Imagery Control Therapy and Lucid Dreaming for REM-Related Symptoms in Narcolepsy (ICLDR-NAR Tria)

May 26, 2026 updated by: Institute of Behavioral Sleep Medicine, Colombia

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Detailed Description

Narcolepsy type 1 is a chronic neurological sleep-wake disorder characterized by excessive daytime sleepiness, cataplexy, and REM sleep dissociation phenomena, including hypnagogic hallucinations and sleep paralysis. Although pharmacological therapies are effective for managing daytime sleepiness and cataplexy, treatment options for REM-related perceptual symptoms remain limited. Hypnagogic hallucinations and sleep paralysis are frequently associated with emotional distress, impaired quality of life, anxiety, and sleep disruption.

Lucid dreaming refers to the awareness of dreaming while the dream is occurring and may involve the ability to voluntarily influence dream content. Previous studies have suggested that lucid dreaming training and imagery-based cognitive techniques may reduce emotional distress associated with nightmares and other disturbing dream experiences. Given the high prevalence of lucid dreaming experiences among patients with narcolepsy, these strategies may represent a promising behavioral approach for REM-related symptoms.

This study was designed as a randomized controlled longitudinal trial to evaluate the efficacy of a cognitive behavioral intervention integrating lucid dreaming training and imagery control therapy in patients with narcolepsy type 1. The study was conducted between March 2023 and April 2025 using synchronous telehealth sessions delivered through a secure videoconferencing platform.

A total of 98 participants with clinically and polysomnographically confirmed narcolepsy type 1 were recruited from specialized sleep medicine centers in Colombia and Costa Rica. Eligible participants were adults presenting clinically significant hypnagogic hallucinations and/or sleep paralysis and receiving stable pharmacological treatment. Participants with severe psychiatric disorders, dissociative disorders, or active substance use disorders were excluded.

Participants were randomly assigned to one of two groups:

Experimental group (n = 49): received six weekly 90-minute sessions of cognitive behavioral therapy for narcolepsy (CBT-NAR) integrating lucid dreaming training and imagery control therapy in addition to stable pharmacological treatment.

Control group (n = 49): continued standard pharmacological treatment with structured clinical follow-up and sleep hygiene psychoeducation focused on sleep-wake regularity, scheduled naps, healthy sleep habits, and general education about narcolepsy.

The intervention was delivered by trained clinical psychologists specialized in behavioral sleep medicine. Treatment components included:

Psychoeducation about narcolepsy and REM-related symptoms. Dream diary monitoring and dream awareness training. Lucid dreaming induction and maintenance techniques. Reality testing and metacognitive strategies. Imagery rehearsal therapy (IRT) and imagery restructuring techniques. Emotional regulation and coping strategies within lucid dreams. Relapse prevention and guided autonomous practice.

Primary outcomes were reductions in the frequency and distress associated with hypnagogic hallucinations and sleep paralysis. Secondary outcomes included subjective sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI), narcolepsy symptom severity assessed with the Narcolepsy Severity Scale (NSS), dream-related metacognitive variables assessed with the LUCID Scale, and quality of life assessed with the SF-36 questionnaire.

Assessments were conducted at baseline, post-treatment, 6-month follow-up, and 12-month follow-up. Statistical analyses included descriptive statistics, Student's t-tests, Cohen's d effect sizes, mixed-effects longitudinal models, and multiple linear regression analyses. Missing data were handled under the missing-at-random assumption using mixed-effects modeling.

The study hypothesized that systematic lucid dreaming training and imagery control techniques would reduce the frequency and emotional distress associated with REM-related symptoms while improving sleep quality, emotional regulation, and quality of life. Preliminary findings demonstrated clinically significant and sustained reductions in REM-related symptoms, improvements in dream-related metacognitive variables, and better subjective sleep quality and emotional well-being in the intervention group compared with controls.

Study Type

Interventional

Enrollment (Actual)

98

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Colombia
    • Antioquia
      • Medellín, Antioquia, Colombia, 050021
        • Bahavioral Sleep Medicine Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults aged ≥18 years diagnosed with Narcolepsy Type 1, confirmed by clinical evaluation and polysomnography.
  • Experiencing clinically significant hypnagogic hallucinations and/or sleep paralysis.
  • Stable pharmacological treatment for narcolepsy, such as modafinil and/or methylphenidate.
  • Able and willing to provide informed consent electronically.
  • Available to participate in six weekly virtual intervention sessions.
  • Willing to adhere to structured medical follow-up, including sleep hygiene education, nap guidance, sleep habit stabilization, and participation in sleep schedule programs.

Exclusion Criteria:

  • Presence of severe psychiatric disorders or dissociative disorders. Active use of psychoactive substances during the study period.
  • Participation in other interventions targeting lucid dreaming or imagery rehearsal during the trial.
  • Any medical or cognitive condition that, in the investigator's judgment, would interfere with participation or adherence to the intervention.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental: CBT-NAR With Lucid Dreaming and Imagery Control Therapy
Participants received six weekly 90-minute sessions of cognitive behavioral therapy for narcolepsy (CBT-NAR) integrating lucid dreaming training and imagery control therapy, delivered via synchronous telehealth by trained clinical psychologists specialized in behavioral sleep medicine. The intervention included psychoeducation on narcolepsy and REM-related symptoms, dream diary training, lucid dreaming induction techniques, metacognitive strategies, imagery rehearsal therapy (IRT), emotional regulation techniques, relapse prevention, and sleep hygiene education focused on sleep-wake regularity and scheduled nap regulation. Participants continued stable pharmacological treatment throughout the study.
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.
Active Comparator: Active Comparator: Standard Treatment and Sleep Hygiene Education
Participants continued stable standard pharmacological treatment for narcolepsy combined with structured clinical follow-up and psychoeducation in sleep hygiene. Sleep hygiene education included recommendations regarding sleep-wake schedule regularity, scheduled naps, healthy sleep habits, and general education about narcolepsy. No lucid dreaming training, imagery control techniques, or metacognitive dream interventions were administered to this group.
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Frequency and Distress of REM-Related Symptoms (Hypnagogic Hallucinations and Sleep Paralysis) measured by Narcolepsy Severity Scale (NSS)
Time Frame: Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.
The primary outcome is the change in frequency and subjective distress of hypnagogic hallucinations and sleep paralysis in patients with narcolepsy type 1. Symptoms are assessed using the Narcolepsy Severity Scale (NSS), a validated self-report instrument where each item is scored 0-5; higher scores indicate greater severity. Structured clinical evaluations supplement the NSS to evaluate reductions in REM-related intrusion symptoms and associated emotional burden following the behavioral intervention.
Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Subjective Sleep Quality Assessed by the Pittsburgh Sleep Quality Index (PSQI)
Time Frame: Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.
Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), a validated self-report instrument consisting of 7 components, each scored 0-3, with a total score range of 0-21. Lower total scores indicate better sleep quality. The measure assessed perceived sleep quality, sleep disturbances, sleep fragmentation, and overall sleep-related impairment. Changes in PSQI scores were used to evaluate improvement in subjective sleep quality following the intervention.
Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Dream-Related Metacognitive Variables Assessed by the Lucidity and Consciousness in Dreams Scale (LuCiD)
Time Frame: Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.
Dream-related metacognitive variables were assessed using the Lucidity and Consciousness in Dreams Scale (LuCiD), a validated self-report instrument with 28 items across 8 subscales: Insight, Control, Thought, Realism, Memory, Dissociation, Positive Emotion, and Negative Emotion. Each item is scored on a 0-5 Likert scale, with higher scores indicating greater dream awareness, control, or emotional intensity. The study evaluated whether the intervention improved metacognitive awareness and emotional regulation related to REM sleep experiences.
Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.
Change in Health-Related Quality of Life Assessed by the Short Form 36 Health Survey (SF-36)
Time Frame: Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up
Health-related quality of life was evaluated using the Short Form 36 Health Survey (SF-36), a validated self-report instrument with 8 subscales: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Each subscale is scored 0-100, with higher scores indicating better health status. Norm-based scoring uses a population mean of 50 (SD = 10) for each subscale. Changes in SF-36 scores were used to assess improvements in overall and domain-specific quality of life following the intervention.
Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Institute of Behavioral Sleep Medicine, Colombia

Investigators

  • Study Chair: IVAN FRANCISCO IF ALVAREZ OROZCO, MD, MS, PhD (c), Neumocenter, Valledupar, Colombia
  • Study Chair: Ulises U Jiménez Correa, MS, PhD, Seep Disorder Clínic, Research Division, Faculty of Medicine, National Autonomous University of Mexico
  • Principal Investigator: HERNAN ANDRES HA MARIN AGUDELO, MS, PhD, Postdoctoral Research, BEHAVIORAL SLEEP MEDICINE INSTITUTE
  • Study Chair: JENNY J JURADO HERNANDEZ, MD, MS, HOSPITAL MILITAR CENTRAL BOGOTÁ
  • Study Chair: Liliana L Estrada Chaverri, MD, MS, Sleep Med Costa Rica / Sleep Disorders Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2024

Primary Completion (Actual)

June 1, 2025

Study Completion (Actual)

June 15, 2025

Study Registration Dates

First Submitted

May 17, 2026

First Submitted That Met QC Criteria

May 21, 2026

First Posted (Actual)

May 27, 2026

Study Record Updates

Last Update Posted (Actual)

May 28, 2026

Last Update Submitted That Met QC Criteria

May 26, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IMCS0198646478
  • 98646478 (Other Identifier: BEHAVIORAL SLEEP MEDICINE INSTITUTE)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

There is no plan to share individual participant data (IPD). In accordance with Colombian regulations on personal data protection and processing (Law 1581 of 2012 and related regulations), clinical and sensitive participant information is protected under strict confidentiality, privacy, and restricted data handling principles. Access to study data will be limited to authorized members of the research team and relevant regulatory or ethics authorities, in compliance with applicable regulations and the informed consent provided by participants.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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