What is Uncontrollable Daytime Sleepiness?

Narcolepsy is a disorder that disrupts the sleep-wake process. This disruption can lead to excessive sleepiness, the main symptom of narcolepsy, and make it difficult for affected individuals to stay awake for long periods.

Normal sleep occurs in several stages, the last being the REM sleep phase, which usually occurs an hour or more after falling asleep. In narcolepsy, brain changes disrupt sleep function. As a result, REM sleep is irregular and often begins a few minutes after falling asleep, much earlier than normal. The inability to properly regulate the sleep cycle can lead to severe daytime disturbances.

Types of Uncontrollable Daytime Sleepiness The normal sleep cycle includes different stages and, as it progresses, leads to deeper levels of sleep. Narcolepsy interferes with normal sleep function and causes excessive daytime sleepiness. There are two main types of narcolepsy:

1. Type 1: Narcolepsy type 1 is usually accompanied by a sudden loss of muscle tone, called cataplexy. It can be triggered by intense emotions such as joy, sadness, anger, and stress. It causes uncontrollable episodes of sudden muscle weakness, accompanied by a temporary loss of muscle control. This type is also characterized by low levels of hypocretin.
2. Type 2: Chronic condition without cataplexy is considered narcolepsy type 2. Although patients experience excessive daytime sleepiness, their hypocretin levels remain normal.

Symptoms of Uncontrollable Daytime Sleepiness

The most common visual image of narcolepsy is that of a person suddenly falling asleep while performing another task, unable to control their wakefulness. While excessive sleepiness is the main symptom of narcolepsy, it is not the only one. Other symptoms include:

• Excessive daytime sleepiness: All people diagnosed with narcolepsy experience excessive daytime sleepiness. Regardless of how much sleep they get or how long it's been since the last sleep, people with narcolepsy may never feel rested. This sleepiness can lead to "sleep attacks," or the characteristic symptom of suddenly falling asleep, regardless of the environment.
• Cataplexy: Cataplexy is a sudden loss of muscle tone. It causes people with narcolepsy type 1 to feel weak and unable to control their movements. These episodes are often preceded by intense emotions, such as joy, fear, or anger. Cataplexy can be mild or severe, but most episodes last only a few minutes. Not all people with narcolepsy experience episodes of cataplexy.
• Insomnia: Although people with narcolepsy experience excessive daytime sleepiness, their nighttime sleep is often fragmented and of poor quality. They often sleep poorly, unable to fall asleep or stay asleep.
• Sleep Paralysis: People with narcolepsy are more likely to experience episodes of sleep paralysis, a phenomenon in which, even when cognitively awake, the body remains trapped in REM sleep, unable to move for several seconds or minutes. REM sleep is the stage of sleep during which dreams typically occur.
• Hallucinations: When falling asleep or waking up, people with narcolepsy may experience intense and startling sensory hallucinations.

Causes of Uncontrollable Daytime Sleepiness

The exact cause of Uncontrollable Daytime Sleepiness is unknown. People with narcolepsy type 1 have low levels of hypocretin, also known as orexin. Hypocretin is a chemical in the brain that helps control wakefulness and the onset of REM sleep.

People with cataplexy have low levels of hypocretin. The exact cause of the loss of hypocretin-producing cells in the brain is unknown. However, experts suspect it is an autoimmune reaction. An autoimmune reaction occurs when the immune system destroys its own cells.

Genetics likely also plays a role in narcolepsy. However, the risk of a parent passing this sleep disorder on to their child is very low: only 1% to 2%.

How common is Uncontrollable Daytime Sleepiness?

Narcolepsy is relatively rare. In the United States, narcolepsy type 1 affects between 20 and 67 people per 100,000 inhabitants. According to a population study conducted in Olmstead County, Minnesota, narcolepsy type 1 is two to three times more common than type 2, which affects between 20 and 67 people per 100,000 inhabitants.

Estimating the prevalence of narcolepsy is complex due to underdiagnosis and delays in diagnosis. Many people are not diagnosed with narcolepsy until years after the onset of symptoms. Therefore, some estimates place the prevalence of narcolepsy at 180 per 100,000 inhabitants.

Narcolepsy affects men and women almost equally, and can affect both children and adults. It can occur at any age, but its peak onset is around age 15 and later around age 35.

Diagnosis of Uncontrollable Daytime Sleepiness

The symptoms of narcolepsy can resemble other health problems. Diagnosis may include a physical examination and medical history. Your doctor may ask you to record your sleep for a few weeks to track your symptoms and sleep patterns.

Polysomnography: Performed in a clinic or laboratory specializing in sleep disorders, this involves taking constant measurements while you sleep to record abnormalities in your sleep cycle. A PSG can help determine if you enter REM sleep at unusual times in your sleep cycle. This can rule out other problems that may be causing your symptoms.

Multiple Sleep Latency Testing: Performed in a specialized clinic or laboratory, this test measures your tendency to fall asleep during the day and determines if certain periods of REM sleep occur at unusual times of the day. You will take four or five short naps, usually two hours apart.

Lumbar puncture: This procedure, sometimes called a spinal tap, is performed in the hospital or on an outpatient basis. A doctor or nurse removes a small amount of cerebrospinal fluid from your back with a needle. This fluid is tested for hypocretin levels.

How is Uncontrollable Daytime Sleepiness treated?

There is no cure for narcolepsy; once diagnosed, it is permanent. However, there are many treatment options. The most appropriate treatment for you depends on your symptoms, their severity, and any other medical problems you may have.

The first steps in managing the symptoms of narcolepsy are lifestyle changes.

■ Go to bed at the same time every night, even on weekends.
■ Wake up at the same time every morning, even on weekends.
■ Try to get at least 8 hours of sleep each night, even if you need more.
■ Schedule two 15-minute naps a day to recharge.
■ Get physical activity daily.
■ Avoid substances that can disrupt your sleep, such as tobacco, alcohol, caffeine, and drugs.
■ Avoid using electronic devices in bed or close to bedtime.
■ Consult your healthcare professional for other tips for restful sleep. Also see the ATS fact sheet on restful sleep for adults.

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