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Advancements in the understanding of narcolepsy are happening. Register for updates »

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.

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Comorbid Disorders

Significant comorbidities exist in narcolepsy.

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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.1,5

Dream-like hallucinations may occur at the edges of sleep.1,7

Hypnagogic/hypnopompic hallucinations

About one-third of all people living with narcolepsy experience hypnagogic hallucinations—vivid dream-like experiences while falling asleep.1,8 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.4,8,9

The paralysis of REM sleep may occur at sleep-wake transitions.1,10

Sleep paralysis

Up to 46% of people living with narcolepsy experience sleep paralysis—the temporary inability to move or speak during sleep-wake transitions.1,4,9 Sleep paralysis usually occurs at the point of waking but may occur at sleep onset.8 During these episodes, people may feel like they are being suffocated or weighed down,4,8 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.8,10

DID YOU KNOW?
  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
  2. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
  3. 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.
  4. 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.
  5. Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: A Comprehensive Textbook. John Wiley & Sons, Inc.; 2006: 145-149.
  6. Roth T, Dauvilliers Y, Mignot E, et al. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013;9(9):955-965.
  7. 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.
  8. Overeem S, Reading P, Bassetti CL. Narcolepsy. Sleep Med Clin. 2012;7(2012):263-281.
  9. Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31(2):371-381.
  10. Scammell TE. Narcolepsy. N Engl J Med. 2015;373(27):2654-2662.

Performance of routine tasks without awareness.

Sudden and brief loss of muscle tone, often triggered by strong emotions or certain situations. Narcolepsy with cataplexy is known as narcolepsy type 1.

Complete collapse to the ground; nearly all skeletal muscles are involved.

Only certain muscle groups are involved.

Biological clock mechanism that regulates the 24-hour cycle in the physiological processes of living beings. It is controlled in part by the SCN in the hypothalamus and is affected by the daily light-dark cycle.

Frequent awakenings and inappropriate transitions between states of sleep and wakefulness during nighttime sleep.

The inability to stay awake and alert during the day.

A neurotransmitter in the brain that supports wakefulness.

Vivid, realistic, and sometimes frightening dream-like events that occur when falling asleep.

Also known as orexin. A neuropeptide that supports wakefulness and helps suppress non-REM sleep and REM sleep.

Primary brain region for regulating the timing of sleep-wake states.

Unintentionally falling asleep due to excessive daytime sleepiness. Also known as “sleep attacks.”

Brief, unintentional lapses into sleep or loss of awareness.

A validated objective measure of the tendency to fall asleep in quiet situations.

People living with narcolepsy type 1 have low levels of hypocretin.

Narcolepsy without cataplexy; the cause of narcolepsy type 2 is unknown.

A state of sleep characterized by slower-frequency, more synchronized neuronal activity and decreased muscle tone. Deep stages help to restore the body.

A multiparameter test that monitors physiologic signals during sleep; used as a diagnostic tool in sleep medicine.

A state of sleep characterized by fast-frequency, desynchronized activity on EEG, vivid dreams, and loss of muscle tone. Normally occurs 60-90 minutes after sleep onset. Also known as “paradoxical sleep.”

Brief loss of control of voluntary muscles with retained awareness at sleep-wake transitions.

Sleep-onset REM period.

The VLPO as well as the median preoptic nucleus (MnPO) are located in the hypothalamus and contain essential neurons for promoting non-REM sleep. These neurons project to all wake-promoting regions to inhibit wakefulness and promote non-REM sleep during the night.8,11 Neurons in the extended VLPO mediate the promotion of REM sleep by inhibiting certain wake-promoting neurons that suppress REM sleep.8