Impact of Cognitive Behavioral Therapy on Parasomnias
Condition: Parasomnia
MeSH terms: Parasomnias; Sleep Wake Disorders
Study type: Interventional

Summary: 
      This research aims to determine whether cognitive behavioral therapy can effectively reduce
      parasomnias in a sample of 20 adult outpatients with Non-REM and REM parasomnias. A secondary
      objective is to assess whether treatment produces improvements in daytime energy, mood, and
      anxiety symptoms, as well as functional impairment (work/leisure activities).
    

Detailed description: 
      Sleep wake disorders are prevalent and impactful conditions often poorly assessed and
      sub-optimally treated in the clinical setting. Undiagnosed sleep disorders can masquerade as
      mental health conditions and worsen the outcomes associated with these conditions. Further,
      sleep disorders can develop from mental health conditions and the reverse is also true
      (particularly for mood disorders). Successful treatment of sleep disorders requires a
      targeted approach.

      Parasomnias are unwanted physical or mental events that occur during sleep or during arousal
      from sleep. The states of wakefulness, NREM, and REM are normally distinct and occur in an
      organized and predictable pattern over the 24-hour period. However, in parasomnias, aspects
      of more than one state co-occur and intermix. There are four types of parasomnias identified
      by the Diagnostic and Statistical Manual of Mental Disorders ( DSM 5). These include two NREM
      parasomnias: sleepwalking and sleep terrors, and two REM parasomnias: nightmare disorder and
      REM sleep behaviour disorder (RSBD). Lifetime prevalence of these conditions ranges from 6.9%
      (sleepwalking) to 67% (nightmare disorder).

      In general, NREM parasomnia events are primed by conditions that increase sleep pressure and
      triggered by sleep-disrupting factors. They are more likely to occur following sleep
      restriction or deprivation, when SWS rebounds. Immediate triggers of sleepwalking in adults
      are sleep disruptions associated with sleep-disordered breathing, periodic limb movements,
      noises and touch. Pilon et al. induced episodes in adult sleepwalkers, but not in
      non-sleepwalkers, with specific auditory stimuli and this effect was accentuated under
      conditions of prior sleep deprivation.

      Currently accepted interventions for parasomnias include pharmacological and psychological
      treatments. Pharmacological interventions involve the use of sedating medications
      (benzodiazepines, tricyclic antidepressants) or alpha-1 blocker (Prazosin).

      Cognitive Behavioral Therapy. Psychological treatments primarily rely on cognitive behavioral
      therapy to achieve better sleep hygiene, reduced hyperarousal, and to teach the ability to
      practice with reducing cognitive arousal during the sleep period through planned rehearsal
      and scheduled awakenings. There are no well elaborated and systematic treatment packages for
      Non-REM parasomnias and so this protocol will represent an innovation in this area.
      Therefore, the purpose of the study is to develop and test such a package.

      Self-Monitoring of Sleep. Self-monitoring of disturbed sleep has been shown to produce small
      but significant positive impacts on some aspects of sleep (e.g., insomnia). As there is no
      widely accepted placebo for parasomnia treatment, this is viewed as an adequate control
      condition.

      Objectives This research aims to determine whether cognitive behavioral therapy can
      effectively reduce parasomnias in a sample of 20 adult outpatients with Non-REM and REM
      parasomnias. A secondary objective is to assess whether treatment produces improvements in
      daytime energy, mood, and anxiety symptoms, as well as functional impairment (work/leisure
      activities). The hypotheses of the study are that participants who receive a 6-week program
      CBT-p therapy will report fewer episodes of parasomnia than those who self-monitor their
      sleep for 6 weeks, and will have objectively better sleep as measured by the prodigy and
      actigraphy at one-week (T2) post treatment and at two months post treatment (T3).

      METHODS Trial Design This will be a single-blind randomized controlled trial with two
      conditions.
    

Intervention name(s): CBT for parasomnias (CBT-p); Self-Monitoring
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Psychoeducation, sleep hygiene, imagery re-scripting, scheduled awakenings, safety planning, cognitive therapy, and stress management for 6 weeks; Monitoring of sleep quality through sleep diary, actigraphy, nightmare experiences for 6 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 (group) X 3 (time)
Masking: Single (Participant)
Primary purpose: Treatment