Narcolepsy may stem from the lack of the neurotransmitter hypocretin. It is a long-term neurological condition that causes fragmented sleep, daytime sleepiness, brain fog, and other symptoms.

It also features abnormal rapid eye movement (REM) sleep and can involve cataplexy, or brief attacks of muscle weakness and tone that can lead to body collapse.

Narcolepsy can range in severity from mild to severe. In severe cases, it can negatively impact social activities, school, work, and overall health and well-being. A person with narcolepsy may fall asleep at any time, such as while talking or driving.

Symptoms tend to appear in a person’s teenage years or early 20s or 30s. In the United States, it is 50% more likely to affect females than males. Experts believe that around 1 in 2,000 people have narcolepsy.

It may affect 135,000–200,000 people in the U.S. at any one time.

This article outlines the symptoms, causes, and treatment options associated with narcolepsy.

What is narcolepsy?

A person with narcolepsy may experience excessive daytime sleepiness.

Narcolepsy is a sleep disorder that features excessive daytime sleepiness.

In a typical sleep cycle, a person will first enter the early stage of sleep, then the deeper sleep stages. This is when REM sleep occurs. It takes around 60–90 minutes to reach the stage of REM sleep.

For people with narcolepsy, however, REM sleep occurs within 15 minutes in the sleep cycle and intermittently during the waking hours. It is during REM sleep that vivid dreams and muscle paralysis occur.

Types of narcolepsy

There are two main types of narcolepsy: type 1 and type 2.

Type 1 involves sleepiness and cataplexy. Tests will show that the person is almost entirely missing a neurotransmitter known as hypocretin. This may occur after an infection triggers an autoimmune condition.

Type 2 mainly involves excessive daytime sleepiness, but there is usually no sudden weakness.

Secondary narcolepsy can result when trauma or a tumor results in damage to the hypothalamus. This is a part of the brain involved in sleep.

Symptoms

The primary symptom of narcolepsy is excessive daytime sleepiness, but it may also involve cataplexy, hypnagogic hallucinations, and sleep paralysis.

It can also disrupt nighttime sleep patterns. Overall, however, a person with narcolepsy usually spends the same amount of time asleep as a person without the condition.

Excessive daytime sleepiness

People with narcolepsy will usually have a persistent feeling of sleepiness with a tendency to doze off at intervals throughout the day, often at inappropriate times.

They may also experience:

• brain fog
• poor concentration
• decreased energy
• memory lapses
• exhaustion
• a depressed mood

Hypnogogic hallucinations

Hypnogogic hallucinations are vivid, often frightening sensory hallucinations that occur while falling asleep. They may result from the blend of wakefulness and dreaming that occurs with REM sleep.

Cataplexy

Cataplexy refers to sudden muscle weakness that affects the face, neck, and knees. Some people will have only mild weakness, such as a head or jaw drop, but some may collapse to the ground.

This weakness is temporary, lasting 2 minutes or less, but it can lead to falls and other accidents.

Triggers include strong emotions, such as surprise, laughter, or anger.

Sleep paralysis

This is an inability to move or speak while falling asleep or waking up. Episodes can last from a few seconds to several minutes. After the episode, people will recover their full capacity to move and speak.

Diagnosis

Initially, doctors may misdiagnose narcolepsy. This is because it tends to resemble other conditions, such as:

• a psychological disorder
• sleep apnea
• restless legs syndrome

In fact, it can take 5–10 years to confirm a diagnosis.

To determine whether or not a person has narcolepsy, the doctor will:

• take a thorough medical and sleep history
• perform a physical examination
• conduct sleep studies, such as polysomnography and a multiple sleep latency test

Sleep studies can help confirm a diagnosis of narcolepsy.

A person will undergo polysomnography in a sleep clinic. They will sleep in the clinic overnight while a machine measures their sleep patterns.

The multiple sleep latency test will take place a few hours after the polysomnography.

Questions a healthcare professional may ask on obtaining a person’s sleep history may include:

• Are you sleepy most of the day?
• How many hours are you sleeping at night?
• Do you feel rested on waking?
• Are your naps refreshing?
• Do you experience unusual sensations as you are falling asleep?
• Are you ever unable to move as you fall asleep or when you first awake?
• Do you have muscle weakness or collapse when laughing or angry?

Keeping a sleep journal may also help with diagnosis.

Outlook

There is currently no cure for narcolepsy, but taking prescription medication and modifying some lifestyle habits can help a person manage the condition and stay safe.

Scientists are investigating how genetic and other factors may affect the condition, and there is hope that they will find more effective treatments with time.

Organizations such as WUN can help people keep up-to-date with the latest developments. They invite people to join in the search for a cure by participating in research projects.

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