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

26 maja 2026 zaktualizowane przez: 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.

Przegląd badań

Status

Zakończony

Warunki

Interwencja / Leczenie

Szczegółowy opis

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.

Typ studiów

Interwencyjne

Zapisy (Rzeczywisty)

98

Faza

  • Nie dotyczy

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

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

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

  • Dorosły
  • Starszy dorosły

Akceptuje zdrowych ochotników

Nie

Opis

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.

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Pojedynczy

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Eksperymentalny: 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.
Behawioralne: 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.
Aktywny komparator: 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.
Behawioralne: 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.

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Change in Frequency and Distress of REM-Related Symptoms (Hypnagogic Hallucinations and Sleep Paralysis) measured by Narcolepsy Severity Scale (NSS)
Ramy czasowe: 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.

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Change in Subjective Sleep Quality Assessed by the Pittsburgh Sleep Quality Index (PSQI)
Ramy czasowe: 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.

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
Change in Dream-Related Metacognitive Variables Assessed by the Lucidity and Consciousness in Dreams Scale (LuCiD)
Ramy czasowe: 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)
Ramy czasowe: 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

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

Institute of Behavioral Sleep Medicine, Colombia

Śledczy

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

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

1 marca 2024

Zakończenie podstawowe (Rzeczywisty)

1 czerwca 2025

Ukończenie studiów (Rzeczywisty)

15 czerwca 2025

Daty rejestracji na studia

Pierwszy przesłany

17 maja 2026

Pierwszy przesłany, który spełnia kryteria kontroli jakości

21 maja 2026

Pierwszy wysłany (Rzeczywisty)

27 maja 2026

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

28 maja 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

26 maja 2026

Ostatnia weryfikacja

1 maja 2026

Więcej informacji

Terminy związane z tym badaniem

Słowa kluczowe

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

  • IMCS0198646478
  • 98646478 (Inny identyfikator: BEHAVIORAL SLEEP MEDICINE INSTITUTE)

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

NIE

Opis planu IPD

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.

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Nie

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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