Fighting to Stay Awake? Learn About Narcolepsy

Narcolepsy is more than just dozing off to sleep anytime during the day. It is a deep-seated yet common neurological sleep condition with a prevalence of about 0.02%.

However, it might often go unnoticed in the Indian population due to the perceived low prevalence. It does disrupt a person’s ability to stay awake or sleep and can affect daily activities. In many cases, narcolepsy goes unnoticed and may worsen with time.

Out like a light

Narcolepsy is a sleep disorder marked by sudden falling asleep — entry into deep sleep — rapid eye movement (REM) sleep, causing extreme daytime drowsiness and frequent, uncontrollable resistance to staying awake, also called excessive daytime sleepiness (EDS). It frequently entails disrupted nighttime sleep and can feature symptoms such as cataplexy (muscle weakness), sleep paralysis, and vivid hallucinations that occur when falling asleep or waking up.

How common is narcolepsy?

Narcolepsy is a relatively rare sleep condition. It is typically underdiagnosed, with many people waiting 5-10 years for a definitive diagnosis.

What are the causes of narcolepsy?

The causes of narcolepsy vary based on its category. Narcolepsy can be classified into two types: 

Type 1

Caused by the loss of nearly all neurons that produce orexin (hypocretin), triggered by an autoimmune process, possibly due to an infection. Antibodies to streptococcal infections have been linked to narcolepsy type 1, even though no specific autoantibody has been found. These factors suggest an autoimmune basis.

This form of narcolepsy is marked by excessive daytime sleepiness (EDS) and cataplexy, which is a brief, sudden loss of muscle control brought on by strong emotions like laughter, anger, or surprise.

Type 2

The cause is unclear, although possible explanations include partial loss of orexin-secreting cells that control wakefulness and sleep. Some type 2 cases may experience cataplexy, indicating a transition to type 1.

Narcolepsy type 2 is marked by EDS without cataplexy. This type typically includes sleep paralysis, a condition in which an individual cannot move while falling asleep or waking up, as well as hypnagogic hallucinations, which are intense, dream-like experiences that occur during the process of falling asleep.

Here is what Dr George Abraham Ninan, Neurology, Christian Medical College Hospital, Vellore, says: “Though genetic predisposition is the usual culprit, infections such as flu and streptococcal throat infection are known to trigger immune damage to the brain, as well as structural causes such as brain tumours and trauma.”

Who does narcolepsy affect?

Nearly half of those affected develop symptoms throughout adolescence (teenage years). Although the disease has a substantial impact on academic and social functioning, it is treatable.

What are the symptoms of narcolepsy?

Narcolepsy is defined as an ongoing fight against sleepiness that can be challenging to tackle. The symptoms of narcolepsy include:

Extreme daytime sleepiness 

Those with narcolepsy often find it difficult to stay awake during work, school, or social activities. They have issues with concentration, memory, and mood stability. These struggles can significantly affect their relationships, careers, and overall quality of life.

Catalepsy

Lasts for 30 seconds to 2 minutes, involving a sudden loss of muscle control, leaving you unable to move. Common symptoms include head drooping, jaw slackening, and knee buckling. In severe cases, you may collapse and remain paralysed for several minutes.

Hallucinations

People generally see and feel things that are not present, with sudden episodes of impending fear while falling asleep and waking up.

Sleep paralysis

This is when you are unable to move your body while falling asleep or when you are waking up; it may last for up to 15 minutes.

How to prevent narcolepsy?

“Narcolepsy is a disorder characterised by overwhelming daytime sleepiness and unexpected, involuntary bouts of sleep that can happen during inappropriate moments, such as while engaged in work, conversation, or driving. They may also experience sudden falls to the ground when triggered by strong emotions like laughter or surprise (cataplexy). Other symptoms include sleep paralysis, where a person is temporarily unable to move up on waking, and vivid, dream-like hallucinations. The depletion of neurons in certain regions of the brain that are in charge of wakefulness and REM sleep causes narcolepsy,” says Dr Ninan.

“Public awareness, reducing misconceptions, and knowledge about sleep disorders will allow the affected to seek medical attention before negative effects such as accidents. Stimulant medications and scheduled naps are often used to reduce daytime sleepiness and manage cataplexy,” he adds.

Immune-based and emerging therapies in narcolepsy

Ongoing research into narcolepsy has increasingly focused on the possible involvement of the immune system, particularly in cases where certain brain cells are affected. Emerging approaches aim to better understand the underlying causes of the condition rather than only managing symptoms. These developments reflect a shift towards more targeted and long-term strategies, offering hope for improved outcomes and quality of life for those living with narcolepsy.

Is narcolepsy contagious?

No, narcolepsy is a non-transferrable neurological disorder of the brain. Though there is a genetic predisposition, it cannot be passed through touch or physical contact. 

Wake up to a healthier you

Narcolepsy is a challenging condition that affects many. It is critical to reach out to your doctor at the earliest and follow lifestyle changes and prescribed advice closely.

Frequently Asked Questions

1. What is narcolepsy?

Narcolepsy is a chronic neurological condition that affects the brain's ability to regulate sleep-wake cycles. 

2. What are the main symptoms of narcolepsy?

Common symptoms include excessive daytime sleepiness, sudden muscle weakness (cataplexy), sleep paralysis, and vivid dream-like hallucinations during sleep transitions.

3. Is narcolepsy the same as being tired all the time?

No. While it involves severe daytime sleepiness, narcolepsy is a medical condition that disrupts normal sleep cycles and often causes uncontrollable sleep episodes.