Does a Chronobiologic Defect Exist in Narcolepsy?

  • Janet Mullington
  • Roger Broughton


The hypothesis that the sleep/wake changes inherent in the narcolepsy—cataplexy syndrome might be caused by a biological rhythm disturbance was introduced at the First International Conference on Narcolepsy in Montpellier (Kripke, 1976). This proposition was in part based on the prior observations that diurnal sleep is increased and nocturnal sleep decreased in narcolepsy and that, after abrupt phase shifting of the sleep/wake schedule, normal subjects experience fatigue during the new “subjective day,” at times experience insomnia and, like patients with narcolepsy, can show REM onset sleep during the new subjective night (Weitzman, Kripke, Goldmacher, McGregor, and Nogeire, 1970; Kripke, Lewis, and Cook, 1971). Kripke’s thesis was that circadian rhythm desynchronization may underlie both the nocturnal sleep disruption and daytime wake maintenance problems in narcolepsy, and that the pattern of multiple sleep episodes during the day might be due to intrusion of intensified ultradian oscillators into a weak and insufficient circadian synchronizing system. Kripke’s seminal article also contains the insightful statement antedating later postulates of problems of state boundary control when he wrote (Kripke, 1976, p. 479):

“Narcolepsy is a great teacher that we should not regard sleep or the sleep stages as unitary states, but rather as various components which may become qualitatively or quantitatively dissociated.”


Circadian Rhythm NREM Sleep Biological Rhythm Nocturnal Sleep Multiple Sleep Latency Test 
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Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Janet Mullington
    • 1
  • Roger Broughton
    • 2
  1. 1.Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Division of NeurologyOttawa General Hospital, University of OttawaOttawaCanada

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