Narcolepsy is a sleep disorder that is often under-recognized and underdiagnosed. About 1 in every 2,000 people in North America and Europe suffer from narcolepsy, which tends to be a lifelong phenomenon. The symptoms of narcolepsy can be terrifying at first and frustrating even after someone becomes used to them, but they never produce any serious illness. People with narcolepsy are usually healthy in all other respects. They have exactly the same natural life expectancy as those without it. No physical abnormality or tissue damage has ever been linked to this condition, either as a cause or as a consequence.
Men and women are equally likely to suffer from narcolepsy. Some studies suggest that genetics could play a role in narcolepsy, but the risk of parents passing it on to their children is very low. It usually first appears in the teenage years, but it can come on at almost any age. Often the symptoms appear one by one, but in people aged over 20 it’s more likely that several symptoms will appear at once. Symptoms may change over time in an individual, but there’s no general tendency for them to get worse or better with age.
It is thought that people with narcolepsy have low levels of a brain protein called hypocretin (also known as orexin). This protein controls wakefulness and without it, people have a hard time staying awake. It is uncertain why some people have low levels of hypocretin, but scientists think this could be a result one or more of the following: genetic mutations of a sleep gene, a family history, infections, brain injuries or tumours, contact with toxic substances (e.g., pesticides), and autoimmune diseases (e.g., rheumatoid arthritis).
One of the phases of sleep is called rapid eye movement (REM) sleep. In a normal sleep cycle, this usually occurs within 80 to 100 minutes of falling asleep. In a person with narcolepsy, REM sleep can occur anytime, even while a person is awake.
The low brain level of hypocretin is likely what causes a person with narcolepsy to enter rapid eye movement (REM) sleep in the daytime. This can be very concerning because a person’s muscles in REM sleep are also paralyzed. Therefore, a person with narcolepsy could be standing up awake one moment and falling to the floor asleep the next.
There’s no cure for narcolepsy, but symptoms can be brought under control with medications. Medications called nervous system stimulants, which include amphetamines such as dextroamphetamine* and methylphenidate, are commonly used. Modafinil, pitolisant, and solriamfetol are other medications that may be used to help to keep a person awake.
Symptoms of cataplexy, sleep paralysis, and hypnagogic phenomena may be treated with tricyclic antidepressants (e.g., imipramine, desipramine, clomipramine), venlafaxine, or selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline). Sodium oxybate can be used for people who have cataplexy and narcolepsy, but because of potential abuse, this medication is tightly regulated in Canada.
It’s unlikely that medication treatment will completely eliminate all desire to sleep during the day. The best way to deal with this is to take 1 or 2 short, planned naps of about 20 minutes each. If treatment can’t totally control symptoms, a person with narcolepsy may want to avoid work that involves long-distance driving or operating dangerous machinery for long periods.
Good sleep habits can also help with narcolepsy. Your doctor may suggest that you:
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
All material copyright MediResource Inc. 1996 – 2025. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Narcolepsy
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