Narcolepsy is classified as both a sleep disorder and a neurological disorder. Signs of narcolepsy usually develop in your teens. It is a long-term, chronic condition whose symptoms may wax and wane over time, but it never disappears entirely. There are two main types of narcolepsy: narcolepsy with and without cataplexy (sudden muscle weakness). The most common signs of narcolepsy are cataplexy (in those with Narcolepsy Type 2) and “sleep attacks” (sudden onset of sleep). Narcolepsy symptoms that usually accompany these signs include chronic fatigue, sleep paralysis, and hallucinations.
Fragmented sleep, excessive daytime sleepiness, and sleep attacks are all narcolepsy symptoms.  Because narcolepsy affects your brain's ability to control and moderate wakefulness, your sleep-wake cycle is disrupted. People with narcolepsy often find themselves unable to control their sudden bouts of sleepiness. These “sleep attacks,” or microsleeps, can last anywhere between a couple of seconds to several minutes. They can result in falling asleep without any warning during daytime activities, including while talking, driving, or at work. This sign of narcolepsy is one of the greatest dangers of narcolepsy, as losing consciousness while operating a vehicle or machine can be deadly.
Paradoxically, people with narcolepsy can experience trouble sleeping. This narcolepsy symptom can take many forms, and it is common for people with narcolepsy to find themselves waking up periodically throughout the night or suffering from restless legs. Narcolepsy is also one of many common insomnia risk factors.
Many people with narcolepsy who have trouble sleeping experience unusually vivid dreaming and hallucinations upon waking or falling asleep. These hallucinations, either hypnagogic (while falling asleep) or hypnopompic (while waking) often make it difficult for people with narcolepsy to differentiate dreams from reality. These hallucinations can also be accompanied by sleep paralysis and nightmares.
Along with sudden bouts of somnolence, people with narcolepsy Type 1 experience cataplexy. Cataplexy is the sudden loss of muscle tone that is triggered by intense feelings of emotion like joy, anger, or excitement. This can occur in the face, limbs or torso, and can result in temporary collapse. During these instances of cataplexy, the brain is fully conscious. This is in contrast to the lack of consciousness that is characteristic of sleep attacks or fainting.
Cataplexy is indicative of a deficiency or lack of the brain chemical hypocretin, which is a sign of narcolepsy Type 1. Hypocretin promotes wakefulness and prevents your brain from entering REM sleep, which is helpful for people with narcolepsy Type 1. While people without narcolepsy typically take 60 to 90 minutes to enter deep REM sleep, people with narcolepsy can typically enter REM sleep within 15 minutes. Since hypocretin inhibits REM sleep, a lack of it often results in the blurring of sleep and wake states.
Narcolepsy Type 2, or narcolepsy without cataplexy, is often considered to be a less debilitating condition than narcolepsy Type 1. People with narcolepsy Type 2 usually have normal levels of hypocretin and often experience milder and less severe symptoms.
Narcolepsy can blur the lines between sleep and wakefulness. In some cases, narcolepsy causes you to feel very disoriented, or groggy, upon waking.
Narcolepsy is a lifelong, chronic condition. There is currently no known cure. Narcolepsy treatment often includes a combination of behavioral strategies and medications to manage the condition and to reduce its impact on your daily life. Depending on the severity and type of your narcolepsy, different mixtures of medications may be advised in order to promote wakefulness or to handle cataplexy. Many people also find that taking scheduled naps can help them feel more alert during the day, and can help prevent sleep occurring at dangerous or inconvenient times.
While falling asleep quickly at night can be completely normal, it is not normal to fall into deep sleep immediately or unintentionally, and doing so is one of the most indicative signs of narcolepsy.
Research on the relationship between food and narcolepsy is inconclusive. Some recommend eating small, light meals, as many people find that eating large, heavy meals make them drowsy. Avoiding caffeine in the afternoons can also reduce nighttime sleep disruption. The relationship between a high-fat, low-carbohydrate (ketogenic) diet and narcolepsy has been studied, with one study finding that a ketogenic diet moderately helped patients reduce daytime sleepiness.
© 2021 American Sleep Association.