Sometimes Narcolepsy Symptoms Are Hard to See

Narcolepsy symptoms are not as noticeable as they have been portrayed in the movies. The most common symptom is excessive daytime sleepiness or EDS.

It is believed that some 200,000 Americans are actually narcoleptics, but only about 50,000 have been formally diagnosed. Since EDS is a symptom of most sleep disorders, it can be difficult for doctors to make a definitive diagnosis.

Diagnosis is easier if cataplexy is present. Cataplexy is sudden weakness or loss of muscle tone. Although total collapse is possible, the symptom is usually less noticeable than that.

Dropping of the jaw or nodding of the head, weakness at the knees or slack facial muscles may be cataplexy. Instances of slurred speech, seeming to occur for no reason may be cataplexy. An affected person may notice double vision or an inability to focus on an object. During these episodes, hearing and awareness usually remain normal.

If a person is suspected of being narcoleptic, diagnostic tests can be used to confirm the suspicion. The tests include a polysomnogram and a multiple sleep latency test.

A polysomnogram is a nighttime sleep study. Narcoleptics fall asleep quickly and enter REM sleep faster than average. They often awaken at numerous intervals during the night, which is sometimes confused with middle-of-the-night insomnia.

The multiple sleep latency test is used to measure the classic symptoms of narcolepsy, falling asleep during the daytime. If it takes less than five minutes for a person to fall asleep during the daytime, then they are very sleepy. The idea is that the sleepier a person is, the faster they will fall asleep when allowed to take a nap.

The most common of the narcolepsy symptoms is excessive daytime sleepiness or EDS. Photo: Rafal Walczak

Narcoleptics fall asleep quickly when allowed to take a daytime nap, usually in less than 5 minutes. They typically enter the REM or dreaming stage of sleep within 10 minutes. The average person does not enter REM sleep for over an hour.

Other narcolepsy symptoms include sleep paralysis, hypnagogic hallucinations and automatic behavior. Not all patients have each symptom. When all are present along with EDS and cataplexy, doctors refer to it as the tetrad of narcolepsy.

Sleep paralysis is normal during REM. It is what keeps us from acting out our dreams, injuring our sleeping partners or walking in our sleep. In some conditions, sleep paralysis is not present. For example those who walk, eat or perform other activities while sleeping do not have the muscle paralysis normally present during REM.

When sleep paralysis is one of the symptoms of narcolepsy, it occurs in the transitional stages of sleep, between REM and non-REM. The paralysis may still be felt for a few minutes upon awakening. This can cause fear when a person does not understand their condition.

Hypnagogic hallucinations are dream-like hallucinations occurring when a person is waking up or as they are falling asleep. They can also occur during the natural transitional phases that occur throughout the night.

Since the narcoleptic often wakens at multiple times during the night, he or she may experience numerous hallucinations every night. The hallucinations may be as simple as hearing a doorbell or other alarm. They can also be frightening, similar to nightmares.

Automatic behavior can be one of the symptoms of narcolepsy. But it can also be a symptom of low blood sugar, schizophrenia or epilepsy. It involves carrying out an activity without being aware of it or remembering the event. In narcoleptics, the automatic behavior often coincides with a REM state.

There are various treatments. Drug therapy is recommended in most cases, but one group of researchers found that hypnotic psychotherapy was effective for two patients.

If you believe you have narcolepsy symptoms, the first step is to get a definitive diagnosis. Don’t suffer in silence.