“I become more frustrated and then have another cataplexy attack.” – Nicki

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Evaluating for Cataplexy and Other Symptoms

In all patients with excessive daytime sleepiness, evaluate for possible cataplexy and other symptoms.1-3

Evaluating for Cataplexy

Cataplexy is rarely observed in clinical settings,4,5 or patients may not report cataplexy.3 Having someone who knows the patient well present during the clinical evaluation can help, as this person may have noticed less obvious signs of cataplexy.4,5 Videos are also useful to confirm the presence of cataplexy.6,7

  • Partial cataplexy attacks can involve almost any voluntary muscle, but the neck and head are most commonly affected.4,6-10 Complete attacks can involve the whole body.7
    • More obvious cataplexy: knees buckling, collapse to the ground, head drops, slurred speech, sagging of the face or jaw4,6-8,10
    • Less obvious cataplexy: numbness, tingling, twitching, dropping things or clumsiness4,6-10
  • Emotional triggers include happiness, laughter/humor, anger, excitement, stress or anxiety, tension, anticipation, embarrassment.4,5,7
    • Ask patients if they suppress emotions or are withdrawn from family and friends.7,11
  • Situational triggers include telling or hearing a joke, making a witty remark, being tickled, being the center of attention, unexpectedly encountering a friend or acquaintance, being startled, remembering happy or emotional events, intimate moments, a romantic thought or moment, experiencing an orgasm.4,5,7
    • Ask patients if they avoid any situations that may trigger a cataplexy attack.2,7,12-14
  • Cataplexy is usually bilateral, but some patients may report unilateral attacks.4
  • Consciousness is retained.2
  • Cataplexy can range from rare occurrences to frequent complete attacks and usually lasts less than 2 minutes.15

Evaluating for Other Signs or Symptoms of Narcolepsy

Identifying other symptoms or manifestations of narcolepsy may aid in making the diagnosis and can have a substantial impact on patients.2,4,8 Ask patients about the presence and impact of:

  • Sleep paralysis4
  • Hypnagogic/hypnopompic hallucinations4,10,16
  • Vivid dreams at night2,8
  • Vivid dreams during daytime naps2
  • Bizarre dream content2

There’s more to know about the impact of symptoms on quality of life »

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A normal sleep-wake cycle is characterized by consolidated wakefulness during the day.

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Narcolepsy is a disorder characterized by sleep-wake state instability.

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  1. Green PM, Stillman MJ. Narcolepsy: signs, symptoms, differential diagnosis, and management. Arch Fam Med. 1998;7(5):472-478.M
  2. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 201516(1):9-18.M
  3. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281.
  4. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.; 2014.
  5. Anic-Labat S, Guilleminaul 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.
  6. Dauvilliers Y, Siegel JM, Lopez R, Torontali ZA, Peever JH. Cataplexy—clinical aspects, pathophysiology and management strateg. Nat Rev Neurol. 2014;10(7):386-395.
  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. 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.
  9. 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.
  10. Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: a comprehensive textbook. John Wiley & Sons, Inc.; 2006: 145-14.
  11. Broughton R, Ghanem Q, Hishikawa Y, Sugita Y, Nevsimalova S, Roth B. Life effects of narcolepsy: relationships to geographic origin (North American, Asian or European) and to other patient and illness variables. Can J Neurol Sci. 1983;10(2):100-104.
  12. de Zambotti M, Pizza F, Covassin N, et al. Facing emotions in narcolepsy with cataplexy: haemodynamic and behavioural responses during emotional stimulation. J Sleep Res. 2014;23(4):432-440.
  13. Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31(2):371-381.
  14. Daniels E, King MA, Smith IE, Shneerson JM. Health-related quality of life in narcolepsy. J Sleep Res. 2001;10(1):75-81.
  15. Ahmed IM, Thorpy MJ. Clinical evaluation of the patient with excessive sleepiness. In: Thorpy J, Billiard , eds. Sleepiness: causes, consequences and treatment. Cambridge University Press; 2011: 36-47.
  16. 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.

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.