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Narcolepsy

Summary

Narcolepsy is a chronic sleep disorder that affects the brain’s ability to regulate the sleep-wake cycle. It often begins in adolescence and can cause excessive daytime sleepiness and sudden muscle weakness (cataplexy).

Common symptoms include:

  • Excessive daytime sleepiness (EDS) – Feeling extremely tired and struggling to stay awake during the day.
  • Cataplexy – Sudden muscle weakness triggered by strong emotions, such as laughter or surprise.
  • Sleep paralysis – Temporary inability to move or speak when falling asleep or waking up.
  • Hallucinations – Vivid, dream-like experiences when falling asleep (hypnagogic) or waking up (hypnopompic).

Narcolepsy is not caused by poor sleep habits and can significantly impact daily life.

Diagnosis and When to Seek Help

Parents should consult a doctor if their child:

  • Struggles with constant daytime sleepiness despite getting enough sleep.
  • Has episodes of sudden muscle weakness with emotions.
  • Experiences sleep paralysis or hallucinations regularly.
  • Falls asleep suddenly and uncontrollably during activities.

Diagnosis typically involves:

  • A Sleep Study (Polysomnography) – To monitor sleep patterns.
  • Multiple Sleep Latency Test (MSLT) – Measures how quickly a child falls asleep and how often REM sleep occurs.

Management and Treatment

While narcolepsy has no cure, symptoms can be managed with lifestyle changes and medication.

  • Lifestyle Adjustments:
    • Maintain a consistent sleep schedule with adequate nighttime sleep.
    • Schedule short naps during the day to reduce excessive sleepiness.
    • Encourage regular exercise and a balanced diet to improve energy levels.
    • Avoid caffeine and heavy meals before bedtime.
  • Medical Treatment:
    • Stimulants (e.g., modafinil, methylphenidate) may help with daytime sleepiness.
    • Medications for cataplexy (e.g., sodium oxybate, antidepressants) can reduce muscle weakness episodes.

Follow-Up and Support

  • Work with a doctor to adjust medications and treatment as needed.
  • Communicate with teachers about the condition to provide classroom support.
  • Encourage open conversations with the child about their condition to build confidence and coping skills.

With the right management, children with narcolepsy can lead full and active lives. 

History and Exam

Key diagnostic factor

  • Presence of risk factors
  • Excessive daytime sleepiness
  • Cataplexy
  • Hypnagogic/hypnopompic hallucinations

Other diagnostic factors

  • Chronic fatigue or tiredness
  • Poor performance at work
  • Poor memory and concentration
  • Car accidents

Risk factors

  • Low cerebrospinal fluid hypocretin
  • Human leukocyte antigen (HLA)-DQB1*0602
  • Prader-will syndrome
  • Niemann-Pick disease type C

Diagnostic Investigations

1st investigations to order

  • Actigraphy and sleep diary
  • Overnight polysomnography
  • Multiple sleep latency test (MSLT)

Investigations to consider

  • HLA typing
  • Cerebrospinal fluid hypocretin-1 level
  • Maintenance of wakefulness test

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    Other Related Conditions

    Obstructive Sleep Apnoea

    Insomnia

    Parasomnia (night terrors)

    Delayed Sleep Phase

    Restless leg syndrome

    Behavioural sleep conditions

    Rhythmic movement disorder

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      1 Reason for referral *

      2 Parent Surname *

      3 Patient First Name *

      4 Email *

      5 Patient Surname *

      6 Phone *

      7 Child’s date of birth *

      8 ADDRESS