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Evaluating Other Signs and Symptoms of Narcolepsy
Narcolepsy signs and symptoms go beyond excessive daytime sleepiness and cataplexy.1 Know what to look for.
Though not present in all people living with narcolepsy, symptoms like disrupted nighttime sleep, hypnagogic hallucinations, and sleep paralysis can also have a substantial impact on patients.2,3
Ask patients about the presence and impact of:
Sleep paralysis1- Hypnagogic/hypnopompic hallucinations1,4,5
- Vivid dreams at night2,3
- Vivid dreams during daytime naps2
- Bizarre dream content2
Scott, living with narcolepsy
I was afraid to go to bed at night.
People living with narcolepsy may struggle to maintain continuous nocturnal sleep.1
Disrupted nighttime sleep
Many people living with narcolepsy have disrupted nighttime sleep (sleep disruption), reporting frequent awakenings and poor-quality sleep at night.1,6 They may report the inability to sleep through the night as a significant lifestyle limitation and more of a problem than other symptoms.1,7
Dream-like hallucinations may occur at the edges of sleep.1,8
Hypnagogic/hypnopompic hallucinations
About one-third of all people living with narcolepsy experience hypnagogic hallucinations—vivid dream-like experiences while falling asleep.1,9 When these occur while waking up, they are called hypnopompic hallucinations.1 People may see lifelike phenomena, which can be realistic and frightening, including dark shadows, threatening figures, animals, or people.4,9,10
The paralysis of REM sleep may occur at sleep-wake transitions.1,8
Sleep paralysis
Up to 46% of people living with narcolepsy experience sleep paralysis—the temporary inability to move or speak during sleep-wake transitions.1,4,10 Sleep paralysis usually occurs at the point of waking but may occur at sleep onset.9 During these episodes, people may feel like they are being suffocated or weighed down,4,9 and they may become frightened or have anxiety associated with fear that they are dying.4,5
Sleep paralysis and hypnagogic hallucinations can occur together and are the result of REM sleep elements intruding into wakefulness.8,9
- American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Text Revision. American Academy of Sleep Medicine; 2023.
- Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
- Thorpy M, Morse AM. Reducing the clinical and socioeconomic burden of narcolepsy by earlier diagnosis and effective treatment. Sleep Med Clin. 2017;12(1):61-71.
- Dauvilliers Y, Lopez R. Parasomnias in narcolepsy with cataplexy. In: Baumann CR, Bassetti CL, Scammell TE, eds. Narcolepsy: Pathophysiology, Diagnosis, and Treatment. Springer-Verlag New York; 2011:291-299.
- Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: A Comprehensive Textbook. John Wiley & Sons, Inc.:2006:145-149.
- Roth T, Dauvilliers Y, Mignot E, et al. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013;9(9):955-965.
- Maski K, Steinhart E, Williams D, et al. Listening to the patient voice in narcolepsy: diagnostic delay, disease burden, and treatment efficacy. J Clin Sleep Med. 2017;13(3):419-425.
- Scammell TE. Narcolepsy. N Engl J Med. 2015;373(27):2654-2662.
- Overeem S, Reading P, Bassetti CL. Narcolepsy. Sleep Med Clin. 2012;7(2012):263-281.
- Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31(2):371-381.
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