“A person with narcolepsy doesn’t have the same sleep and wake cycles as most people.– Gina

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The Science of Narcolepsy

In people living with narcolepsy, the separate states of wakefulness and sleep do not work properly.

To better understand narcolepsy, it may help to understand what happens in the brain during normal wakefulness and sleep in people without narcolepsy.

Understanding Normal Wakefulness and Sleep

There are three separate states of wakefulness and sleep.

Normally, states of wakefulness and sleep occur one at a time in a regular pattern. People can:

  • Stay awake all day
  • Stay asleep at night, switching between non-REM sleep and REM sleep

If the brain loses hypocretin, histamine and other naturally occurring chemicals in the brain don’t work well enough, and wakefulness, non-REM sleep, and REM sleep can happen at the wrong time.

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What Happens in People Living With Narcolepsy?

In most people living with narcolepsy, hypocretin levels are low—sometimes too low to be detected.

With low or no hypocretin (sometimes called orexin), the separate states of wakefulness and sleep do not work properly, shifting often from one state to another at the wrong time.

The boundaries between wakefulness and sleep may also break down.

  • Some parts of sleep can interrupt wakefulness
  • Some parts of wakefulness can interrupt sleep
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Certain parts of REM sleep, like the inability to move certain muscles, can happen briefly during wakefulness and lead to cataplexy.

Parts of REM sleep can happen when a person is falling asleep or waking up.

  • During sleep paralysis, people are unable to move, like in REM sleep
  • Hypnagogic hallucinations are vivid dream-like images, similar to the dreams that normally happen during REM sleep
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THE SCIENCE OF NARCOLEPSY HANDOUT

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Vivid dream-like experiences that occur while falling asleep or while waking up.

Occurs at night and includes dreams; muscles are not active to prevent people from acting out dreams.

People with type 1 narcolepsy can be diagnosed by their cataplexy or low levels of hypocretin.

The cause of type 2 narcolepsy is unknown.

Restorative sleep state with decreased muscle tone.

Daytime and evening habits to improve sleep.

Brief total loss of voluntary muscle control when falling asleep or while waking up.

A naturally occurring chemical in the brain that helps maintain wakefulness and prevent non-REM sleep and REM sleep from occurring at the wrong time.

Unintentionally falling asleep due to excessive daytime sleepiness; “sleep attacks.”

The inability to stay awake and alert during the day; a constant need for sleep or unintentionally falling asleep.

A naturally occurring chemical in the brain that helps maintain wakefulness.

Vivid dream-like experiences that occur while falling asleep or while waking up.

Frequent shifts between different states of sleep and wakefulness at night.

Difficulty focusing or concentrating.

Brief loss of muscle tone with retained awareness, often triggered by strong emotions.

Performance of routine tasks without awareness or memory.