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EDS in Narcolepsy Is Not Always Obvious

All people living with narcolepsy have excessive daytime sleepiness (EDS), although some manifestations are not always obvious.1-3

People with EDS associated with narcolepsy are unable to stay awake or alert throughout the day and feel an intense pressure for sleep, with lapses into drowsiness or sleep.1 This symptom can have a significant impact on people living with narcolepsy, as well as their family and friends.1,4,5

Obvious Eds Character

Obvious Excessive Daytime Sleepiness

EDS can cause obvious changes in wakefulness. For example, the pressure for sleep may be so great that people living with narcolepsy experience brief lapses into sleep (microsleep episodes) and unplanned naps.1,3,6,7 People may also perform tasks such as writing, cooking, or having a conversation with no awareness or memory (automatic behavior).1,7

Less Obvious Eds Character

Less Obvious Excessive Daytime Sleepiness

EDS can also cause changes in wakefulness that may be difficult to recognize.3 People with EDS associated with narcolepsy often report feeling tired all the time, fatigued, or that they have mental fog.3,8

People with narcolepsy rarely feel completely awake and alert.1,2,7,9 They often struggle with poor memory, decision-making, or following a conversation.3,7 Sustaining attention, concentrating, remaining awake during conversations or meetings, and reading can all become a struggle.3,7

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  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.; 2014.
  2. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
  3. Ahmed IM, Thorpy MJ. Clinical evaluation of the patient with excessive sleepiness. In: Thorpy MJ, Billiard M, eds. Sleepiness: causes, consequences and treatment. Cambridge University Press; 2011: 36-47.
  4. Daniels E, King MA, Smith IE, Shneerson JM. Health-related quality of life in narcolepsy. J Sleep Res. 2001;10(1):75-81.
  5. Broughton R, Valley V, Aguirre M, Roberts J, Suwalski W, Dunham W. Excessive daytime sleepiness and the pathophysiology of narcolepsy-cataplexy: a laboratory perspective. Sleep. 1986;9:205-215.
  6. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281.
  7. 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.
  8. Maski K, Steinhart E, Williams D, et al. Listening to the patient voice in narcolepsy: diagnostic delay, disease burden, and treatment efficacy. J Clin Sleep Med. 2017;13(3):419-425.
  9. Nishino S. Clinical and neurobiological aspects of narcolepsy. Sleep Med. 2007;8(4):373-399.

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.