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Manipulation of skin temperature improves nocturnal sleep in narcolepsy
  1. R Fronczek1,2,
  2. R J E M Raymann1,
  3. S Overeem2,3,
  4. N Romeijn1,
  5. J G van Dijk2,
  6. G J Lammers2,
  7. E J W Van Someren1,4
  1. 1
    Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
  2. 2
    Department of Clinical Neurology and Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3
    Center for Sleep–Wake Disorders “Kempenhaeghe,” Heeze, The Netherlands
  4. 4
    Department of Clinical Neurophysiology, Neurology and Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
  1. Dr R Fronczek, Leiden University Medical Centre, Department of Neurology (K5Q), PO Box 9600, 2300 RC, Leiden, The Netherlands; r.fronczek{at}


Objective: Besides excessive daytime sleepiness, disturbed nocturnal sleep is a major complaint of patients with narcolepsy. Previously, alterations in skin temperature regulation in narcoleptic patients have been shown to be related to increased sleepiness. This study tests 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 (five males) diagnosed as having narcolepsy with cataplexy according to the ICSD-2 criteria, mean (SD) age 28.6 (6.4) years, 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 cycle slowly 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 with 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.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Medical Ethics Committees of the Academic Medical Center in Amsterdam and the Leiden University Medical Center.

  • Patient consent: Obtained.