Dietrich, Meghan P, Pravin, Raam, Furst, Jacob et al. · Healthcare (Basel, Switzerland) · 2025 · DOI
Some people with ME/CFS experience sleep reversal, where they sleep during the day and stay awake at night. This study looked at 2,313 ME/CFS patients to understand how common sleep reversal is and what symptoms go with it. People with sleep reversal reported more severe ME/CFS symptoms overall and greater difficulty with daily activities compared to those with normal sleep patterns.
Sleep disturbance is a hallmark of ME/CFS, but sleep reversal has received limited research attention despite being distressing and functionally impairing for affected patients. Identifying predictive factors for sleep reversal may help clinicians recognize at-risk patients earlier and tailor interventions. Understanding the symptom profile associated with sleep reversal provides clues toward understanding the underlying biological mechanisms driving this dysfunction.
This study cannot establish causality—it does not prove that specific symptoms cause sleep reversal or vice versa. The cross-sectional design captures a single time point, so temporal relationships and whether sleep reversal develops early or late in ME/CFS progression remain unknown. The identified predictors are associations; whether they reflect shared underlying mechanisms or are incidental co-occurrences cannot be determined from this data alone.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Dietrich, Meghan P, Pravin, Raam, Furst, Jacob, & Jason, Leonard A (2025). The Implications and Predictability of Sleep Reversal for People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Machine Learning Approach.. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare13111255
BibTeX
@article{mecfsatlas-dietrich-2025-implications-predictability,
author = {Dietrich, Meghan P and Pravin, Raam and Furst, Jacob and Jason, Leonard A},
title = {The Implications and Predictability of Sleep Reversal for People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Machine Learning Approach.},
journal = {Healthcare (Basel, Switzerland)},
year = {2025},
doi = {10.3390/healthcare13111255},
note = {PubMed: 40508869},
url = {https://www.mecfsatlas.com/evidence/dietrich-2025-implications-predictability},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/dietrich-2025-implications-predictability
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