Narcolepsy is a neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. The disease is often associated with excessive daytime sleepiness, sudden sleep attacks, dream-like hallucinations, and a condition called sleep paralysis. Its prevalence in the developed world is approximately the same as that of multiple sclerosis or Parkinson’s disease. However, with increased public education about narcolepsy and physician training in the diagnosis and treatment of sleep disorders, these figures are expected to rise.

In order to understand the basics of narcolepsy, it is important to first review the features of “normal sleep.” Sleep happens in cycles. When we fall asleep, we initially enter a light stage of sleep and then progress into increasingly deeper stages. Both light and deep sleep stages are called non-REM (rapid eye movement) sleep. After about 90 minutes, we enter the first stage of REM sleep, which is the dreaming portion of sleep, and throughout the night we alternate between stages of REM and non-REM sleep. For people with narcolepsy, sleep begins almost immediately with REM sleep and fragments of REM may occur involuntarily throughout the waking hours. When you consider that, during REM sleep our muscles are paralyzed and dreaming occurs, it is not surprising that narcolepsy is associated with paralysis, hallucinations, and other dream-like and debilitating symptoms.

Symptoms

• Excessive daytime sleepiness – this is usually the first symptom to appear in people who have narcolepsy.
• Cataplexy – cataplexy is a sudden loss of muscle tone, usually triggered by emotional stimuli such as laughter, surprise, or anger. It may involve all muscles and result in collapse.
• Hypnagogic hallucinations – during transition from wakefulness to sleep, the patient has bizarre, often frightening dream-like experiences that incorporate his or her real environment.
• Sleep paralysis – a temporary inability to move during sleep-wake transitions. Sleep paralysis may last for a few seconds to several minutes and may accompany hypnopompic hallucinations.
• Fragmented nocturnal sleep – coupled with nightmares, and restlessness.

There is currently no widely-accepted cure for Narcolepsy but symptoms can be alleviated to the point of near-normal functioning in many patients. Treatment for narcolepsy includes the use of medication as well as behavioral therapy.

Behavioral Treatment

• Taking three or more scheduled short naps throughout the day.
• Avoiding heavy meals and alcohol, which can disturb or induce sleep.

Counseling is very important for people with narcolepsy. The disease can also be quite frightening and the fear of falling asleep inappropriately often significantly alters life for people with narcolepsy.

Medication Treatment

In treating narcolepsy, doctors typically prescribe:

• Stimulants to improve alertness and diminish excessive daytime sleepiness.
• Antidepressants may be used to treat cataplexy, hypnagogic hallucinations and sleep paralysis.
• Sodium oxybate, a strong sleep-inducing agent, may be given at night to improve disturbed nocturnal sleep and reduce daytime sleepiness and cataplexy.