Navigating the Neurophysiology of Sleep and Cataplexy: The Significance of Select Neurotransmitters

This activity is part of a series


Michael J. Thorpy, MD
Professor of Neurology, Albert Einstein College of Medicine
Director, Sleep-Wake Disorders Center, Department of Neurology
Montefiore Medical Center, Bronx, NY
President, New York State Society of Sleep Medicine
Past President, Sleep Section of the Academy of Neurology
Michael J. Thorpy, MD

Dr. Thorpy is a Professor of Neurology at Albert Einstein College of Medicine and Director of the Sleep-Wake Disorders Center in the Department of Neurology at Montefiore Medical Center, both in New York. In addition to treating patients with sleep disorders, he conducts research in narcolepsy, insomnia and sleep apnea. He is President of the New York State Society of Sleep Medicine, Past President of the Sleep Section of the Academy of Neurology, and Past Secretary of the National Sleep Foundation. In 1993 Dr. Thorpy received the Nathaniel Kleitman Award from the American Academy of Sleep Medicine, one of the field’s highest honors, and in 2012 he received the Lifetime Achievement Award from the National Sleep Foundation.

Born in New Zealand, Dr. Thorpy earned his medical degree from the University of Otago Medical School. After receiving postgraduate training in Dunedin, New Zealand; Bombay, India; and London, England, he completed his residency in neurology at the State University of New York in Syracuse and a neuroendocrinology fellowship at Albert Einstein College of Medicine and Montefiore Medical Center. Dr. Thorpy is board certified in sleep medicine.

He has published extensively on narcolepsy, insomnia, and sleep disorders. He chaired the first International Classification of Sleep Disorders and has published more than 250 peer-reviewed articles and chapters, including publications in journals such as The New England Journal of Medicine. His numerous books include “The Encyclopedia of Sleep and Sleep Disorders“, ‘ ‘Parasomnias’ (2010), ‘Sleepiness” (2011), ‘Neuroimaging of Sleep and Sleep Disorders’ (2012), ‘Genetics of Sleep and Sleep Disorders’ (2013), ‘Narcolepsy: a clinical guide’ (2016),  and ‘SleepMultiMedia, a computerized textbook of sleep medicine’ (v12).0 (2023)

Dr. Thorpy has given more than 100 television, radio, and print interviews on sleep disorders.

Phyllis C. Zee, MD, PhD
Professor of Neurology, Northwestern University Feinberg School of Medicine
Director, Sleep Disorders Center, Northwestern Memorial Hospital, Chicago, IL
Phyllis C. Zee, MD, PhD

Phyllis C. Zee, MD, PhD is the Benjamin and Virginia T. Boshes Professor in Neurology and Professor of Neurobiology at Northwestern University. She is also the Director of the Center for Circadian and Sleep Medicine (CCSM) and Chief of the Division of Sleep Medicine at Northwestern University’s Feinberg School of Medicine. As Director of CCSM, Dr. Zee oversees an interdisciplinary program in basic and translational sleep and circadian rhythm research, and findings from her team have paved the way for innovative approaches to improve sleep and circadian health.

A central theme of Dr. Zee’s research program is understanding the role of circadian-sleep interactions on the expression and development of cardiometabolic and neurologic disorders. Her research has focused on the effects of age and neurodegeneration on sleep and circadian rhythms and pathophysiology of sleep-wake disorders. In addition, her laboratory is studying the effects of circadian-sleep based interventions, such as exercise, bright light and feed-fast schedules on cognitive, cardiovascular and metabolic functions and their potential to delay cardiometabolic aging and neurodegeneration.

Dr. Zee also has authored more than 300 peer reviewed original articles, reviews, and chapters on the topics of sleep, circadian rhythms, and sleep/wake disorders. She has also trained over 50 pre-doctoral and post-doctoral students and has mentored numerous faculty members.

Dr. Zee is a fellow of the American Academy of Sleep Medicine, a member of the American Academy of Neurology and member of the American Neurological Association. She has served on numerous national and international committees, NIH scientific review panels, and international advisory boards. She is past President of the Sleep Research Society, past President of the Sleep Research Foundation, past Chair of the NIH Sleep Disorders Research Advisory Board, a past member of the NIH National Heart Lung and Blood Disorders Advisory Council and is the current President-Elect of the World Sleep Society.

Dr. Zee is the recipient of the 2011 American Academy of Neurology Sleep Science Award, the 2014 American Academy of Sleep Medicine academic honor, the William C. Dement Academic Achievement Award, and the 2020 Sleep Research Society Distinguished Scientist Award and the 2021 NSF Lifetime Achievement Award.

Statement of Need

Sleep is a complex physiological process that is mediated by a number of neurotransmitters — including histamine, acetylcholine, dopamine, gamma-amino butyric acid (GABA), norepinephrine, serotonin, glutamate, histamine, and orexin (or hypocretin). The interaction of these various neurotransmitters play different roles in the sleep-wake cycle to promote sleep and/or wakefulness in patients with narcolepsy. It is imperative that clinicians differentiate the neurotransmitters involved in the sleep-wake cycle and, when making treatment selections, apply knowledge of how novel therapies target those neurotransmitters to exert their clinical effect.

Join Drs. Thorpy and Zee in part two of a CMEOCast series on excessive daytime sleepiness (EDS) in narcolepsy as they walk clinicians through identifying the mechanisms of action (MOAs) of novel therapies and differentiating the neurotransmitters involved when individualizing therapy selection for optimal outcomes.

Learning Objectives

At the end of this CME/CE activity, participants should be able to differentiate the neurotransmitters involved in cataplexy and the sleep-wake cycle, including their differential impact on wakefulness.

Financial Support

Supported by an educational grant from Harmony Biosciences, LLC.

Target Audience

Physicians, PAs, nurse practitioners, nurses, and pharmacists specializing in psychiatry and/or primary care.

Credit Information

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Physicians (ACCME) 1.0

CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note to Nurse Practitioners

Nurse Practitioners can apply for AMA PRA Category 1 Credit through the American Academy of Nurse Practitioners (AANP). AANP will accept AMA PRA Category 1 Credit  from organizations accredited by the Accreditation Council for Continuing Medical Education. Nurse practitioners can also apply for credit through their state boards.

Note for California Nurses

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters LLC’s provider number is CEP15510.


Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Royal College MOC

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MIPS Improvement Activity

This activity counts towards MIPS Improvement Activity requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Nurses (ANCC) 0.5

This activity is designated for 0.5 contact hours.

Disclosure Declaration

it is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigate any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Thorpy reports the following financial relationships: Advisory Board/Consultant: Axsome Therapeutics, Inc.; Balance Therapeutics; Eisai Inc.; Flamel Technologies/Avadel; Harmony Biosciences, LLC; Jazz Pharmaceuticals, Inc.; NLS Pharmaceutics; Suven Life Sciences Limited; Takeda Pharmaceutical Company Limited; and XWPharma

Dr. Zee reports the following financial relationships: Consultant: Eisai Inc.; Harmony Biosciences, LLC; Idorsia Pharmaceuticals US Inc.; Jazz Pharmaceuticals, Inc.; Sanofi-Aventis; and Takeda Pharmaceutical Company Limited. Grants: Vanda Pharmaceuticals (Paid to Northwestern University)

Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

  • Marlon (Tony) Graham, MD
  • Kashemi D. Rorie, PhD (planning committee)
  • Evan Luberger(planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credit

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NOTE: Pharmacist CE Universal Activity Number, Enduring: JA0007185-0000-22-031-H01-P.


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Navigating the Neurophysiology of Sleep and Cataplexy: The Significance of Select Neurotransmitters
Event Date: 05/09/2022