Narcolepsy is a long-term, chronic sleep disorder that is commonly identified by its excessive daytime sleepiness and “sleep attacks.” There are two main types of narcolepsy. Type 1 is identified as narcolepsy with cataplexy, or sudden loss of muscle control, while Type 2 is narcolepsy without cataplexy. The cause of Type 2 narcolepsy is not well understood, and there are many differing opinions as to its causes. Conversely, narcolepsy Type 1 is more common, and whose causes are better understood.
There are some neurological indicators in people with narcolepsy with cataplexy, or narcolepsy Type 1.1 This form of narcolepsy is typically understood as a neurological condition, as it is almost always accompanied by low levels of the brain chemical hypocretin. This neurotransmitter helps to regulate sleep and promote alertness. The presence of hypocretin helps to prevent REM sleep from occurring at inopportune times. When the neurons that create these neurotransmitters in the hypothalamus die off, it can make one sleepy and unable to control the REM sleep cycles.2 This often results in slipping between dreaming and waking, cataplexy, and hallucinations.
There are several narcolepsy Type 1 risk factors. One of these is your genetic family history. If you have someone in your family with narcolepsy, it makes you more likely to develop it, as you may have a genetic lack of hypocretin. Autoimmune disorders and brain injuries can also reduce levels of hypocretin. Infections, such as cold or flu, are also thought to trigger narcolepsy in those who are already predisposed.3
The causes of narcolepsy without cataplexy, or narcolepsy Type 2, are a little less straightforward. People with this type of narcolepsy generally experience less severe symptoms than those with Type 1. However, individuals with low levels of hypocretin but without cataplexy are often reclassified as having Type 1 narcolepsy.4
Type 2 narcolepsy is rarer and more difficult to diagnose.5 Environmental, genetic factors, stress, and other unknown factors are thought to possibly play a role in the causes of narcolepsy Type 2.6 Because so little is understood about the causes of narcolepsy without cataplexy, the treatment for it tends to be towards symptom management, such as encouraging good sleep hygiene and the use of stimulant drugs such as Modafinil to promote wakefulness.7
Currently, there is no definitive cure for narcolepsy. It is a chronic, lifelong condition. However, narcolepsy symptoms may subside for long periods of time, and do not tend to intensify or worsen with age.
Legally, you can drive with narcolepsy. The laws of driving with narcolepsy depend on where you live. Narcolepsy is often listed as a condition that may impact driving abilities, and people with narcolepsy are warned to take extra precaution when driving. In the U.S., some states require a medical note from a physician, while others leave it to the individual to check in with their condition and safety to drive.8
Narcolepsy treatment can take many forms, depending on the cause and how much the condition affects your daily life. Low levels of hypocretin are irreversible, but their effects can be managed through a combination of medications and lifestyle changes.9 Some of the most effective medications for daytime sleepiness and the presence of cataplexy are modafinil, stimulants, sodium oxybate and antidepressants.10 Lifestyle changes that have been known to help some people include creating a regular sleep schedule, taking brief naps throughout the day, and avoiding caffeine and alcohol. These are some core ways to improve sleep and the quality of your rest.
Narcolepsy often first begins to show itself in people between the ages of 10 and 30.11 One of the first and most noticeable narcolepsy symptoms is finding yourself inexplicably falling asleep during the day. This excessive daytime tiredness is often the first sign of narcolepsy. However, this symptom often gets misdiagnosed, as it can also be a sign of sleep apnea and other sleep-wake disorders.
No, narcolepsy is not a mental illness. However, it is often misdiagnosed as a mental illness.12 In some instances, it has been known to either co-occur with other psychiatric disorders or to lead to mental illnesses such as depression.
© 2021 American Sleep Association.