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Narcolepsy

Narcolepsy causes periods of extreme daytime sleepiness. It may also may cause episodes of muscle weakness called cataplexy, hallucinations while falling asleep or waking up, and sleep paralysis.

Overview

People who have narcolepsy often fall into REM sleep quickly and wake up directly from it. As a result, they may have vivid dreams while falling asleep and waking up. People who have narcolepsy may find it hard to function at school, work, home, and in social situations because of extreme tiredness.

Causes

  • Heredity. Up to 10 percent of people who have narcolepsy report having a relative who has the same symptoms.
  • Infections.
  • Brain injuries caused by conditions such as brain tumors, strokes, or trauma such as car accidents or military injuries.
  • Autoimmune disorders. With these disorders, the body’s immune system mistakenly attacks the body’s cells and tissues. An example of an autoimmune disorder is rheumatoid arthritis.
  • Low levels of histamine, a substance in the blood that promotes wakefulness.

Risk Factors

Narcolepsy affects men and women. Symptoms usually begin during the teen or young adult years. The disorder also can develop later in life or in children, but it’s rare before age five.

Signs and Symptoms

Extreme Daytime Sleepiness

All people who have narcolepsy have extreme daytime sleepiness.

Strong emotions such as anger, fear, laughter, or excitement can trigger this sleepiness.

People who have daytime sleepiness often complain of:

  • Mental cloudiness or “fog.”
  • Memory problems or problems focusing.
  • Lack of energy or extreme exhaustion.
  • Depression.

Some people who have narcolepsy have episodes in which they fall asleep suddenly. This is more likely to happen when they’re not active, such as while reading, watching TV, or sitting in a meeting.

However, sleep episodes also may occur in the middle of talking, eating, or another activity. Cataplexy (muscle weakness) also may occur at the same time.

Cataplexy

This condition causes loss of muscle tone while you’re awake. This muscle weakness affects part or all of your body.

Cataplexy may make your head nod or make it hard for you to speak. Muscle weakness also may make your knees weak or cause you to drop things you’re holding. Some people actually fall down.

Strong emotions such as anger, surprise, fear, or laughter often trigger cataplexy. It usually lasts a few seconds or minutes. During this time, you’re usually awake.

Cataplexy may occur weeks to years after you first start to have narcolepsy.

Hallucinations

If you have narcolepsy, you may have vivid dreams while falling asleep, waking up, or dozing. These dreams can feel very real. It may seem like you can see, hear, smell, and taste things you are dreaming about.

Sleep Paralysis

This condition prevents you from moving or speaking while falling asleep or waking up. However, you’re fully conscious during this time. Sleep paralysis usually lasts just a few seconds or minutes, but it can be scary.

Other Symptoms

Most people who have narcolepsy don’t sleep well at night. They may have trouble falling and staying asleep. Vivid, scary dreams may disturb sleep. Not sleeping well at night worsens daytime sleepiness.

Rarely, people who fall asleep in the middle of an activity, such as eating, may continue that activity for a few seconds or minutes. This is called automatic behavior.

During automatic behavior, you’re not aware of your actions, so you don’t do them well. For example, if you’re writing before falling asleep, you may scribble rather than form words. If you’re driving, you may get lost or have an accident. Most people who have this symptom don’t remember what happened while it was going on.

Children who have narcolepsy often have trouble studying, focusing, and remembering things. Also, they may seem hyperactive. Some children who have narcolepsy speed up their activities rather than slow them down.

Children who have narcolepsy may have severe sleepiness. They may fall asleep while talking or eating, or during sporting events and social activities.

Diagnosis

Narcolepsy sometimes is mistaken for learning problems, seizure disorders, or laziness, especially in school-aged children and teens. When narcolepsy symptoms are mild, the disorder is even harder to diagnose.

Your sleep specialist will diagnose narcolepsy based on your signs and symptoms, medical and family histories, diagnostic tests and a physical exam.

Diagnostic Tests like Sleep Studies

If your sleep specialist  thinks you have narcolepsy, he or she will likely suggest a sleep study to find out more about your condition.

Sleep studies usually are done at a sleep center. Doctors use the results from two tests to diagnose narcolepsy. These tests are a polysomnogram (PSG) and a multiple sleep latency test (MSLT.)

Polysomnogram. You usually stay overnight at a sleep center for a PSG. The test records brain activity, eye movements, heart rate, and blood pressure.

Multiple sleep latency test. This daytime sleep study measures how sleepy you are. It’s often done the day after a PSG. During the test, you’re asked to nap for 20 minutes every two hours throughout the day.

Treatment

Medicines

You may need one or more medicines to treat narcolepsy symptoms. These may include stimulants to ease daytime sleepiness and raise your alertness. If you take regular naps when you feel sleepy, you may need less medicine to stay awake.

Lifestyle Changes

Lifestyle changes also may help relieve some narcolepsy symptoms. Specialists may suggest you follow a regular sleep schedule, going to bed and waking up at the same time every day.