Narcolepsy is actually just as common as Multiple Sclerosis, affecting 1 in every 2,000 Americans and 3 million people worldwide. It is a sleep disorder characterized by constant daytime sleepiness as well as a tendency to sleep at inappropriate times. The sleepiness is generally not relieved by sleep (though naps can be refreshing for short periods of time).
What are the symptoms of narcolepsy?
The symptoms of narcolepsy can appear all at once or slowly develop over time. The symptoms of narcolepsy can be confusing to those who are unfamiliar with the official diagnostic criteria. Patients suffering from narcolepsy are commonly misdiagnosed with a myriad of medical issues, including psychiatric problems like depression, bipolar disorder, or even schizophrenia. They usually go through many medical tests before going to a sleep center for an evaluation. Many patients can go 10-15 years before getting a proper diagnosis. If not properly recognized, narcolepsy can have many negative repercussions on one’s life.
1. Excessive Daytime Sleepiness (EDS).
EDS is present in every patient with narcolepsy, and it is usually the first symptom that appears. EDS is present during both “normal” times when most people tend to become sleepy (such as in sedentary situations) but also at times when most people would stay awake (such as while talking to someone). Narcolepsy patients may even become drowsy during dangerous situations such as driving or operating heavy machinery.
Cataplexy affects nearly 50% of narcolepsy patients. It sometimes appears as the initial symptom and may change in severity over time. It is a sudden, short loss of muscle strength that is usually triggered by strong emotion such as anger, surprise, or even laughter. Cataplexy can range in severity from mild (brief weakness in the face or knees) to severe (resulting in a complete physical collapse). For some, even the memory of an event that is highly emotional can lead to an attack.
Thought to be REM sleep behaviour that intrudes into wakefulness, this symptom causes a complete lack of muscle tone in everywhere but my diaphragm and eyes. It is the function that paralyzes the average person during sleep to protect them from acting out their dreams. It is triggered by strong emotions such as laughter, surprise, fear, etc.
3. Hypnagogic hallucinations (HH).
HH are vivid dreams/images that occur when a person is drowsy (especially while falling asleep or waking up). HH content varies from person to person, but can involve disturbing images and/or sound. Typically, the person is partly awake but has no ability to control the hallucination. As hallucinations are also seen in various mental illnesses, patients with narcolepsy who report HH may sometimes be misdiagnosed as having a psychiatric illness.
4. Sleep paralysis (SP).
SP is also a very brief loss of muscle tone, but it happens when someone is falling asleep or waking up. It can be very alarming to the patient, as the person may mentally be awake but his or her body is unable to move or speak. It is not harmful (in fact, many people who are “normal sleepers” may report having had an episode of SP), but if you have SP along with other symptoms noted here (or it is repeatedly occurring), you should be evaluated at a sleep center.
5. Disturbed nighttime sleep.
Despite being excessively sleepy during the daytime, many narcolepsy patients also report having trouble staying asleep throughout the night. Their sleep is commonly reported as broken up and non-restorative.
6. Automatic behaviors.
Although not as common as the above symptoms, some patients may report performing habitual tasks while not being fully aware of it at the time. Sometimes, the patient may even fall asleep and continue an activity. This can be particularly dangerous if engaged in an activity such as driving or cooking.
7. Other symptoms.
Narcolepsy patients may also report problems with attention/ concentration/ memory, occasional double vision, headaches and trouble losing weight. They often have other sleep disorders such as sleep apnea. Sleepiness may then negatively impact the ability to fulfill school, work or social obligations. Narcolepsy patients can develop in some as a result of social and occupational troubles. Some patients with narcolepsy may be labeled “lazy” or “unmotivated” because of their sleepiness, further worsening their mood.
Diagnosis As indicated above, many patients with narcolepsy don’t receive the proper diagnosis for upwards of 10-15 years after the onset of their first symptoms. If you find that any of the symptoms of narcolepsy (e.g. excessive daytime sleepiness, cataplexy, broken nighttime sleep, vivid dreaming or hallucinations around sleep) are making it difficult to drive, attend work or school, perform daily activities and chores, or socialize, talk with your doctor to rule out any other medical problems that may be the culprit. If nothing else is found to contribute to these symptoms (especially excessive sleepiness), ask for a referral to a sleep specialist.