Symptoms of Narcolepsy

Narcolepsy is a life-long problem but it does not usually get worse with age. Symptoms can vary between people. Some symptoms may improve over time or with treatment but never go away completely. The most common symptoms and how many people with narcolepsy have those symptoms are:1,2

  • Excessive daytime sleepiness (100 percent)
  • Cataplexy (87 percent)
  • Hallucinations and vivid dreams (56 percent)
  • Sleep paralysis (51 percent)

Symptoms usually begin between the ages of 7 and 25. In studies, only 1 in 3 people had all 4 of the most common symptoms.1,2

Less common symptoms of narcolepsy include:1

  • Fragmented sleep (waking up often during the night)
  • Automatic behaviors

Excessive daytime sleepiness

Unlike other sleep disorders, people with narcolepsy usually feel rested and alert when they first wake up. However, they tend to feel sleepy during the rest of the day. This sleepiness, sometimes called sleep attacks, can be so strong that they doze off without meaning to. This can happen quickly while sitting, driving, eating, or working.

Many people with narcolepsy find that a 15- to 20-minute nap keeps them alert for the next 1 to 2 hours. People with narcolepsy tend to be as alert as other people in between their sleep attacks.

Cataplexy

Cataplexy is a sudden loss of muscle tone or muscle weakness in response to a strong emotion. Cataplexy may last several seconds up to 1 to 2 minutes. Some people with narcolepsy have cataplexy only a few times in their life. In others, it can occur many times a day. Strong, positive emotions such as laughter, joking, or joy usually trigger cataplexy. It is less common for fear, stress, or anger to cause cataplexy.1,2

These attacks can be mild, such as a sudden drooping of the eyelids or slurred speech. With severe cataplexy, the whole body collapses and the person cannot move, speak or keep their eyes open. Unlike other fainting or seizure disorders, the person with narcolepsy is fully conscious. Episodes usually last 1 to 2 minutes.1,2

When someone’s first symptom of narcolepsy is cataplexy, it may be misdiagnosed as a seizure disorder.1 Cataplexy develops 3 to 5 years after the daytime sleepiness began in 60 percent of people.3

Fragmented sleep

A majority of people with narcolepsy wake up often during the night and may have trouble going back to sleep. This can make it hard to get enough sleep and make daytime sleepiness worse. Disrupted nighttime sleep occurs because a person with narcolepsy may sleep 8 out of 24 hours, it is just spread across the entire 24 hours rather than concentrated at night.3

People with narcolepsy may also have other sleep disorders that disrupt their sleep at night. This makes daytime sleepiness worse. People with narcolepsy may also have sleep apnea, periodic limb movement disorder, or act out while dreaming.1,2

Hallucinations and vivid dreams

About half of those with narcolepsy have hallucinations and vivid dreams. During these hallucinations and dreams, sounds, smells, and images can seem so real it is hard for the person to tell them from reality. Most hallucinations occur when the person is falling asleep or waking up. The vivid, intense dreams and nightmares occur while sleeping.1,2

Sleep paralysis

The inability to move can occur when someone with narcolepsy is just drifting off to sleep or just waking up. This can last from a few seconds to a few minutes. Like with cataplexy, the person is awake but unable to move or speak. It can be alarming but once the episode is over the person returns to the normal ability to move and speak.1,2

Automatic behaviors

Automatic behaviors mean the person with narcolepsy continues to eat, talk, write, type, or drive while briefly asleep. They often cannot remember what they did when they wake up. While the person wakes up feeling refreshed, their performance is usually poor. For example, handwriting may become unreadable or they may have an accident if driving.1

Rapid weight gain

It is common for people with narcolepsy to be overweight. Rapid weight gain is common in children when they first develop narcolepsy.4

Mental illness

People with narcolepsy are more likely than the general population to have depression, anxiety, attention deficit hyperactivity disorder, and other mental health issues.4

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Written by: Jessica Johns Pool | Last reviewed: June 2020