Narcolepsy: Signs and Symptoms
Medically reviewed by Daniel Combs, MD
Narcolepsy is a neurological condition that affects your sleep-wake cycles, causing excessive daytime sleepiness and several other sleep-related symptoms. Some types of narcolepsy also cause low muscle tone, a symptom known as cataplexy.
Many people develop narcolepsy symptoms gradually over time, beginning in childhood or early adolescence. The cause of narcolepsy is still somewhat unknown, but contributing factors likely include autoimmune diseases, family history, brain injury, or a variation in the genes associated with narcolepsy.
Narcolepsy is a chronic condition, but you may have times when symptoms improve and times when they flare up. Narcolepsy doesn’t get progressively worse as you age, however. Here are the typical symptoms you might experience.
Excessive Daytime Sleepiness
The primary symptom of narcolepsy affecting every person that has it is excessive daytime sleepiness. This is more than just feeling drowsy during the day; people with narcolepsy have “sleep attacks,” or the uncontrollable urge to simply fall asleep in the middle of their regular activities. These attacks occur no matter how much sleep a person with narcolepsy has gotten, and regardless of what task they are in the middle of performing.
Hallucinations and Sleep Paralysis
People with narcolepsy are prone to sleep-related disturbances like hallucinations and sleep paralysis. Both phenomena are more likely to happen as you are falling asleep or waking up from sleep.
Hallucinations often involve seeing something in your bedroom that isn’t there or sensing a presence in the room. Sometimes, other senses like touch and taste can be involved. Hallucinations can be deeply terrifying for the person experiencing them.
Sleep paralysis is a REM-associated sleep event. As you’re falling asleep or waking up, the part of your brain that controls muscle movements is supposed to “wake up” as well, but when it doesn’t, you may become mentally awake and alert but unable to move. This temporary paralysis doesn’t only occur in people with narcolepsy, but it’s more common in people with the condition.
Insomnia and Fragmented Sleep
Though most people associate narcolepsy with excess sleep, insomnia and poor nighttime sleep are also common symptoms. People with narcolepsy may have difficulty both falling and staying asleep, partly because of the hallucinations, vivid dreams, and sleep paralysis that occur so commonly in the disorder.
Memory Loss
Because of excessive sleepiness, you may have trouble remembering things easily. People may give you information that you don’t fully process because of your sleepiness.
You may also continue performing a basic task, like eating or writing, as a sleep attack begins, leaving you with a gap in your memory about what happened as you were falling asleep. These automatic behaviors are common in people with narcolepsy and can be very disorienting when you wake up again.
Cataplexy
There are two different types of narcolepsy: type 1 and type 2.
Type 1: People with type 1 narcolepsy have low levels of a brain hormone called hypocretin, which is responsible for regulating the sleep-wake cycle as well as appetite. Low levels of hypocretin also cause people with narcolepsy to experience something called cataplexy, or the sudden loss of muscle tone or muscle control.
Type 2: People with type 2 narcolepsy don’t have low levels of hypocretin, so they don’t experience cataplexy.
Episodes of cataplexy are typically triggered by heightened emotions, like fear or excitement. This muscle weakness can be mild, including brief moments of eyelid drooping or slurred speech, or more severe, resulting in temporary body paralysis or sudden physical collapse (i.e. there’s no loss of consciousness, only loss of the ability to control muscle movements). Episodes are brief, but cataplexy is often misdiagnosed as a symptom of a seizure disorder because of the involuntary movements and muscle weakness it causes.
Symptoms in Children
Though it can occur at any age, narcolepsy often begins in childhood; there is frequently a significant delay in diagnosis after symptoms start, and it may go unrecognized for many years in children.
Children with narcolepsy have many of the same symptoms as adults, including excessive daytime sleepiness and sleep-related hallucinations. But children may respond to fatigue in different ways: they can become irritable or hyperactive, or have difficulty focusing. At times, these symptoms may be mistaken for other conditions like attention deficit hyperactivity disorder (ADHD).
Children with type 1 narcolepsy (with cataplexy) may also have different signs of muscle weakness than adults. Their movements are sometimes called “choreatic,” which means they can include fidgeting, dancing, twisting, and appearing generally restless. By comparison, adults often experience cataplexy as drooping, slumping, slurred speech, or temporary body paralysis.
Finally, children with narcolepsy are also more likely to develop obesity, go through early onset puberty, display poor school performance, and have mental health issues such as anxiety and depression. Combined with the more common symptoms of narcolepsy, like disrupted sleep or extreme daytime fatigue, these other symptoms can help healthcare providers come to a diagnosis of narcolepsy in younger children.
When to See a Healthcare Provider
On its own, narcolepsy won’t affect your lifespan or directly cause negative effects on your health. But the side effects of narcolepsy, like excessive sleepiness, can lead to further illnesses as well as injury; driving is a risky behavior, for example, when there’s a chance you could fall asleep behind the wheel. People with narcolepsy are also at higher risk of other health conditions like heart disease, obesity, sleep apnea, and depression.
If you have any of the common symptoms of narcolepsy—such as chronic or persistent daytime sleepiness, insomnia or poor sleep, hallucinations, or difficulty with memory or attention—it’s important to see a healthcare provider. If you’re diagnosed with narcolepsy, there are treatments that can help keep you safe and healthy day-to-day and in the long run.
A Quick Review
The most common symptoms of narcolepsy include excessive daytime sleepiness, hallucinations, difficulty sleeping, and in some cases, sudden muscle weakness or loss of muscle tone, depending on the type of narcolepsy you have.
Since narcolepsy often develops in childhood and adolescence, it’s also helpful to recognize that kids with narcolepsy may have the typical symptoms or may also exhibit other symptoms, like hyperactive or inattentive behaviors, unpredictable movements, poor school performance, poor mental health, and physical issues such as obesity and early puberty.
Frequently Asked Questions
Can people with narcolepsy symptoms drive?
It depends on where you live, as well as whether or not your narcolepsy symptoms are being successfully treated. Some studies suggest that certain narcolepsy treatments and lifestyle changes can improve driving performance, but there is an overall lack of evidence about the effect of interventions on driving with narcolepsy. Official laws vary by state, so check with your state's Department of Motor Vehicles (DMV).
Drivers with sleep disorders are at a higher risk of traffic accidents, so it’s important to honestly discuss your symptoms with your healthcare provider, find a treatment plan that reduces your symptoms, and consider how often you feel drowsy during the day before driving a car.
How many hours of sleep do people with narcolepsy need?
There’s no fixed amount of sleep recommended for people with narcolepsy, but you may need to schedule more time for sleep than most other people. It can be helpful to take a few short naps throughout the day and stick to a consistent sleep routine that includes going to bed and waking up at the same time each day, as well as keeping your sleep environment as comfortable and non-stimulating as possible.
How long do narcoleptic episodes last?
Narcoleptic sleep attacks and narcoleptic cataplexy episodes last anywhere from a few seconds to a few minutes.
What's the difference between type 1 narcolepsy and type 2 narcolepsy?
People with type 1 narcolepsy have low levels of hypocretin, which causes them to experience cataplexy in addition to sleep-related symptoms. People with type 2 narcolepsy do not have low levels of hypocretin and don’t experience cataplexy.
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