Definition

Narcolepsy is a disorder of the nervous system. It results in frequent, involuntary, episodes of sleep during the day. Sleep attacks can occur while you drive, talk, or work.

Causes

The cause is unknown. It is thought to have a genetic link. There is increasing evidence that it may be an autoimmune disorder. In this type of disorder the body’s own immune system attacks a part of the brain.

Risk Factors

Factors that include your chance of narcolepsy include:

• Family members with narcolepsy

Symptoms

Symptoms usually start during the teenage years. Onset may range from 5 to 50 years old. Symptoms may worsen with aging. They may improve in women after menopause.

Symptoms include:

• Excessive daytime sleepiness
• Daytime involuntary sleep attacks
• Unrefreshing sleep
• Sudden loss of muscle tone without loss of consciousness (cataplexy)
• Temporary paralysis while awakening
• Frightening mental images that appear as one falls asleep
• Memory problems
• Symptoms may be triggered by:
  • A monotonous environment
  • A warm environment
  • Eating a large meal
  • Strong emotions

Brainstem—Area of Brain Related to Alertness

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Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. If narcolepsy is suspected, you may be referred to a specialist in sleep disorders.

Tests may include:

• Multiple sleep latency test (MSLT)—measures the onset of rapid eye movement sleep, which occurs earlier than normal in narcolepsy
• General sleep lab study—often performed the night before an MSLT; helps to rule out other causes of daytime sleepiness by monitoring:
  • Brain waves
  • Eye movements
  • Muscle activity
  • Respiration
  • Heart beat
  • Blood oxygen levels
  • Total nighttime sleep
  • Amount of nighttime REM sleep
  • Time of onset of REM sleep
  • Degree of daytime sleepiness

Treatment

Treatment may include:

• Stimulant medications that increase levels of daytime alertness include:
  • Methylphenidate]]>
  • Pemoline (requires regular blood testing for liver function)
  • Dextroamphetamine
  • ]]>Methamphetamine]]>
  • ]]>Modafinil]]>
  • Gamma hydroxyl butyrate (GHB) (for excessive daytime sleepiness and cataplexy)
• Antidepressants—to help treat many symptoms of narcolepsy (eg, cataplexy, hallucinations, sleep paralysis)
• Other treatment options include:
  • Planned short naps throughout the day
  • Counseling to cope with issues of self esteem
  • Wearing a medical alert bracelet or pendant

Prevention

There are no guidelines for preventing narcolepsy itself. However, you can try to prevent symptoms.

• Avoid activities that carry a risk of injury from a sudden sleep attack, such as:
  • Driving
  • Climbing ladders
  • Using dangerous machinery
• Exercise on a regular basis.
• Get adequate sleep at night.