We all feel tired some days. But when daytime sleepiness reaches the point where it’s interfering with your life, it could be a sign of narcolepsy.
This relatively uncommon sleep disorder causes a person to feel overly sleepy or fall asleep at unwanted times during the day. And it isn’t always obvious.
As a pulmonologist specializing in sleep disorders, I've seen how untreated narcolepsy can impact someone’s life. Here's why it’s so important to seek help for possible symptoms — and how you can manage the condition.
Narcolepsy vs. daytime sleepiness
It’s normal to feel sleepy once in a while. But people with narcolepsy tend to feel sleepy throughout the day, every day. It’s different than feeling fatigue, the tiredness you might have after running around all day. When you’re sleepy from narcolepsy, you really do have the intense urge to close your eyes and nod off whenever you become inactive. That intense sleepiness can cause people with narcolepsy to experience what’s called automatic behavior, like continuing to take notes that turn out to be gibberish. In severe cases, people may fall asleep where they are — even in the middle of a conversation or meal. That’s what’s known as a sleep attack.
In less severe cases, people with narcolepsy can resist sleepiness for short periods. For example, many of my patients cope by taking a short nap in a private area.
Even a short nap can be refreshing, as it helps restore the balance of the neurotransmitters in the brain that regulate sleep and wakefulness. But the sleepiness soon returns.
Narcolepsy affects nighttime sleep too. The condition breaks a person’s sleep into short segments. So even though people with narcolepsy feel very sleepy during the day, they have trouble getting a full night’s rest when they go to bed. They might wake up frequently then struggle to fall back to sleep. Some also experience symptoms such as hallucinations or paralysis as they’re falling asleep or waking up. Some people may also have episodes where they may act out dreams, risking injury to themselves or their bed-partner.
Beyond sleepiness
There are two types of narcolepsy:
Type 1 narcolepsy also includes cataplexy, where a person suddenly loses control of their muscles. The loss is often triggered by heightened emotions like laughter, excitement, anger, or fear. The person might collapse (while still remaining conscious) or have signs of muscle weakness, like head bobbing or facial drooping.
Type 2 narcolepsy does not involve cataplexy. Experts are still working to understand what causes it. More than half of people with narcolepsy have type 2.
Either type of narcolepsy can have a major impact on a person’s quality of life. Sleepiness can make it hard to focus or perform at a person’s best at work or school. And the condition can make it difficult to do everyday activities, like driving, increasing the risk of motor vehicle accidents.
Disruptive symptoms can take a toll on someone’s mood and lead to depression or other mental health problems. Narcolepsy can also raise the risk for other serious health problems, including heart disease. Weight gain is not uncommon, and the risk of developing concomitant obstructive sleep apnea is 2-5 times more likely than the general population.
Narcolepsy can impact a person’s relationships too. Some of my patients have told me they avoid situations that could trigger their cataplexy. That can mean missing out on social events or important occasions.
Further, it can be hard for people who aren’t familiar with the condition to recognize narcolepsy or understand that the symptoms are involuntary.
Getting the right diagnosis can be life-changing — and not just because treatment can improve symptoms. For many of my patients, the diagnosis finally allowed them to explain their experiences to themselves and their loved ones.
Diagnosing narcolepsy
If daytime sleepiness is disrupting your life, let your doctor know. Ask for a referral to a specialist in sleep medicine. Often, sleep specialists are also pulmonologists, because many sleep disorders affect the respiratory system.
At a specialized sleep center like the Temple Sleep Disorders Center, you’ll have access to diagnostic tests, including:
An overnight sleep study, which can also check for other sleep disorders like sleep apnea. The study collects information about a person’s health while they sleep. That includes their brain wave patterns, breathing effort and rate, snoring volume, and blood oxygen level.
A multiple sleep latency test, or MSLT. This test involves having someone undergo 5 nap opportunities where we measure how quickly a person falls asleep and what stage of sleep they go into. If a person goes into REM sleep in less than 20 minutes on 2 or more naps, they may have narcolepsy.
Managing narcolepsy
There's no cure for narcolepsy, but treatment can help manage symptoms. That might include:
- Antidepressants to control cataplexy, hallucinations, and sleep paralysis.
- Stimulants or wake-promoting agents to help you stay awake during the day.
- Oxybate salts to promote the deep sleep that is lacking in people with narcolepsy.
Lifestyle changes and sleep strategies can help reduce symptoms. Here are a few I often share with my patients:
- Take short naps to stave off sleepiness. You can time these to help you feel more awake and alert at the most important times of the day.
- Practice good sleep hygiene. Try to go to bed and wake up at the same time each day.
- Exercise regularly. It can promote better, more restful sleep.
- Avoid alcohol. Though it might make you tired at first, it disrupts sleep later on.
Experienced care for narcolepsy
At the Temple Sleep Disorders Center, our sleep specialists have the tools and expertise to diagnose and treat narcolepsy. Schedule an appointment online or call 800-TEMPLE-MED (800-836-7536).