Narcolepsy

This content was created by the National Sleep Foundation

The most prominent symptom of narcolepsy is extreme daytime sleepiness. This is often the first symptom to develop, and many people with narcolepsy suffer with this and other issues for years before receiving a proper diagnosis and treatment.

Some common symptoms of narcolepsy include:

  • Excessive daytime sleepiness and sleep attacks during normal activities
  • Cataplexy (sudden loss of muscle tone), triggered by emotions
  • Hallucinations and sleep paralysis
  • Disrupted nighttime sleep
  • Vivid dreaming

If you experience some or all of these symptoms, it’s important to consult with your doctor, who may refer you to a sleep specialist. Treatments and lifestyle changes may greatly improve the symptoms of narcolepsy.

Excessive Daytime Sleepiness

One of the most prominent symptoms of narcolepsy is excessive daytime sleepiness. People with narcolepsy feel moderately or severely tired during the day. They have difficulty paying attention, concentrating, and staying awake, even if they’ve slept a lot the night before.

People with narcolepsy can start out feeling rested, but have trouble staying awake for long periods of time and fall asleep during routine daytime activities. This is very dangerous, because a person with narcolepsy can fall asleep during an activity like driving, walking, or cooking. Some people fall asleep while performing an activity and continue the activity, with no memory of it later.

Excessive sleepiness is one of the first symptoms to develop in people with narcolepsy. Narcolepsy can be hard to spot, unless a doctor knows how to interpret the symptoms. There are many reasons for extreme sleepiness (lack of proper sleep, sleep apnea, and more), so narcolepsy can go undiagnosed for a long time. This is especially true given that the disorder develops in the teen years, when sleepiness is common.

Hallucinations and Sleep Paralysis

People with narcolepsy can have vivid, dream-like hallucinations while falling asleep or as they are waking up. During these episodes, the visions feel real—for example, seeing a person in the bedroom. The hallucinations are called hypnagogic if they happen while falling asleep, and hypnopompic if they happen while waking up.

At the same time, people with narcolepsy experience paralysis as they’re falling asleep or waking up. This is the normal muscle paralysis associated with rapid eye movement (REM) sleep, but occurring at the wrong time. Although the paralysis usually only lasts a few seconds, it can be very frightening, especially in combination with hallucinations.

Hallucinations and paralysis are caused by a disrupted boundary between dream sleep and wakefulness. Rather than gradually reaching REM sleep at the end of a sleep cycle, a person with narcolepsy can enter REM immediately. This means the dreaming and muscle paralysis of REM will occur directly from a waking state. Like sleepiness, these symptoms can sometimes be seen in those without narcolepsy, too.

Disrupted Nighttime Sleep

Despite feeling tired and sleepy during the day, many people with narcolepsy have trouble sleeping at night. They wake up frequently (also called “fragmented” sleep), and have a hard time falling back to sleep. The reason for this is not completely understood, but sleep research suggests people with narcolepsy have more light sleep and more transitions out of deep sleep into light sleep or awake.

In the case of narcolepsy, poor nighttime sleep is not enough to explain daytime sleepiness. A person with narcolepsy can feel very tired and sleepy during the day regardless of how well they slept the night before.

Vivid Dreaming

People with narcolepsy often report having vivid, bizarre, or disturbing dreams. These dreams can seem very life-like and hard to distinguish from reality. Vivid dreams in narcolepsy may be related to differences in rapid eye movement (REM) sleep. Having narcolepsy, a person can enter REM sleep at sleep onset shortly after falling asleep, making it possible to dream vividly even during a brief nap. Frequent nighttime awakenings are also common in people with narcolepsy, and if the person wakes up during or right after REM sleep, they are more likely to remember dreaming.

Lucid dreaming, or being aware that you’re dreaming during the dream itself, is also more common in those with narcolepsy.

Depression, Weight Gain, and Health Complications

People with narcolepsy may have a tendency towards being overweight. This is not completely understood, but it could be due to lower activity levels, diet, metabolism, medications, or a combination of these factors.

Narcolepsy is also linked to an increased risk of developing depression. This could be because narcolepsy symptoms can be stressful and isolating, especially without proper treatment. It is also possible that the brain chemistry involved in narcolepsy is linked to changes in a person’s mood and overall mental health.

Other sleep disorders can accompany narcolepsy, such as REM sleep behavior disordersleepwalking, and sleep apnea. These disorders should be evaluated if symptoms are present and may require different, additional treatment.