Signs and Symptoms of Narcolepsy

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Narcolepsy: A Serious Sleep Disorder

Narcolepsy is a rare neurological condition that interferes with the brain’s normal wake/sleep/dream cycle. People with narcolepsy have abnormal brain wave patterns when they fall asleep, and they enter dreaming sleep (rapid eye movement or REM sleep) much more quickly than normal after falling asleep. The symptoms of narcolepsy can interfere with daily activities and are profoundly disabling for some sufferers. The disorder is not a direct cause of danger or death, but it carries an increased risk of accidents that can cause injury or death. Fortunately, while the disorder itself cannot be cured, narcolepsy symptoms can be managed with lifestyle changes and, for some, medication.

The First Signs and Symptoms

The primary symptom of narcolepsy, and usually the first to appear, is excessive daytime sleepiness (EDS). People with EDS spend much or all of their waking time feeling abnormally drowsy, even when they get adequate, high-quality sleep every night. They may be difficult to rouse in the morning, and some find it impossible to get out of bed on time. All people with narcolepsy generally have some degree of EDS, but most people with EDS do not have narcolepsy, as this symptom has many other causes.

A related symptom is daytime sleep attacks, in which a person falls asleep suddenly at unexpected times. Often these attacks result in “microsleeps” which last no more than a few seconds. Sleep attacks can happen to narcolepsy sufferers at any time, including while driving, carrying an infant, cooking, swimming, etc. Because of the danger both to sufferers and to those around them, sleep attacks can sharply curtail a person’s activities and independence. Not all narcolepsy sufferers have uncontrollable sleep attacks, and for those who do, this symptom can often be managed or eliminated with treatment.

The Dream-Like Signs and Symptoms

The dream world is a peculiar place, and narcolepsy, which affects dreaming, has some peculiar symptoms. Four dream-like symptoms are common in this disorder:

Cataplexy. In normal dreaming, the body’s muscles are paralyzed to prevent the sleeper from acting out the dream. In cataplexy, this muscle paralysis is triggered while the person is awake. Attacks can last from a few seconds to several days (in the most extreme and rarest cases), during which time the person is completely aware. They can happen a few times a day or a few times in a lifetime. Severity ranges from slight weakness in the knees or slackness in the jaw to full-body paralysis. Cataplexy attacks are typically brought on by extreme emotions, particularly laughter. Cataplexy is the only symptom unique to narcolepsy, but not all narcoleptics experience cataplexy.

Sleep hallucinations. These hallucinations occur at the border between sleep and waking. When experienced while the person is falling asleep, they are called hypnogogic hallucinations; while waking up, they are called hypnopompic hallucinations. They are dreamlike sensations, sometimes frightening, that are experienced as real. Common descriptions include a person (often a bad or evil person) in the room, a weight or even a creature sitting on one’s chest, overheard snatches of conversation, or a feeling of levitation.

Sleep paralysis. Sleep paralysis is like cataplexy in that the person’s voluntary muscles are frozen, but unlike cataplexy, it occurs only at falling asleep or at waking, and lasts only a few seconds or minutes. While it is often reported as frightening, it is harmless, does not cause accidents, and does not interfere with breathing, though sufferers may feel they are suffocating.

Automatic behavior. Sleepwalking is the best known form of automatic behavior, but this symptom can also include talking (even having whole conversations with another person), eating, or driving while asleep. The sufferer performs these tasks poorly (for example, speech during sleep-talking is usually incomprehensible) and does not remember them upon waking.

Any person experiencing unexplained EDS should contact a neurologist to be evaluated for a sleep disorder. Cataplexy, being unique to narcolepsy, is diagnostic, but when there is no history of cataplexy, additional tests are needed to confirm the abnormal brain function of narcolepsy.


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