Symptoms often start in childhood, adolescence, or young adulthood (ages 7 to 25), but can occur at any time in life. Since people with narcolepsy are often misdiagnosed with other conditions, such as psychiatric disorders or emotional problems, it can take years for someone to get the proper diagnosis.
Daytime sleepiness often is the first symptom to appear. Feeling sleepy makes it hard to focus and function. Some people with narcolepsy continue doing a task when they fall asleep briefly. For example, you may fall asleep while writing, typing or driving.
Some people have symptoms regularly, while others are less frequently affected. Narcolepsy is usually a long-term (chronic) condition. Symptoms may develop slowly over a number of years, or suddenly over the course of a few weeks.
There are 5 main symptoms of narcolepsy, referred to by the acronym CHESS (Cataplexy, Hallucinations, Excessive daytime sleepiness, Sleep paralysis, Sleep disruption). While all patients with narcolepsy experience excessive daytime sleepiness, they may not experience all 5 symptoms.
Possible triggers
A number of factors may increase a person's risk of narcolepsy or cause an autoimmune problem. These include: an inherited genetic fault. hormonal changes, including those that take place during puberty or the menopause.
Narcolepsy is characterized by uncontrollable excessive daytime sleepiness, paroxysmal cataplexy, sleep paralysis, and hallucinations. It is often misdiagnosed as psychiatric disorders such as depression and schizophrenia, resulting from the overlap in symptoms and a lack of understanding of narcolepsy.
A sleep study, known as polysomnography.
This test measures signals during sleep using flat metal discs called electrodes placed on your scalp. For this test, you must spend a night at a medical facility. The test measures your brain waves, heart rate and breathing. It also records your leg and eye movements.
Multiple sleep latency test
This test involves testing whether or not you're prone to falling asleep during the daytime. This test involves timed naps that happen in a specific timeframe. This test can help determine if a person has excessive daytime sleepiness, which is a required symptom of narcolepsy.
Doctors look at how quickly and frequently the patient goes into rapid eye movement (REM)/dream sleep stage during the sleep study. The results of the sleep study combined with any medical tests performed and a comprehensive medical history help doctors determine whether a patient has narcolepsy.
A person with narcolepsy is extremely sleepy all the time and, in severe cases, falls asleep involuntarily several times every day. Narcolepsy is caused by a malfunction in a brain structure called the hypothalamus. Mild cases of narcolepsy can be managed with regular naps, while severe cases need medication.
There are barriers to narcolepsy diagnosis because it isn't as obvious as a broken arm. You may not know you keep falling asleep during the day, and friends and family might overlook it.
The onset of narcolepsy can occur anytime between early childhood and 50 years of age. Two peak time periods have been identified; one around 15 years of age and another around 36 years of age. Some researchers believe that narcolepsy is under-diagnosed in children.
Narcolepsy symptoms are often called a tetrad, meaning that there are four core symptoms of this condition: excessive daytime sleepiness, sleep paralysis, hallucinations, and cataplexy.
Use of amphetamines was among the earliest approaches to narcolepsy treatment; they were first used for this purpose in 1935 based on their strong wake-promoting effects.
One feature that does distinguish excessive daytime sleepiness due to narcolepsy is a “sleep attack,” when people fall asleep suddenly, unintentionally, and in a way that is out of their control. Such episodes can occur multiple times throughout a day and last for varying amounts of time.
Both narcolepsy and insomnia can make you feel sleepy during the day. But with narcolepsy, you might fall asleep while driving or doing another activity. Or your body could suddenly go limp when you laugh or cry. If you don't sleep well and you feel tired during the day, talk to your doctor.
Many of the symptoms of narcolepsy can occur in any person who is severely sleep deprived, with the exception of cataplexy, which is unique for otherwise neurologically intact persons. CSA is mainly secondary to congestive heart failure or to brainstem structural damage and can lead to disrupted sleep.
Functional imaging studies and VBM analysis of brain MRI showed abnormalities in the hypothalamus-thalamus-orbitofrontal pathway, revealing altered hypocretin pathways in narcolepsy. These distinct morphometric changes could account for deficits in wake-sleep control, attention, and memory seen in this disease.
Disrupted nighttime sleep: Sleep fragmentation is common in people with narcolepsy who may awaken multiple times during the night. Other bothersome sleep problems like excess physical movements and sleep apnea are also more common in narcoleptics.
Multiple sleep latency test
You may have this test after polysomnography. You'll be asked to take several naps throughout the day, and a specialist will analyse how quickly and easily you fall asleep. If you have narcolepsy, you'll usually fall asleep easily and enter rapid eye movement (REM) sleep very quickly.
Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling.
Excessive daytime sleepiness in narcolepsy can be similar to symptoms of ADHD. Children with excessive daytime sleepiness may present as aggressive, irritable, or hyperactive in an attempt to cope with or counteract sleepiness.