Narcolepsy refers to a chronic neurological disorder in which the brain is unable to control the body’s sleep-wake cycles. Consequently, individuals with this condition typically feel energized immediately after waking up but feel lethargic throughout the day. Although narcolepsy does not lead to serious health conditions in the long run, it can impact one’s daily functioning significantly. So, here are some signs of narcolepsy one shouldn’t ignore:

Warning signs of narcolepsy

1. Excessive sleepiness throughout the day
A brain chemical known as hypocretin or orexin typically controls one’s sense of wakefulness. However, patients with narcolepsy are deficient in hypocretin. This deficiency is believed to be caused by the immune system’s attack on the cells that produce this brain chemical or the receptors that enable its functioning in the body. Consequently, the onset of narcolepsy leads to excessive sleepiness throughout the day despite a good night’s sleep.

2. Sleep paralysis
Sleep paralysis is when one experiences loss of speech and movement while falling asleep or upon waking up. Although it lasts for a few seconds or minutes, sleep paralysis can be debilitating. This symptom is not experienced by all individuals with narcolepsy but may be a sign of the disorder and should not be ignored.

3. Fluctuations in REM sleep
Rapid Eye Movement (REM) sleep is the initial stage of sleep, wherein one’s eyes move rapidly in different directions while the individual is asleep. This sleep stage is indispensable to ensure the brain’s optimal consolidation of memories during sleep and the development of the central nervous system. It is also the stage in which most individuals experience dreams. Although most individuals enter the REM stage 60-90 minutes after falling asleep, patients with narcolepsy enter REM prematurely, typically within 15 minutes. Such fluctuations in REM sleep result from changes in brain activity.

4. Unexplained loss of muscle tone
The sudden loss of muscle tone, also called cataplexy, is a characteristic feature of narcolepsy and is usually caused by extreme emotional outbursts, such as intense laughter, anger outbursts, excitement, and fear. In these cases, the patient’s head may drop involuntarily, or knees may weaken, leading to a fall.

5. Obstructive sleep apnea
Obstructive Sleep Apnea (OSA) involves complete or partial blockage of the airways, triggering severe breathing difficulties and nonrestorative sleep, a state in which one does not feel adequately refreshed regardless of the number of hours one may have slept. Many individuals with narcolepsy simultaneously experience obstructive sleep apnea. Consequently, patients with the latter condition may be experiencing narcolepsy and should consult a doctor.

6. Hallucinations
Sleep paralysis, a common sign of narcolepsy, may cause one to experience hallucinations. However, these hallucinations may also occur among patients with narcolepsy who do not have sleep paralysis. Some examples of such hallucinations include feeling the presence of a stranger in one’s room or perceiving objects or stimuli that are not present. Hallucinations can be extremely distressing and may be a sign of narcolepsy, although they may also indicate the onset of some other neurological disorder. In any case, timely consultation with a psychiatrist is necessary.

7. Involuntary sleep while engaging in an activity
Patients with narcolepsy may often fall asleep engaging in a regular activity, such as eating, working, driving, or even talking. Such involuntary sleep patterns may be risky when engaging in an activity such as driving or riding, requiring undivided attention. Such sleep is typically nonrestorative, meaning that one feels refreshed only briefly before beginning to feel drowsy again.

8. Loss of appetite
Hypocretin deficiency, a prevalent symptom of narcolepsy, often leads to loss of appetite, causing one to eat much less than usual.

9. Muscle mass accumulation
Despite grappling with loss of appetite (as mentioned above), many patients with narcolepsy may gain muscle mass rapidly, also resulting from a lack of hypocretin, which controls not only wakefulness but also hunger. Consequently, despite eating less, patients with narcolepsy may experience a lack of brown fat, responsible for burning calories, due to hypocretin deficiency.

Lifestyle tips for patients with narcolepsy

1. Avoid caffeine, especially after sunset
Individuals with narcolepsy are prone to lethargy and excess sleepiness throughout the day. Caffeine intake, particularly after sunset, can cause problems with falling asleep on time at night, worsening drowsiness during the day, and worsening narcolepsy symptoms.

2. Stay physically active
Studies have shown that exercising daily for at least four to five hours before bedtime enhances sleep quality. It can also prevent patients with narcolepsy from gaining excess muscle mass. Hence, cardio activities like walking, running, jogging, cycling, swimming, and other workouts like strength training can considerably help manage narcolepsy symptoms.

3. Take planned naps
Planned naps are among the best ways to manage daytime sleepiness, a common narcolepsy sign. Patients with narcolepsy should ideally schedule their naps for midmorning or early afternoon, resting in a quiet, comfortable place and setting an alarm to avoid oversleeping.

4. Regulate work shift hours
Patients with narcolepsy are susceptible to fatigue and lethargy, which can affect their productivity. Hence, it is a good idea to speak with one’s supervisor and regulate work hours, working in a focused way for fewer hours than working long hours under stressful conditions. For instance, switching to six-hour shifts instead of ten hours can help manage work while ensuring optimal rest.