Narcolepsy is a disorder of the nervous system that causes
drowsiness and sleep attacks. It’s also known as daytime sleep disorder, or
cataplexy. Narcolepsy isn’t a deadly disease, but accidents that occur during
an episode can cause injuries or be life-threatening.
The symptoms of narcolepsy usually begin between the ages of 10
and 25, and the people who develop the condition earlier than others tend to
have more severe symptoms. Most people with narcolepsy are undiagnosed and
What Are the Symptoms of Narcolepsy?
The symptoms of narcolepsy are related to the processes of rapid
eye movement (REM) sleep. These include a recurrent and irrepressible need to
sleep, a lapse into sleep, and napping occurring within the same day. These symptoms
must occur at least three times per week for at least three months. The person
may report experiencing dreaming, decreased consciousness, and muscle
Excessive daytime drowsiness
is usually the first symptom of narcolepsy. It makes it difficult to
function properly on the job and elsewhere.
A sudden, temporary loss
of muscle tone, also known as cataplexy, can be triggered by intense
emotions. These may include:
The frequency of cataplexy varies. Some people have it several
times per day. Other people experience it a few times per year.
also occur in people with narcolepsy. This is because dreaming is part of REM
sleep. If dreams occur when you’re partially awake, they may seem like reality.
Sleep paralysis is
an inability to move or speak while falling asleep or waking. Episodes last
only a few minutes. Out of all people with narcolepsy, young adults are most
likely to experience sleep paralysis. Sleep paralysis mimics the paralysis seen
during REM sleep and can even occur in people who don’t have narcolepsy.
Narcolepsy is also associated with other disorders such as
obstructive sleep apnea, restless legs syndrome, and insomnia.
What Causes Narcolepsy?
The cause of narcolepsy is unknown. However, people with it have a
decreased amount of a brain protein called hypocretin. Hypocretin helps regulate
your cycles of wakefulness and REM sleep.
Some scientists think low hypocretin levels may be caused by an
autoimmune response. In autoimmune diseases, the immune system attacks healthy
cells. Other factors such as stress, exposure to toxins, and infection also may
play a role in narcolepsy.
Occurrence of Abnormal Sleep Patterns
Sleep occurs in stages. At the beginning of the sleep process,
brain waves slow down. This is when non-rapid eye movement (NREM) sleep occurs.
After 90 minutes to two hours, REM sleep begins. In REM sleep, brain waves
increase. Dreaming and muscle paralysis occur during REM sleep.
People with narcolepsy can suddenly fall asleep, lose muscle
tone, and begin to dream. This may happen no matter what they’re doing or what
time of day it is. When this happens, their REM sleep occurs spontaneously and
they skip NREM sleep. The symptoms of REM sleep happen all at once.
How Is Narcolepsy Diagnosed?
The Center for Narcolepsy at the Stanford University School of
Medicine reports that one in
every 2,000 Americans has narcolepsy. Your doctor will ask you about your
medical history and perform a physical exam. They’ll look for a history of
excessive daytime drowsiness and episodes of sudden loss of muscle tone. Formal
diagnosis may require a sleep study and several tests may be needed to diagnose
Some of these tests include the following:
- The Epworth sleepiness scale (ESS) is
a simple questionnaire. It asks how likely you are to sleep in different
- ActiGraph monitoring keeps track of
how and when you fall asleep. This device is worn like a wristwatch and may be
used together with a sleep diary.
- Multiple sleep latency tests
determine how long it takes you to fall asleep during the day. You’ll need to
take four to five naps, two hours apart.
- Polysomnogram testing requires that
you spend the night in a medical facility. You’ll be monitored while you sleep,
with electrodes attached to your scalp to measure brain activity, heart rate
and rhythm, eye movement, muscle movement, and breathing. This test can also detect
- A spinal tap, or lumbar puncture, is
used to collect cerebrospinal fluid (CSF). Hypocretin in CSF is expected to be
low in people with narcolepsy. For this test, your doctor will insert a thin
needle between two lumbar vertebrae.
Treatment Options for Narcolepsy
Narcolepsy has no cure. It’s a chronic condition that lasts a
lifetime. The goal of treatment is to control symptoms and improve daytime
functioning. Stimulants, lifestyle adjustments, and avoidance of hazardous
activities are all used to treat this disorder. There are several classes of
medications used to treat narcolepsy, including the following:
- Stimulants such as armodafinil and
dextroamphetamine (Dexedrine, DextroStat) and methylphenidate (Ritalin) may be
used to improve wakefulness. Armodafinil is usually the first medication to be
prescribed because it’s the least likely to be abused.
- Tricyclic antidepressants can reduce
cataplexy, sleep paralysis, and hallucinations. These medications can have
unpleasant side effects such as dry mouth and urinary retention.
- Selective norepinephrine reuptake inhibitors,
or SNRIs, can help keep you awake. Norepinephrine is a natural stimulant and a
part of the sympathetic nervous system. Preventing the reabsorption of
norepinephrine prolongs its activity and keeps sleep at bay.
- Xyrem (sodium oxybate) can be used
to help you sleep at night.
- Selective serotonin reuptake
inhibitors, or SSRIs, can help improve your mood.
What You Can Do at Home
Here are some steps you can take to make living with narcolepsy
easier and safer:
- Tell teachers and supervisors about
your condition. If you do fall asleep, they should understand the reason for
- Be aware that some narcolepsy
treatments will cause you to test positive for stimulants on drug screens. Talk
to your employer in advance to prevent misunderstandings.
- Eat light or vegetarian meals during
the day. Don’t eat a heavy meal before important activities.
- Try taking 10-15 minute naps after
- Schedule naps throughout the day.
This may help you avoid daytime drowsiness.
- Avoid nicotine and alcohol. They can
make symptoms worse.
- Exercise regularly. Try exercising
four to five hours before bedtime. This can help you rest better at night. It
can also help keep you alert during the day.
- Some states may limit driving
privileges for people with narcolepsy. Be sure to check with your local
department of motor vehicles. They can help keep you from endangering anyone or
breaking the law.
Living with narcolepsy can be challenging. It can be stressful to
have an episode at an awkward time, and it’s possible for you to injure
yourself or others during an episode. By following the above tips, you can
manage your narcolepsy and continue to live a healthy life.