“It’s hard to tell where the narcolepsy ends and where I begin.” – Nicki

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There’s More to Know About the Other Symptoms of Narcolepsy

Recognizing sleep paralysis, hypnagogic hallucinations, and disrupted nighttime sleep is important when evaluating patients.1,2

In addition to excessive daytime sleepiness and cataplexy, people with narcolepsy may experience several other symptoms.1,3,4 These symptoms are not specific to narcolepsy and may occur in any individual.4-6 However, recognizing them can be useful when evaluating for narcolepsy, and their impact on people living with the disorder can be significant.1,4

Sleep Paralysis

People living with narcolepsy may experience sleep paralysis—the temporary inability to move or speak during sleep-wake transitions.2,3,5,7 Sleep paralysis usually occurs at the point of waking but may occur at sleep onset.2,3,5,6 During these episodes, people may feel like they are being suffocated or weighed down,2,5,7 and they may become frightened or have anxiety associated with fear that they are dying.5,7

Hypnagogic/Hypnopompic Hallucinations

Many people living with narcolepsy experience hypnagogic hallucinations—vivid dream-like experiences while falling asleep.2,3 When these occur while waking up, they are called hypnopompic hallucinations.3,6 People may see lifelike phenomena, which can be realistic and frightening, including dark shadows, threatening figures, animals, or people.2,7,8

Disrupted Nighttime Sleep

Many people with narcolepsy have disrupted nighttime sleep, reporting frequent awakenings and poor-quality sleep at night.1-4,9 They may report the inability to sleep through the night as a significant lifestyle limitation and more of a problem than other symptoms.3,4,9,10

Sleep paralysis and hypnagogic hallucinations can occur together and are the result of REM sleep elements intruding into wakefulness.2,5-7

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Narcolepsy symptoms can have a significant impact on people living with the disorder.

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  1. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
  2. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281.
  3. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.; 2014.
  4. 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.
  5. Pelayo R, Lopes MC. Narcolepsy. In: Lee-Chiong, TL, ed. Sleep: a comprehensive textbook. John Wiley & Sons, Inc.; 2006: 145-149.
  6. Scammell TE. Narcolepsy. N Engl J Med. 2015;373(27):2654-2662.
  7. 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.
  8. Sturzenegger C, Bassetti CL. The clinical spectrum of narcolepsy with cataplexy: a reappraisal. J Sleep Res. 2004;13(4):395-406.
  9. Roth T, Dauvilliers Y, Mignot E, et al. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013;9(9):955-965.
  10. 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.

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.