Narcolepsy: Causes, Symptoms, Diagnosis, and Treatment

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime sleepiness and sudden sleep attacks. Regardless of the circumstances, someone with narcolepsy often find it difficult to stay awake for long periods. Check out the full explanation of the causes, symptoms, diagnosis, and treatment of narcolepsy below.

Causes of Narcolepsy

Before explaining about the cause, please note that narcolepsy is a condition that can be accompanied by sudden muscle loss (cataplexy) that can be triggered by strong emotions. Narcolepsy that occurs with cataplexy is called type 1 narcolepsy. Narcolepsy that occurs without cataplexy is known as type 2 narcolepsy.

Meanwhile, the cause of narcolepsy is not yet known with certainty. Someone who has type 1 narcolepsy has low hypocretin levels. Hypocretin is an important neurochemical in the brain that helps regulate wakefulness and sleep. Meanwhile, the condition that causes the loss of hypocretin-producing cells in the brain is unknown, but some experts suspect it is caused by an autoimmune reaction.

Besides autoimmune, narcolepsy can also be influenced by genes, but the risk of parents transmitting this condition to children is very low at around 1 percent.

Normal vs. Narcolepsy Sleep Patterns

The normal process of falling asleep starts with a phase called non-rapid eye movement (NREM) sleep. During this phase, your brain waves are very slow. After about an hour of the NREM phase, brain activity changes and the REM sleep phase begins. Most dreams occur during the REM phase.

Narcolepsy makes you suddenly enter the REM sleep phase without first experiencing the NREM sleep phase, both at night and during the day. Some narcolepsy characteristics such as cataplexy, sleep paralysis, and hallucinations are similar to changes that occur in REM sleep, but occur when awake or sleepy.

Risk Factors

Some conditions that are known to increase narcolepsy are:

  • Age. Narcolepsy usually starts between the ages of 10 and 30 years.
  • Family history. The risk of narcolepsy increases 20 to 40 times higher if you have family members who experience this condition.

Narcolepsy Symptoms

Not everyone with narcolepsy has the same symptoms of a sleep attack. Some people have symptoms regularly, while others are affected less frequently. Symptoms can develop slowly for several years or suddenly for several weeks.

Here are the symptoms that you can recognize, including:

  • Excessive Daytime Sleepiness

Someone who has a sleep attack, can make him fall asleep without warning, anywhere, and at any time for several minutes to half an hour. When you wake up feeling refreshed, but it still does not eliminate the drowsiness that attacks again.

You may also experience a decreased level of alertness and focus throughout the day. Excessive sleepiness during the day is usually the first symptom that appears and is most troublesome, making it difficult for you to concentrate and be fully functional.

  • Sudden Muscle Loss

This condition called cataplexy can cause a number of physical changes, for example speaking indistinctly that lasts several minutes. Cataplexy can be triggered by strong emotions such as laughter, but this condition can also occur due to fear, surprise or anger.

Some people who experience narcolepsy only experience one or two episodes of cataplexy in a year, while others experience many episodes every day. Not all people with narcolepsy experience cataplexy.

  • Paralysis

Narcolepsy is a condition that often makes a person experience a temporary inability to move or talk when he sleeps or when he wakes up. This phase is usually brief lasting a few seconds or minutes, but can also be dangerous.

This sleep paralysis mimics the type of temporary paralysis that usually occurs during sleep periods called rapid eye movement (REM). Temporary immobility during REM can prevent you from dreaming.

However, not all people with sleep paralysis experience narcolepsy. Many people without narcolepsy experience several episodes of sleep paralysis. The REM sleep phase can occur at any time of the day in people with narcolepsy. People with narcolepsy often switch quickly to the REM sleep phase, usually within 15 minutes after falling asleep.

  • Hallucinations

This delusion can occur at any time and is often clear and frightening. If the condition occurs when you fall asleep, it is called hypnagogic hallucinations. If the condition occurs when you wake up, it is called hypnopompic hallucinations.

When is the Right Time to See a Doctor?

Consult a doctor immediately if you experience excessive sleepiness during the day that interferes with all daily activities.

Narcolepsy diagnosis

The initial diagnosis of narcolepsy is based on excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). In addition, a formal diagnosis requires that you spend the night at a sleep center to analyze sleep more deeply.

Diagnosis may involve:

  • Physical examination and medical history.
  • Sleep notes: Your doctor may ask you to track your symptoms and when you sleep for several weeks.
  • Polysomnogram (PSG): This examination is carried out in a sleep disturbance clinic or sleep laboratory. This is an overnight test that performs constant measurements during sleep to note problems in the sleep cycle. PSG can help reveal whether you entered the REM sleep phase at an unusual time in the sleep cycle. This check can get rid of other problems that might be causing the same symptoms.
  • Multiple latency sleep test (MSLT): This examination is also done in a special clinic or laboratory. The test takes place during the day to measure your tendency to fall asleep and find out whether certain elements of REM sleep occur at unusual times during the day.

Narcolepsy treatment

Basically there is no narcolepsy drug that can help eliminate this disorder. But drugs can help manage symptoms.


Drugs for narcolepsy include:

  • Stimulants

Medications that stimulate the central nervous system are the main treatment to help people with narcolepsy stay awake during the day. Doctors often recommend modafinil or armodafinil first. Both of these drugs are not addictive and rarely cause side effects. Even so, you may feel headaches, nausea or anxiety.

Some people need treatment with methylphenidate or various amphetamines. These drugs are very effective but can be addictive and cause side effects such as nervousness and palpitations.

  • Tricyclic antidepressants

These types of antidepressants, such as protriptyline, imipramine, and clomipramine, are effective for treating cataplexy. But many people complain of side effects such as dry mouth and mild headaches.

  • Sodium oxybate

This drug is very effective in dealing with cataplexy and in high doses can also help control daytime sleepiness. The drug must be taken in two doses, one before going to bed and another taken four hours later. This drug has side effects such as nausea, bedwetting and worsening sleepwalking.

Another important thing that needs attention is if you have other health problems such as high blood pressure or diabetes, ask your doctor whether the drugs you are taking can interact with narcolepsy drugs.

Over-the-counter medicines such as allergies and flu can cause drowsiness. If you suffer from this disorder your doctor will probably advise you to avoid taking this drug.

Complications of Narcolepsy

  • Misunderstanding Understanding Conditions

Narcolepsy can cause serious problems because it interferes with all your daily activities. Others may see you as lazy or tired.

  • Disrupting Social Relations

Intense feelings like anger or excitement can trigger narcolepsy signs such as cataplexy. This condition causes people around you to withdraw from emotional interactions.

  • Injury

A sleep attack can result in physical damage to people with this disorder. You are at higher risk of having a car accident if you experience an attack while driving.

  • Obesity

Someone who has this disorder is more likely to be overweight. Weight gain may be related to low metabolism.

Narcolepsy Prevention

Lifestyle modification is very important in managing symptoms. The following are prevention steps that can be done, including:

  • Have a sleep schedule. Try to sleep and wake up at the same time every day, including weekends.
  • Siesta. Schedule a short nap periodically. Naps 20 minutes at strategic times during the day may be refreshing and reduce drowsiness for one to three hours. Some people may need to take a longer nap.
  • Avoid nicotine and alcohol. Using these substances, especially at night can worsen symptoms.
  • Regular exercise. Mild and regular exercise for at least four to five hours before bedtime can help you feel more awake during the day and sleep better at night.


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