Kishi, Akifumi, Togo, Fumiharu, Cook, Dane B et al. · Physiological reports · 2013 · DOI
This study looked at how sleep changes after exercise in healthy people versus those with ME/CFS. Researchers found that while exercise helped healthy people sleep more deeply and continuously, people with ME/CFS showed different sleep patterns—specifically more disruptions when moving from REM sleep (dream sleep) back to wakefulness. Importantly, these REM sleep disruptions in ME/CFS patients were linked to increased fatigue, pain, and sleepiness the next day.
ME/CFS patients frequently report unrefreshing sleep despite adequate sleep duration, but the physiological mechanisms remain unclear. This study provides evidence that REM sleep fragmentation—not simply lack of deep sleep—may be a key factor in why ME/CFS patients wake unrefreshed, opening new avenues for understanding and potentially treating this disabling symptom. Identifying distinct sleep pathophysiology in ME/CFS versus healthy controls strengthens the biological basis for the condition.
This study does not prove that REM fragmentation causes ME/CFS symptoms or that treating REM sleep disruption will improve ME/CFS. As a mechanistic study in a small sample (n=33), findings require replication and do not establish causation. The correlation between REM transitions and next-day fatigue, while intriguing, may reflect association rather than a causal pathway.
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
Kishi, Akifumi, Togo, Fumiharu, Cook, Dane B, Klapholz, Marc, Yamamoto, Yoshiharu, Rapoport, David M, et al. (2013). The effects of exercise on dynamic sleep morphology in healthy controls and patients with chronic fatigue syndrome.. Physiological reports. https://doi.org/10.1002/phy2.152
BibTeX
@article{mecfsatlas-kishi-2013-effects-exercise,
author = {Kishi, Akifumi and Togo, Fumiharu and Cook, Dane B and Klapholz, Marc and Yamamoto, Yoshiharu and Rapoport, David M and Natelson, Benjamin H},
title = {The effects of exercise on dynamic sleep morphology in healthy controls and patients with chronic fatigue syndrome.},
journal = {Physiological reports},
year = {2013},
doi = {10.1002/phy2.152},
note = {PubMed: 24400154},
url = {https://www.mecfsatlas.com/evidence/kishi-2013-effects-exercise},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/kishi-2013-effects-exercise
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