What is Narcolepsy?

Narcolepsy is a sleep disorder characterized by abnormal nightly sleep cycles leading to excessive daytime sleepiness. It affects an estimated 135,000 – 200,000 Americans. People with narcolepsy typically wake up frequently during the night and fall asleep or lose muscle control suddenly and without wanting to during daytime activities like driving, eating, walking or talking. Narcolepsy can:

  • make people more susceptible to having accidents while driving or operating machinery;
  • interfere with psychological, social, and cognitive function and development;
  • inhibit one’s ability to enjoy social activities and perform well at school and at work.

If you or a loved one are showing signs or symptoms of narcolepsy, the sleep disorder specialists at Comprehensive Neurology and Sleep Medicine can provide the diagnostic testing and treatments needed to restore normal sleep cycles and protect your health, well-being and safety.

Narcolepsy Signs and Symptoms

People with narcolepsy typically report that they:

  • Often experience overwhelming feelings of sleepiness during daytime hours, no matter how long they have slept the previous night;
  • Experience unusual sensations as they are falling asleep;
  • Sometimes experience sleep paralysis and are unable to move as they fall asleep or when they first awake;
  • Often have vivid dreams or involuntary leg movements that wake them up during the night;
  • Sometimes experience a sudden loss of muscle control or collapse when laughing or feeling angry, stressed or excited. This is known as cataplexy.

In a normal sleep cycle, rapid eye movement (REM) sleep starts about 60 to 90 minutes after falling asleep. Dreams occur during REM sleep, and the brain keeps muscles limp during this sleep stage, which prevents people from acting out their dreams. People with narcolepsy frequently enter REM sleep within 15 minutes of falling asleep. Also, the muscle weakness or dream activity of REM sleep can occur during wakefulness or be absent during sleep.

Types of narcolepsy

There are two major types of narcolepsy: Individuals with Type 1 narcolepsy have low levels of a brain hormone (hypocretin) or report experiencing cataplexy (muscle weakness and loss of voluntary muscle control) and excessive daytime sleepiness on a special nap test. Individuals with Type 2 narcolepsy experience excessive daytime sleepiness but usually do not have muscle weakness triggered by emotions. They usually also have less severe symptoms and have normal levels of the brain hormone hypocretin.

What causes narcolepsy?

The causes of narcolepsy are not known or completely understood. Nearly all people with narcolepsy who have cataplexy have extremely low levels of the hypocretin hormone, which regulates REM sleep and keeps people from feeling excessively sleepy during the day. People who have narcolepsy without cataplexy typically have normal levels of hypocretin. Current research suggests that factors contributing to narcolepsy include:. Autoimmune disorders. Researchers believe that in individuals with narcolepsy, the body’s immune system selectively attacks the hypocretin-containing brain cells because of a combination of genetic and environmental factors. Family history. Up to 10 percent of individuals diagnosed with narcolepsy with cataplexy report having a close relative with similar symptoms. Brain injuries. Traumatic injury to parts of the brain that regulate wakefulness and REM sleep can trigger narcolepsy.

Narcolepsy Diagnosis and Treatment

Narcolepsy diagnosis and treatment starts with a physical exam to determine if there are any other neurological conditions that are causing or contributing to this sleep disorder. You may also be asked to keep a sleep journal noting the times of sleep and symptoms over a one- to two-week period. Although narcolepsy’s major symptoms can be present in other sleep disorders as well, cataplexy almost never occurs in any other diseases. Two specialized tests are also required to confirm a diagnosis of narcolepsy: Polysomnogram (PSG or sleep study). The PSG is an overnight diagnostic sleep study that measures the quality of a person’s sleep by measuring the body’s involuntary functions during sleep, such as breathing and heart rate. It can tell us whether REM sleep occurs early in the sleep cycle and if the patient’s symptoms could be caused by another condition such as sleep apnea. Multiple sleep latency test (MSLT). The MSLT assesses daytime sleepiness and is used to diagnose narcolepsy. It consists of a series of 20-minute naps, during which the patient tries to fall asleep. The test is given every two hours throughout the day, with each nap lasting about 20 minutes. During each nap, sensors and electrodes record data on body functions (heartbeat, breathing, eye movement, etc).

Narcolepsy Treatments

Although there is no cure for narcolepsy, some of the symptoms can be treated with medicines such as Provigil, Nuvigil or other stimulants. The following lifestyle changes can also help people cope with narcolepsy:

  • Take short regularly scheduled naps.
  • Keep a regular sleep schedule. A regular bedtime and wake-up time usually helps people sleep better.
  • Avoid smoking, especially at night.
  • Exercise at least 20 minutes per day and at least 4 or 5 hours before bedtime.
  • Avoid large, heavy meals right before bedtime.
  • Relax before bed. A warm bath before bedtime can help you feel sleepy.

Where to Find a Good Narcolepsy Doctor

The sleep experts at Comprehensive Neurology and Medicine have more than 30 years experience diagnosing and successfully treating thousands of patients throughout Maryland for narcolepsy and other sleep disorders. Dr. Konrad Bakker is board certified in sleep medicine by the American Board of Sleep Medicine as well as board certified in sleep by the American Board of Psychiatry and Neurology. He has extensive experience treating patients seeking help for narcolepsy, insomnia, restless legs syndrome and other common sleep disorders. Sarah E. Jamieson is a physician’s assistant with specialized training and experience in the diagnosis and treatment of insomnia. Together, Dr. Bakker and Ms. Jamieson will listen to you carefully and develop a personalized treatmet plan to help you get the sleep you need to restore your physical and mental health as well as your overall quality of life. Call us today at (301) 694-0900 to schedule an appointment. Virtual appointments are also available, allowing you to receive a narcolepsy consultation via our own phone or computer in the comfort of your home.

Information about REM Sleep Disorder