Healthy Living
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Narcolepsy

Narcolepsy

Narcolepsy is a sleep disorder in which you suddenly and unexpectedly fall asleep during the day. It can cause extreme daytime drowsiness and other symptoms that affect your well-being and quality of life.

At present, there is no cure for narcolepsy. However, this sleep disorder can be effectively managed using a combination of medications and lifestyle behaviors that can help you control your symptoms.

Symptoms of Narcolepsy

There are two types of narcolepsy: type 1 (with cataplexy) and type 2 (without cataplexy).

Cataplexy is the sudden loss of muscle tone. This condition can lead to slurred speech and all-over-body muscle weakness. It is usually triggered by intense emotions like excitement or surprise and cannot be controlled. Cataplexy is thought to be caused by low levels of a brain chemical called hypocretin, which is responsible for preventing you from entering deep sleep during the day.

People with type 2 narcolepsy have normal levels of hypocretin and do not experience cataplexy. In the United States, the prevalence of type 1 narcolepsy is 14 per 100,000 people, and the prevalence of type 2 narcolepsy is 65.4 per 100,000 people.

Symptoms of narcolepsy may include:

  • Extreme daytime drowsiness and sleepiness
  • Falling asleep at any time without warning
  • Difficulty staying awake
  • Difficulty focusing
  • Waking frequently at night
  • Hallucinations
  • Sleep paralysis
  • Automatic behaviors after falling asleep, such as continuing to drive or eat

Causes of Narcolepsy

The exact cause of narcolepsy remains unknown, especially since not everyone with this sleep disorder has low levels of hypocretin. Some researchers think low levels of hypocretin may be linked to genetics.

Other possible causes of narcolepsy include:

  • Family history of narcolepsy or another sleep disorder
  • Upper airway infection
  • Head injury
  • Stroke
  • Stress
  • Sarcoidosis (a condition that occurs when groups of immune system cells form inflamed lumps in organs throughout the body)
  • Exposure to toxins
  • Autoimmune disorders

Diagnosing Narcolepsy

If you think you have narcolepsy, your doctor may review your personal and family medical histories to determine whether you meet any of the risk factors for this sleep disorder. Then, your doctor may refer you to a sleep specialist for an overnight sleep study and/or daytime sleep test.

During a sleep study, a team of specialists will monitor your vitals and behaviors while you sleep. For instance, in cases of suspected narcolepsy, you may be monitored during a daytime nap to determine how deeply you sleep and how quickly you move into the rapid eye movement (REM) sleep phase.

Common sleep evaluations and tests for narcolepsy include:

  • Spinal fluid test, to check your brain’s levels of hypocretin
  • Polysomnography (PSG), a sleep study in a hospital or sleep clinic
  • Epworth sleepiness scale (ESS), which is a simple questionnaire about your sleep behaviors
  • Keeping a sleep diary to track your sleep patterns and behaviors
  • Multiple sleep latency test (MSLT), which determines how long it takes you to fall asleep during the day and how quickly you enter the REM sleep phase

Treatments for Narcolepsy

Narcolepsy is often a lifelong condition that cannot be cured. However, some symptoms may be successfully managed with medications.

Medications used to treat narcolepsy include:

  • Stimulants like amphetamines, which can help you stay awake during the day
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs)—these medications can help you avoid entering the REM sleep phase during the day and reduce narcolepsy symptoms including cataplexy, sleep paralysis, and hallucinations
  • Tricyclic antidepressants, such as clomipramine and protriptyline, which may prevent cataplexy
  • Sodium oxybate (Xyrem) and oxybate salts, which may also prevent cataplexy and help you sleep better at night
  • Pitolisant, which may help prevent daytime sleepiness
  • Sedatives such as benzodiazepines, which are commonly used to treat insomnia and can help you sleep better at night

Tips on Living With Narcolepsy

Certain behaviors may help you successfully cope with narcolepsy, manage your symptoms, and prevent this sleep disorder from affecting your productivity and quality of life. You can take steps to manage your narcolepsy, including:

  • Establishing a consistent sleep schedule by going to sleep and waking at the same times every day
  • Taking short, 10- to 20-minute naps during the day to combat daytime sleepiness
  • Avoiding the use of alcohol and nicotine, as these substances can disrupt your natural sleep cycle
  • Exercising regularly, which can give you more energy during the daytime hours and naturally induce sleep at night
  • Spending time in the sun, which can help regulate your natural circadian rhythm and sleep cycle
  • Avoiding heavy meals before bedtime, as this can stimulate digestion and make it difficult to fall and stay asleep
  • Implementing a relaxing bedtime routine, such as taking a warm bath, reading, or listening to soothing music
  • Avoiding screens within a few hours before bedtime, as exposure to blue light can disrupt your sleep patterns

Make an appointment with your healthcare provider if you think you may have narcolepsy. Your doctor can refer you to a sleep specialist who can properly diagnose your condition and get you started on a treatment regimen right away.