Pandemic Linked With Circadian Misalignment, Exacerbation of Narcolepsy Symptoms

Amid the coronavirus disease 2019 pandemic, patients with narcolepsy reported changes in bedtime and waking schedules, as well as an increase in adverse symptoms such as cataplexy and sleep paralysis.

Amid the coronavirus disease 2019 (COVID-19) pandemic, patients with narcolepsy reported changes in bedtime and waking schedules, as well as an increase in adverse symptoms such as cataplexy and sleep paralysis, according to study findings published in the Journal of Clinical Sleep Medicine.

Along with the threat of infection, changes in daily routine emerged as a significant issue amid the pandemic, particularly in patients who need to have their routine regulated by factors such as work and physical activity. As researchers of the study noted, these related effects could have an extensive impact on those with narcolepsy, a chronic sleep disorder whose symptoms of excessive daytime sleepiness and cataplexy could be further exacerbated by changes in one’s circadian rhythm.

In a recent study examining effects of COVID-19 quarantine, researchers indicated that respondents were found to be going to bed later and getting up earlier, with consequent poor sleep quality, decreased total sleep time, and circadian misalignment all associated with the study cohort. They sought to examine the potential impact on patients with narcolepsy, who they highlight have yet to be examined on the effects of the pandemic, particularly in relation to sleep schedules, symptoms, need for medication, work, income, and quality of life.

Exploring these factors and their potential influence on sleep, circadian timing, and narcolepsy symptoms, researchers recruited 76 patients with narcolepsy from São Paulo, Brazil, who had been in quarantine for at least 3 months (mean age = 36.9 years; 68.7% diagnosed with narcolepsy type 1).

“In Brazil, the effects of the COVID-19 outbreak have gone beyond the direct action of the virus, because of the collateral damage it has caused in respect of unemployment, financial hardship and a reduction in quality of life,” explained researchers. “These impacts have been amplified in Brazil because of the level of social inequality found in the country, and they have particularly affected vulnerable patients with rare diseases, such as the narcolepsy population.”

In the study, respondents completed a 36-question online survey that polled them on the conditions of the quarantine, sleep-related behaviors, and factors known to affect sleep and circadian rhythms, including work status, income, appetite, narcolepsy symptoms, and medication, as well as the quality of life during the quarantine period.

After assessing cohort responses, researchers found that routines of surveyed patients with narcolepsy had been altered by quarantine, notably, changes in their place of work and in sleep and wake times, which resulted in altered sleep patterns in the majority of respondents. Additionally, an increase in narcolepsy symptoms were reported, involving cataplexy, sleep paralysis, hallucinations, nocturnal awakenings, and excessive daytime sleepiness (P < .01).

There was no association found between changes in the place of work and narcolepsy symptoms, as well as fewer intake of antidepressant pills and increased intake of stimulants. Self-reported quality of life was also found to have decreased among more than half (n = 39) of the cohort, with appetite found to be increased during quarantine.

“Our results can be used as an evidence base to promote actions to treat narcolepsy patients in this new situation,” wrote the study authors. “These should include reinforcing the importance of creating a daily exercise routine, increasing exposure to sunlight, and eating and napping at regular times.”


Aguilar ACR, Frange C, Huebra L, Gomes ACD, Tufik S, Coelho FMS. The effects of the COVID-19 pandemic on patients with narcolepsy. J Clin Sleep Med. Published online October 30, 2020. doi:10.5664/jcsm.8952