Commonly Asked Questions About Narcolepsy

Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis and hallucinations. This disorder is equally common among males and females, affecting approximately 1 in 2,000 people.

People with narcolepsy, known as narcoleptics, typically feel very sleepy during the day and may involuntarily fall asleep during normal activities. The borderline between being awake and asleep can become distorted so characteristics of sleep may occur while an individual is awake. These sleep-like characteristics may include experiencing dream-like hallucinations and paralysis as they are falling asleep or waking up.

For narcoleptics, REM sleep occurs almost immediately in the sleep cycle, even sometimes during waking hours. REM sleep is when someone experiences dream and muscle paralysis.

What is Narcolepsy?

Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis and hallucinations. This disorder is equally common among males and females, affecting approximately 1 in 2,000 people. Symptoms typically appear in childhood or adolescence, but many people have an onset of symptoms of narcolepsy for years before being diagnosed.

Types of Narcolepsy

Narcolepsy symptoms can vary, some cases are more severe There are two main types of narcolepsy: Narcolepsy Type 1 and Narcolepsy Type 2.

Narcolepsy Type 1

This type of narcolepsy involves a combination of excessive daytime sleepiness and cataplexy. Cataplexy is when someone has sudden strong emotional outbursts, like laughter, anger, shock or surprise. Cataplexy can cause a sudden collapse of someone’s physical abilities. During a cataplexy episode, the patient can lose muscle tone while being awake and they can also lose control of the muscles in their face, arms, legs or torso. Cataplexy can cause slurred speech, buckling knees or even complete paralysis in more severe cases.

Narcolepsy Type 2

This type of narcolepsy occurs when someone experiences excessive sleepiness, but cataplexy is not present. These people may take a nap for a couple of hours and wake up feeling rejuvenated, though end up feeling overly tired a short time after. A person with narcolepsy type 2 has all the symptoms of narcolepsy type 1, like extreme sleepiness, sleep attacks, dream-like hallucinations, paralysis while falling asleep or waking up and disrupted nighttime sleep.

Narcolepsy Symptoms

Narcolepsy symptoms differ among patients. In some people, they may be mild and in other people, symptoms can be severe and impact many aspects of their life. Narcolepsy symptoms can include:

• Sleepiness. Sleepiness, especially daytime sleepiness, may interfere with normal activities daily, whether or not an individual gets sufficient sleep at night. Individuals who experience excessive sleepiness report confusion, a lack of energy and concentration, memory lapses, depression and extreme exhaustion.
• Cataplexy. The symptom of cataplexy consists of a sudden loss of muscle tone that results in feelings of weakness and loss of voluntary muscle control. Cataplexy can cause slurred speech or total body collapse, depending on the muscles involved. Intense emotions like surprise, laughter or anger can trigger cataplexy.
• Hallucinations. Hallucinations may be present in people with narcolepsy. These delusional experiences can be frightening. The content is primarily visual, but any of the other senses can be involved. An example would be feeling that there is a stranger in the bedroom, but not seeing anybody. These hallucinations may be particularly vivid and terrifying because the patient may not be fully asleep when they begin dreaming, and they experience their dreams as reality.
• Sleep Paralysis. Sleep paralysis involves the temporary inability to move or speak while falling asleep or waking up. These occurrences are usually brief, lasting a few seconds to several minutes. After they end, individuals rapidly recover their full ability to move and speak.

Causes of Narcolepsy

Though there are questions about the causes of narcolepsy doctors suggest that it may be an inherited condition that links to a chemical in the brain. The brain of the individual thinks it needs to stay awake, causing confusion in a healthy sleeping routine. As a result, narcoleptics can experience excessive daytime sleepiness as well as sleeping problems at night. Injuries to the brain, tumors and other diseases that affect the brain can also lead to the development of narcolepsy.

How is Narcolepsy Diagnosed?

Narcolepsy can be challenging to diagnose because some of its symptoms, like fatigue, are common for busy lifestyles, stress, depression and other disorders. People will often live with symptoms for several years before being diagnosed with narcolepsy. A clinician can diagnose narcolepsy through a process of examinations and medical history review.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptoms of a narcolepsy diagnosis include:

• Excessive daytime sleepiness
• Interrupted nighttime sleep
• Experience cataplexy, hallucinations or sleep paralysis

Narcolepsy tests and exams are based on:

• Physical examination and an assessment of symptoms
• Evaluation of personal and family medical history
• Sleep study (polysomnography)
• Measurement of hypocretin levels in the spinal fluid
• Neurologic exam to elicit features supporting the diagnosis and to exclude other causes of sleepiness (such as insufficient sleep or sleep apnea)

Some of the sleep studies consist of an overnight stay so the physicians can study all stages of a patient’s sleep. Other clinical tests and examinations may be conducted to eliminate possible causes to the symptoms.

Who Is at Risk for Narcolepsy?

Some known risk factors for developing narcolepsy may include:

• Family history of narcolepsy
• Low levels of histamine in blood
• Autoimmune disorders
• Certain infections
• Brain injuries (due to disorders) disease or trauma
• Exposure to heavy metals, second-hand smoke or pesticides

Use of over-the-counter drugs that causes drowsiness and being between the ages of 10-20 years can also increase someone ’s risk of having narcolepsy. It is important to note that having one or more risk factors does not mean the person will develop the condition; it simply increases their chances of developing narcolepsy compared to someone without the risk factors.

Someone may have narcolepsy without having any of risk factors. However, the more risks someone has, the higher their chances of having the disorder.

Narcolepsy Statistics

Sleep disorder statistics suggest that only 25 percent of people who have narcolepsy have been diagnosed and are receiving treatment. Symptoms of narcolepsy typically have an onset between the ages of 10 and 20, although narcolepsy can occur at any age.

If you are or a loved one is struggling with a substance use or co-occurring disorder, like narcolepsy, The Recovery Village can help.  A team of professionals provides a number of treatment programs for substance use and co-occurring disorders. Call and speak with a representative to learn more about which treatment program could work for you.

Editor – Jennifer Kopf

Jennifer Kopf is a Florida-based writer who likes to balance creative writing with helpful and informative pieces. Her passion for helping people has translated into writing about the importance of treatment for substance use and mental health disorders. Read more

Medically Reviewed By – Krisi Herron, LCDC

Krisi Herron is an Adjunct Psychology Professor, a Licensed Chemical Dependency Counselor and a freelance writer who contributes to several mental health blogs. Read more