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Narcolepsy Symptoms Overview

Narcolepsy is characterized by excessive daytime sleepiness (present in all people living with narcolepsy) and symptoms of REM sleep dysregulation (e.g., cataplexy).1,2 People living with narcolepsy with cataplexy are diagnosed with type 1 narcolepsy.1 If cataplexy is not present, patients are diagnosed with type 2 narcolepsy.1

Other symptoms, such as sleep paralysis, hypnagogic/hypnopompic hallucinations, and disrupted nighttime sleep, should be considered when evaluating for narcolepsy.1-5 Narcolepsy symptoms are not always obvious, so it is important to be aware of the various manifestations of each.1,6,7

Excessive daytime sleepiness

The inability to stay awake or alert throughout the day, with lapses into drowsiness or sleep, which can manifest in ways such as automatic behavior, unplanned napping, or forgetfulness.1,7,8


More than one episode of generally brief (<2 minutes), usually bilateral, symmetrical sudden loss of muscle tone with retained consciousness.1 Can occur in almost any muscle group, often triggered by strong emotions such as laughter, fear, and surprise.1,7-10 Some people may not realize they have cataplexy.6

Sleep paralysis

The temporary inability to move or speak during sleep-wake transitions.1,10,11

Hypnagogic/hypnopompic hallucinations

Vivid, dream-like experiences while falling asleep (hypnagogic) or waking up (hypnopompic).1,8,11

Disrupted nighttime sleep

The inability to maintain continuous nocturnal sleep. Nighttime sleep may feature frequent and unpredictable shifts between sleep stages.1,2,4,8

Get to know more about the symptoms of narcolepsy.

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How does EDS manifest in people living with narcolepsy?

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What are partial and complete cataplexy attacks?

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Why are sleep paralysis, hypnagogic hallucinations, and disrupted nighttime sleep important?

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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. Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: a comprehensive textbook. John Wiley & Sons, Inc.; 2006: 145-149.
  4. Roth T, Dauvilliers Y, Mignot E, et al. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013;9(9):955-965.
  5. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281.
  6. 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.
  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. Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31(2):371-381.
  9. 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.
  10. 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.
  11. Scammell TE. Narcolepsy. N Engl J Med. 2015;373(27):2654-2662.

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.

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.

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.