Objective: Besides excessive daytime sleepiness, disturbed nocturnal sleep is a major complaint of patients with narcolepsy. Previously, we showed alterations in skin temperature regulation in narcoleptic patients that were related to increased sleepiness. We here tested the hypothesis that direct control of nocturnal skin temperature might be applied to improve the disturbed sleep of narcoleptic patients.
Methods: Participants were eight patients (5 males) diagnosed with narcolepsy with cataplexy according to the ICSD-2 criteria, age 28.6±6.4 years (mean ± standard deviation), range 18-35 years. During two nights sleep was recorded polysomnographically while proximal and distal skin temperature were manipulated using a comfortable thermosuit that induced skin temperature to slowly cycle with an amplitude of only 0.4°C within the comfortable range normally observed during sleep. Logistic regression was used to evaluate the effect of skin temperature manipulation on the probability of occurrence of different sleep stages and nocturnal wakefulness.
Results: Proximal skin warming significantly suppressed wakefulness and enhanced slow wave sleep (SWS). In contrast, distal skin warming enhanced wakefulness and stage 1 sleep at the cost of SWS and REM sleep. The optimal combination of proximal skin warming and distal skin cooling led to a 160% increase in SWS, a 50% increase in REM-sleep and a 68% decrease in wakefulness, compared to the least beneficial combination of proximal skin cooling and distal skin warming.
Interpretation: Subtle skin temperature manipulations under controlled conditions significantly improved the typical nocturnal sleep problems in narcolepsy.