Narcolepsy: Symptoms, Causes, and Diagnosis

Narcolepsy is a chronic sleep disorder characterized by a loss of boundaries between sleep and wakefulness. An affected person becomes very tired while awake and may fall into sleep in any relaxing situation during the day, such as sitting on a comfortable chair. Narcolepsy is often accompanied by cataplexy, a partial or total loss of muscle control triggered by strong emotions, such as laughter.

Symptoms of narcolepsy

There are five symptoms of narcolepsy you need to be aware of:

1. Excessive daytime sleepiness – The first symptom people with narcolepsy may experience is daytime sleepiness. Individuals with this disorder are not able to stay fully awake during the day and struggle not to fall asleep in relaxing positions or situations.

That doesn’t mean that those with narcolepsy sleep well at night. They actually have fragmented sleep, waking up 4-5 times a night, which leads to low quality sleep.

2. Cataplexy – Cataplexy is a partial or total loss of control over the body muscles triggered by strong emotions such as laughter, anger, or anxiety. It often affects the muscles of the face, but it can happen to the rest of the body, too. Cataplexy can be harmful because it causes incapacitating paralysis, which can interfere with driving or delicate tasks such as holding a baby.

Cataplexy can also cause psychological damage, causing individuals to avoid situations where they may be facing strong emotions to avoid embarrassment.

Cataplexy occurs mainly because REM sleep is happening at the wrong moment. REM (Rapid Eye Movement) sleep is when most people start dreaming. When we dream, the brain commands the different muscles of the body to go into paralysis so as not to interact with the dream and harm the dreamer. For people who don’t have narcolepsy, this paralysis happens at the right moment. In narcolepsy, individuals’ sleep phases get shifted, and their brains get confused. As a result, REM sleep occurs at the wrong moments when strong emotions get triggered, causing paralysis to the muscles.

3. Hallucinations – People with narcolepsy may have hypnagogic or hypnopompic hallucinations. These are hallucinations that occur during the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic). They can be very vivid and frightening, causing psychological harm to a person.

4. Sleep Paralysis – Those affected by narcolepsy can also experience sleep paralysis, which is an inability to move that happens for a few seconds to a few minutes during waking up or falling asleep. This condition can be very frightening for people who suffer from it, especially when it is combined with hallucinations.

5. Changes in REM Sleep – People who suffer from narcolepsy end up with shifted sleep phases, and their REM occurs at unusual times, which can cause cataplexy or sleepiness in general during the day.

Causes Of Narcolepsy

The exact causes of narcolepsy are unknown, but let’s take a deeper look at what happens inside the brain during narcolepsy.

There is a chemical called hypocretin that is produced in a region of the brain called the hypothalamus. Hypocretin is responsible for regulating sleep-wake cycles so your brain transitions from sleeping to wakeful states in an organized manner.

In narcolepsy, hypocretin levels are low because the cells that are responsible for producing it are killed off by the immune system. The reason why this happens is still not confirmed.

What we know is that the immune system attacks the brain cells that are responsible for producing the sleep-regulating chemicals that help organize sleep-wake cycles. That is why narcolepsy is categorized as an autoimmune disorder.

How Is Narcolepsy Diagnosed

Narcolepsy is diagnosed through multiple specialized tests that are performed in a sleep disorders clinic. These tests are:

Polysomnogram (PSG)
Multiple Sleep Latency Test (MSLT)
Also, questionnaires, such as the Epworth Sleepiness Scale to measure daytime sleepiness

The goal of a PSG is to measure different physical actions of the body while asleep, such as breathing and muscle movements. The results of the test are analyzed by a sleep specialist to determine whether the patient has a sleep disorder.

An MSLT is performed the day after the PSG occurs. It measures how long it takes the patient to fall back to sleep during the day. Patients are asked to take naps during the day, starting after two hours of being awake from a night’s sleep. If someone has narcolepsy, it will take a very short time to fall asleep, usually less than 5 minutes.

Coping Strategies With Narcolepsy

Unfortunately, narcolepsy is a chronic disorder that has no cure yet. However, there are strategies that can help reduce the severity of the symptoms.

The medications that can help with narcolepsy are:

Stimulants
Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants
Sodium oxybate

You must check with a doctor to find out the exact treatment for your case.

There are also lifestyle tips that can help you manage your narcolepsy:

Sticking to a schedule – this would help your body recognize sleeping and waking times, so they don’t get mixed together
Taking naps – this will help you be more awake during the day because you are fulfilling your body’s need to sleep
Avoiding nicotine and alcohol – these substances can worsen the situation
Exercise can help you sleep better at night and be more awake during the day

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About the Author: Karim Mohamed is a sleep researcher who became interested in the topic of sleep because he suffered insomnia, so he started the journey of researching the topic of sleep and educating other people about it.

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