“When I start regaining muscle control, I start realizing how much control I had lost.” – Nicki

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What Is Cataplexy?

The pathognomonic symptom of narcolepsy can be debilitating even when manifestations are not obvious.1,2

Most people living with narcolepsy also have cataplexy (narcolepsy type 1), a sudden, brief loss of muscle tone triggered by strong emotions or certain situations.3-6 Cataplexy attacks can be different for each person. These attacks range from obvious complete collapse to less obvious manifestations and may range from multiple attacks per day to less than one attack per month.2-5,7

Obvious Cataplexy Character

Obvious Complete Cataplexy

A person’s knees may buckle or he or she may collapse to the ground and remain there for a brief period.3,7,8 During these attacks, people can be paralyzed but remain conscious.2,3,7,8

Cataplexy can cause weakness in almost any muscle group, including the arms and legs.2,7 Cataplexy more commonly occurs in the head and neck, manifesting as head drops, slurred speech, and sagging of the jaw or eye muscles when facial muscles are affected.2,3,7,8

Less Obvious Cataplexy Character

Less Obvious Partial Cataplexy

More commonly, cataplexy is partial.1,7 Less obvious cataplexy can be difficult to recognize, although someone who knows the person well may be able to notice subtle signs.3,5,7 People may not realize that they have cataplexy or they may not recognize its impact.7 They often believe that these experiences are normal or they may avoid situations that trigger attacks.7

Your patients may describe their cataplexy as:

  • tingling9
  • a tremor7
  • a small muscle jerk or twitch of the face3,4
  • being clumsy/dropping things8

Recognizing Less Obvious Cataplexy in Practice

Cataplexy is the pathognomonic symptom of narcolepsy,2 but it rarely presents in a clinical setting.10,11 It is important to know how to evaluate for less obvious manifestations of cataplexy and to have your patients come to their appointment with a family member or close friend who may recognize symptoms.3

There’s more to know about recognizing cataplexy »

Cataplexy can be triggered by a wide range of emotions or situations.3,7

  • Happiness12
  • Laughter/humor7
  • Anger7
  • Excitement10
  • Stress7 or anxiety12
  • Tension10
  • Anticipation7
  • Embarassment7,10
  • Telling or hearing a joke, making a witty remark3,7
  • Being tickled7
  • Being the center of attention7
  • Unexpectedly encountering a friend or acquaintance7
  • Being startled7
  • Remembering happy events or being emotionally moved10
  • Intimate moments
    • Romantic thought or moment10
    • Experiencing an orgasm7
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Cataplexy is not always obvious.

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  1. Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31(2):371-381.
  2. Dauvilliers Y, Siegel JM, Lopez R, Torontali ZA, Peever JH. Cataplexy—clinical aspects, pathophysiology and management strategy. Nat Rev Neurol. 2014;10(7):386-395.
  3. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.; 2014.
  4. Overeem S, van Nues S, van der Zande WL, Donjacour CE, van Mierlo P, Lammers GJ. The clinical features of cataplexy: a questionnaire study in narcolepsy patients with and without hypocretin-1 deficiency. Sleep Med. 2011;12(1):12-18.
  5. 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.
  6. Silber MH, Krahn LE, Olson EJ, Pankratz VS. The epidemiology of narcolepsy in Olmsted County, Minnesota: a population-based study. Sleep. 2002;25(2):197-202.
  7. Overeem S. The clinical features of cataplexy. In: Baumann CR, Bassetti CL, Scammell TE, eds. Narcolepsy: Pathophysiology, Diagnosis, and Treatment. Springer-Verlag New York; 2011:283-290.
  8. Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: a comprehensive textbook. John Wiley & Sons, Inc.; 2006: 145-149.
  9. Lee EK, Douglass AB. Baclofen for narcolepsy with cataplexy: two cases. Nat Sci Sleep. 2015;7:81-83.
  10. Anic-Labat S, Guilleminault C, Kraemer HC, Meehan J, Arrigoni J, Mignot E. Validation of a cataplexy questionnaire in 983 sleep-disorders patients. Sleep. 1999;22(1):77-87.
  11. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281
  12. Sturzenegger C, Bassetti CL. The clinical spectrum of narcolepsy with cataplexy: a reappraisal. J Sleep Res. 2004;13(4):395-406.

Performance of routine tasks without awareness.

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

Complete collapse to the ground; 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 inappropriate transitions between states of sleep and wakefulness.

The inability to stay awake and alert during the day.

A neurotransmitter that supports wakefulness. The TMN is the only source of histamine in the brain.

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

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

A neuropeptide that supports wakefulness and helps control 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.

Brief, unintentional lapses into sleep or loss of awareness.

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

A state of sleep when muscle tone is decreased. Deep stages help to restore the body.

Overnight study used to diagnose sleep disorders by monitoring sleep stages and cycles to detect disruptions of a normal sleep pattern.

Normally occurs at night and includes vivid dreams. Also known as “paradoxical sleep.”

Daytime and evening habits and routines to help improve nighttime sleep.

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

Sleep-onset REM period.

People with type 1 narcolepsy have low levels of hypocretin.

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