Narcolepsy: symptoms, causes, diagnosis, and treatment

With narcolepsy, it’s common to have sleep attacks in which you suddenly fall asleep during the day, even while you’re actively talking or working. Sleep attacks can also occur while driving, which makes this condition potentially dangerous for yourself and others. Narcolepsy can also cause sleep disturbances and hallucinations. 

Read on to learn more about the symptoms of narcolepsy––and how this neurological disorder is diagnosed and treated.

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Narcolepsy is a neurological disorder that involves extreme, uncontrollable daytime sleepiness. Healthcare providers call it an excessive sleep disorder (Pérez-Carbonell, 2018).

The primary sign of narcolepsy is falling asleep even when you don’t want to. With narcolepsy, it’s common to have sleep attacks where you suddenly fall asleep during the day regardless of the activity. For example, sleep attacks may strike while eating a meal or having a conversation. These episodes can put you or others in serious danger if they occur while you’re driving or operating heavy machinery. 

There are two main types of narcolepsy: narcolepsy with cataplexy (a temporary loss of muscle control) and narcolepsy without it. Narcolepsy is typically diagnosed around age 15 or later on between 30 to 40 years old.

Depending on the type of narcolepsy, sleep-related symptoms you may experience include (Barker, 2020; Pérez-Carbonell, 2018; Slowik, 2020):

• Cataplexy: Cataplexy is a brief, sudden loss of muscle tone, usually triggered by strong emotions, such as laughter or anger. It can affect your entire body or specific parts like your neck. When someone is first diagnosed with narcolepsy, they may not have cataplexy. It sometimes develops years later. 

• Automatic behaviors: This is when you go through repetitive motions while in an excessively sleepy, unaware state. For example, you might be physically putting groceries away, but your brain isn’t fully awake. Later, your family members might find the milk in the pantry instead of the refrigerator, but you don’t remember doing it (Morandin, 2013).

• Sleep paralysis: Sleep paralysis is a temporary inability to speak or move your muscles. It most often occurs as you’re waking up or falling asleep. This happens when your brain wakes up, but your muscles are still in sleep mode. 

• Hallucinations: People with narcolepsy may see things that aren’t there, especially just before falling asleep. Hallucinations may occur at the same time as sleep paralysis and can be very frightening.

• Nighttime sleep disturbances: With narcolepsy, you may wake up during the night due to sleep paralysis or hallucinations, resulting in poor sleep quality. People with narcolepsy also have a higher risk of other sleep disorders such as sleep apnea (Barker, 2020). With sleep apnea, you stop breathing for brief periods throughout the night. When this occurs, your body wakes you up to start breathing again. These interruptions to nighttime sleep can worsen the excessive daytime sleepiness of narcolepsy.    

Other symptoms and behaviors can stem from narcolepsy including brain fog (trouble thinking or concentrating), depression, anxiety, and hyperactive or aggressive behavior (Abad, 2017).

Note that just because you have some of the above symptoms doesn’t mean that you have narcolepsy. Some of the symptoms, such as drowsiness and sleep paralysis, also occur in people who don’t have narcolepsy or any other brain disorder.

The cause of narcolepsy isn’t fully understood. It’s thought to be caused by low levels of hypocretin, a neurotransmitter that functions to promote wakefulness. Also called orexin, this neurotransmitter is essential for regulating rapid eye movement (REM) sleep, which is the deep sleep stage in which we dream (Barker, 2020).

Before making a diagnosis of narcolepsy, your healthcare provider may send you to a brain or sleep specialist who will ask you about your symptoms. If they’re occurring at least three times a week over the last three months, you may have narcolepsy. But first, they’ll rule out other medical conditions that could cause similar symptoms. They may also have you do a sleep study such as a polysomnogram. They'll also check your hypocretin levels in your cerebrospinal fluid, which is a clear fluid that surrounds your brain and spinal cord (Slowik, 2020).

There’s no cure for narcolepsy, but certain medications along with good sleep hygiene can help reduce symptoms. It’s also helpful to take short, frequent naps on a consistent schedule throughout the day (Slowik, 2020). With proper treatment, people with narcolepsy are able to work, drive, and have productive lives.

A healthcare provider will guide you on the type of medication that’s best for you. This will depend on what symptoms you have and how severe those are. Common medications include (Abad, 2017; Wise, 2007):

• Excessive daytime sleepiness is treated with stimulants like modafinil (Provigil), armodafinil (Nuvigil), methylphenidate (Ritalin), or amphetamines (such as Adderall).

• Sodium oxybate (Xyrem) is an effective treatment to control cataplexy.

• Antidepressants may also reduce cataplexy. Examples include protriptyline (Vivactil), venlafaxine (Effexor), and fluoxetine (Prozac). 

• Newer narcolepsy medications are available that only have to be taken once a day. These act to improve wakefulness and ease daytime sleepiness. Examples include pitolisant (Wakix) and solriamfetol (Sunosi).

Like all medications, narcolepsy treatments carry a risk of side effects. Talk with a healthcare professional or pharmacist for more details or questions about narcolepsy treatment options.

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Current version

June 30, 2021

Written by

Patricia Weiser, PharmD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.