery; TMR; Odors
• Additional Relevant MeSH Terms: Mental Disorders; Nervous System Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Sleep Initiation and Maintenance Disorders
• Other Study ID Numbers: 2023-00456

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No