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Recognizing and Managing the Symptoms of Narcolepsy

Key takeaways Narcolepsy causes extreme daytime sleepiness, which can lead to dozing off at inappropriate times and difficulty concentrating. Type 1 narcolepsy involves cataplexy, or sudden muscle weakness, that can be triggered by strong emotions, while both types can cause sleep paralysis and hallucinations as you fall asleep or wake up. Lifestyle changes like short naps, regular sleep schedules, and avoiding caffeine, along with medications such as stimulants and SNRIs, can help manage narcolepsy symptoms. Narcolepsy is a rare neurological condition that causes extreme daytime drowsiness and overwhelming urges to sleep. Narcolepsy symptoms usually begin when people are in their teens. However, most diagnoses occur in people 20–40 years old. There are two types of narcolepsy. Type 1 features a sudden loss of muscle tone, known as cataplexy. Type 2 does not have cataplexy as a symptom. What causes narcolepsy is unknown, but people with type 1 usually have lower amounts of hypocretin, a brain protein that regulates sleep-wake cycles. This may be due to a gene mutation. People with a parent or sibling with narcolepsy are up to 40 times more likely to have it. Keep reading to learn more about narcolepsy symptoms and how to manage them. Excessive daytime sleepiness People with type 1 and type 2 narcolepsy experience excessive daytime sleepiness. You may doze off at inappropriate times during the day. Because of this, you may lack energy and have difficulty concentrating. Cataplexy People with type 1 narcolepsy experience cataplexy. This sudden muscle weakness usually occurs in your face, neck, and knees. Cataplexy can be mild, where your head drops, or it can be severe, causing you to collapse. It may look like you're having a seizure, but you're not. Strong emotions like fear or anger, or when you're laughing, may trigger cataplexy. The frequency of cataplexy varies by person. You may experience cataplexy several times a day or only once a year. Medications such as sodium oxybate (Xyrem) and venlafaxine (Effexor) can help prevent cataplexy. Sleep paralysis Narcolepsy may cause you to lose muscle function while falling asleep or waking up. Sleep paralysis is the inability to move or talk during these times. Episodes of sleep paralysis may last from a few seconds to a few minutes. People who don't have narcolepsy may also experience sleep paralysis. According to the American Academy of Sleep Medicine, 5–40% of people experience it. Hallucinations As you fall asleep or wake up, you may hallucinate, seeing vivid images that aren't real. They may seem so realistic that they may scare you, and you may jump out of bed. Most hallucinations are visual. They may also affect your other senses, such as touch, smell, and sound. These visions that occur when you fall asleep are called hypnagogic hallucinations. About one-third of all people have these hallucinations at some point. If you have narcolepsy, you may experience these hallucinations during the day. Other symptoms Some other symptoms associated with narcolepsy include: Fragmented sleep: You may have difficulty falling asleep or staying asleep at night. Automatic behaviors: If you fall asleep while eating, driving, or doing another activity, you may continue to do that activity without consciously knowing it. Immediate rapid eye movement (REM) sleep: People usually begin the REM stage of sleep, during which dreaming occurs, about 60–90 minutes after falling asleep. With narcolepsy, you may enter REM sleep in under 15 minutes after falling asleep and at any time during the day. How can I manage narcolepsy symptoms? Although there is no cure for narcolepsy, you can manage its symptoms with lifestyle strategies and medications. Some lifestyle strategies that may help include the following: Take a few 15- to 20-minute naps during the day if possible. Try to go to bed and wake up at the same times every day. Let your teachers or supervisors know you have narcolepsy and may fall asleep. Get regular physical activity during the week. Avoid heavy meals, caffeine, and alcohol before bedtime. Medications a doctor may prescribe to treat narcolepsy include: stimulants to help reduce excessive daytime sleepiness, such as: armodafinil (Nuvigil) modafinil (Provigil) methylphenidate (Ritalin) serotonin-norepinephrine reuptake inhibitors (SNRIs) to hold off REM sleep and prevent symptoms like cataplexy and hallucinations, such as venlafaxine (Effexor) pitolisant (Wakix), which reduces daytime sleepiness by releasing histamines in your brain When to contact a doctor If your daytime sleepiness affects your quality of life, or if you often fall asleep during the day, contact a doctor to determine the cause. They can make a diagnosis and prescribe treatments to help you feel better. Takeaway The symptoms of narcolepsy, especially excessive sleepiness, may make it difficult to do your daily activities. A treatment plan that includes lifestyle strategies and medications can help you manage this condition and improve your quality of life.