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What is Narcolepsy? Symptoms, Causes, and Treatment Options

Narcolepsy is a sleep disorder often surrounded by misconceptions. It is marked by profound drowsiness, leading to professional and social difficulties. Furthermore, it increases the risk of accidents and injuries because of sudden muscle weakness. This resource will explain what narcolepsy is, symptoms, causes, and treatment options.

While relatively uncommon when compared to other sleep disorders, narcolepsy impacts the lives of a significant number of individuals across different age groups, affecting both children and adults. Gaining a comprehensive understanding of the various types of narcolepsy and their specific symptoms and learning how to treat narcolepsy is essential for individuals to manage their condition more effectively.

What is Narcolepsy?

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and disrupted sleep patterns. It affects the brain’s ability to regulate sleep-wake cycles, leading to difficulties in maintaining wakefulness during the day and disturbances in nighttime sleep. 

Types of Narcolepsy

Narcolepsy is generally classified into two main types: type 1 and type 2. But there are also other subtypes of the condition. Understanding the different types of narcolepsy can provide insights into the specific symptoms associated with each of them.

Narcolepsy Type 1 (NT1)

Narcolepsy type 1, known as narcolepsy with cataplexy, is the most well-known and severe form of narcolepsy. Individuals with NT1 experience excessive daytime sleepiness and sudden loss of muscle tone, known as cataplexy. Cataplexy is often triggered by intense emotions such as laughter, surprise, or anger. People with NT1 commonly experience sleep paralysis, hallucinations, and disrupted nighttime sleep. The underlying cause of NT1 is a deficiency of hypocretin/orexin, a neurotransmitter involved in regulating wakefulness and REM sleep. Treatment of cataplexy and narcolepsy usually includes medications such as antidepressants and changes in sleep routines.  

Narcolepsy Type 2 (NT2)

People with NT2 experience all the symptoms of narcolepsy, such as excessive daytime sleepiness, daytime sleep attacks, sleep paralysis, and hallucinations, but without cataplexy. While the cause of NT2 is not fully understood, it is believed to involve a less severe deficiency of hypocretin/orexin than NT1. Despite the absence of cataplexy, NT2 can still significantly impact an individual’s daily life and require treatment for managing excessive daytime sleepiness.

Secondary Narcolepsy

Secondary narcolepsy is narcolepsy-like symptoms arising from another medical condition or an external factor. For example, certain neurological disorders, such as brain tumors, traumatic brain injuries, or autoimmune disorders like multiple sclerosis, can lead to symptoms resembling narcolepsy. Medications, substance abuse, or sleep disorders like sleep apnea may also trigger narcolepsy-like symptoms. Treating the underlying cause is essential in addressing secondary narcolepsy.

Childhood-onset Narcolepsy

Narcolepsy can also occur in children, although it is relatively rare. Childhood-onset narcolepsy shares similar symptoms to adult-onset narcolepsy, including excessive daytime sleepiness, cataplexy, hallucinations, and sleep paralysis. However, children may also exhibit symptoms unique to their age groups, such as bedwetting, night awakenings, or the signs of attention deficit hyperactivity disorder (ADHD). 

Managing childhood-onset narcolepsy involves a combination of pharmacological treatments and lifestyle adjustments to ensure proper sleep hygiene.

Symptoms of Narcolepsy

Let’s review the common symptoms of narcolepsy in more detail.

  • Excessive daytime sleepiness (EDS). It is one of the hallmark symptoms of narcolepsy. Individuals with the disorder often experience an overwhelming and persistent sense of tiredness, regardless of how much sleep they get at night. They may need help to stay awake during daily work, studies, or social engagements. This excessive sleepiness can be disruptive and affect their ability to function normally.
  • Sleep attacks. People with narcolepsy may experience sudden and irresistible sleep attacks. They can occur at any time, often without warning. Individuals may fall asleep at inappropriate moments, such as during conversations, eating, or driving. These episodes of sleep can last from a few seconds to several minutes.
  • Cataplexy. Cataplexy is a distinctive symptom of narcolepsy and is characterized by a sudden loss of muscle tone, leading to temporary muscle weakness or paralysis. It is often triggered by intense emotions such as laughter, surprise, or anger. The affected person may experience slurred speech, drooping facial muscles, or collapse. Although cataplexy can be alarming, it is generally brief and resolves independently.
  • Sleep paralysis. Sleep paralysis is a temporary inability to move or speak between sleep and wakefulness. Individuals with narcolepsy may experience sleep paralysis when falling asleep or waking up. During these episodes, they may feel conscious and aware of their surroundings but unable to move or communicate. Sleep paralysis can be accompanied by vivid hallucinations, which can be distressing for some individuals.
  • Fragmented nighttime sleep. Narcolepsy can disrupt the typical sleep architecture, leading to fragmented and disturbed sleep during the night. People with narcolepsy often experience frequent awakenings, vivid dreams, and nightmares. They may also exhibit abnormal behaviors during sleep, such as sleep talking, sleepwalking, or rapid eye movement (REM) sleep behavior disorder.
  • Other symptoms. In addition to the primary symptoms mentioned above, narcolepsy may be associated with other less common symptoms, including automatic behaviors, cognitive difficulties, etc.

All these symptoms can significantly impact a person’s quality of life, affecting their productivity, social interactions, and overall well-being. However, with proper diagnosis and management, individuals with narcolepsy can lead fulfilling lives and effectively manage their symptoms.

Risk Factors of Narcolepsy

Several risk factors have been identified to increase the likelihood of developing narcolepsy. While they do not guarantee the occurrence of narcolepsy, they do contribute to an increased likelihood. It is crucial to consider the following factors when assessing the overall risk:

  • Family history. Heredity is a significant risk factor for narcolepsy, particularly among first-degree relatives. If individuals have first-degree relatives who have been diagnosed with narcolepsy, their own risk of developing the condition increases 20-40 times
  • Environmental factors. Individuals who experience severe sleep disturbances are at a higher risk of developing or intensifying narcolepsy symptoms. Furthermore, certain infections, including upper airway infections, as well as conditions such as head injury, stroke, and sarcoidosis, have the potential to trigger narcolepsy, particularly in individuals who already have a genetic predisposition for the disorder. 
  • Genetic factors. Investigation of genetic factors involved in narcolepsy susceptibility is complicated and still ongoing. Variations in HLA (human leukocyte antigen) genes have been strongly linked to an increased risk of narcolepsy. Additionally, certain other genes, such as T-cell receptor alpha genes, have been found to have an association with the risk of narcolepsy. 
  • Autoimmune response. In certain cases, the body’s immune system mistakenly targets and attacks its own hypocretin-containing brain cells. The destruction or impairment of these crucial brain cells leads to a deficiency of hypocretin, a neuropeptide that plays a vital role in regulating sleep-wake cycles. This autoimmune response is believed to contribute to the development of narcolepsy. 

How is Narcolepsy Treated

There is no cure for narcolepsy, but several treatment options can help manage the symptoms and improve the patient’s quality of life. Treatment choice depends on the severity of symptoms and the individual’s specific needs. Here, we will explore some common options for narcolepsy treatment.

Stimulants

Methylphenidate (brand names Ritalin and Concerta) is a commonly prescribed medication for narcolepsy. It is a stimulant drug that promotes wakefulness and can reduce excessive daytime sleepiness. Also, doctors can prescribe Adderall, which contains amphetamine and helps individuals with narcolepsy stay alert throughout the day. It’s essential to use these medications under the guidance of a healthcare professional, as they can have side effects and may cause dependency if used for a long time.

Selective Serotonin Reuptake Inhibitors (SSRIs)

In cases where narcolepsy is accompanied by cataplexy (sudden loss of muscle tone triggered by emotions), doctors may prescribe selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, venlafaxine, or protriptyline. These medications can help in treating cataplexy episodes by regulating serotonin levels in the brain.

Sodium Oxybate

Sodium oxybate (Xyrem) is another drug for narcolepsy that can improve both daytime sleepiness and cataplexy. It is taken at bedtime and enhances deep sleep, which reduces cataplexy episodes during the day. Sodium oxybate is a controlled substance and requires careful monitoring due to its potential side effects and the risk of abuse.

Lifestyle Modifications

Certain lifestyle modifications can complement pharmacological treatments and improve narcolepsy symptoms. Establishing a regular sleep schedule, maintaining good sleep hygiene, and creating a comfortable sleep environment can help promote better nighttime sleep and reduce daytime sleepiness. Additionally, short scheduled naps throughout the day can provide temporary relief from excessive sleepiness.

Behavioral Therapy

Behavioral therapy, such as cognitive-behavioral therapy for insomnia (CBT-I), can benefit individuals with narcolepsy. CBT-I focuses on identifying and changing negative thoughts and behaviors associated with sleep difficulties. It can help improve sleep quality and reduce sleep-related anxiety or stress.

Supportive Measures

Living with narcolepsy can be challenging, and support from healthcare professionals, family, friends, and support groups can make a significant difference. Educational resources, counseling, and support from others who understand the condition can help individuals cope with the physical and emotional aspects of narcolepsy.

Final Thoughts on Narcolepsy

Thank you for reading this resource on Narcolepsy symptoms, causes, and treatment options. Narcolepsy is a complex neurological disorder that significantly impacts the sleep-wake cycle. Recognizing its symptoms is crucial for early detection and intervention. Each person’s experience with narcolepsy may differ, and treatment plans should be tailored to individual needs.

While there is no cure for narcolepsy, various treatments can help manage its symptoms. Certain antidepressants, stimulant medications, and sodium oxybate can help alleviate excessive sleepiness, regulate mood, and improve overall sleep quality. Lifestyle modifications, behavioral therapy, and support from healthcare professionals, family, friends, and support groups can complement medications and help to establish effective coping strategies.

By increasing awareness and understanding of narcolepsy, we can promote empathy and support for people with this condition. Seeking medical attention and exploring available treatment options are essential to improve the quality of life for individuals with narcolepsy.

Dr. Taryn Fernandes, MD
Author: Dr. Taryn Fernandes, MD

Born and raised in Northern California, graduated from San Diego State University in 2009 with a Bachelor’s Degree in Biology. Continued my education with a double Master’s degree in healthcare administration and management and biomedical sciences. Finished my education with an MD from Chicago medical school in 2016. Attended internal medicine residency program at Northwestern Medicine and began practicing in 2020. My primary practices have been mental health, medical weight loss, Geriatrics and Regenerative Medicine. My practice philosophy is providing evidence based, patient centered care. I believe mental wellness is the starting point in achieving overall health, happiness and success. With the correct tools and guidance, the possibilities are endless. I am honored to guide patients along their journey to reach their personal health goals.

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