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Brainstem\u2010cerebellar (BSC) gray matter blood flow (Fg) values in the awake state were r educed below normal (p &lt; 0.05) in both narcolepsy and sleep apnea; in sleep apnea, bihemispheric Fg values were also reduced in the awake state. After sleep onset, Fg paradoxically increased in narcolepsy but decreased further in sleep apnea. Maximal regional Fg changes occurred in BSC regions in both groups of patients. Oral administration of methylphenidate hydrochloride (Ritalin) increased resting Fg values in awake narcoleptics, particularly in BSC regions, but attenuated Fg increases during sleep onset. Regional Fg values during visual dreaming or hypnagogic hallucinations in narcoleptics were maximally increased in right parietooccipital regions.<\/jats:p><jats:p>In narcoleptics, impaired control of sleep\u2010wake and REM mechanisms is attenuated by methylphenidate. 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