Narcolepsy Symptoms: Sleep Paralysis and Hallucinations

Reviewed by: HU Medical Review Board | Last reviewed: June 2020

Everyone with narcolepsy experiences excessive daytime sleepiness. Almost 9 out of every 10 have cataplexy, the unexpected loss of muscle tone. But, half of people with narcolepsy also have hallucinations and sleep paralysis:1-2

  • Hallucinations and vivid dreams (56 percent)
  • Sleep paralysis (51 percent)

Doctors believe that hallucinations and sleep paralysis are the result of the rapid eye movement (REM) stage occurring at the wrong time.3

These symptoms can vary between people. Some symptoms may improve over time or with treatment, but never go away completely. 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

Hallucinations and vivid dreams in people with narcolepsy

About half of those with narcolepsy have hallucinations and vivid dreams 2 to 3 times a month. During these hallucinations, sounds, smells, and images can seem so real it is hard to tell them from reality.1-3

Most hallucinations occur when the person is falling asleep or waking up. The vivid, intense dreams and nightmares happen while sleeping and can be frightening. Hallucinations are called:1-4

  • Hypnagogic: Dreams that happen while falling asleep
  • Hypnopompic: Dreams that happen when waking up

Most people with narcolepsy recognize their hallucinations are not real unlike people who have a serious mental issue like schizophrenia. If these dreams disturb nighttime sleep, the person may be even sleepier during the day.4

Sleep paralysis as a symptom of narcolepsy

Sleep paralysis is the inability to move or speak when just drifting off to sleep or when just waking up. This can last from a few seconds to a few minutes. The touch of another person may cause the paralysis to stop.1-4

Sleep paralysis is similar to cataplexy in that the person is awake while unable to move or speak. It can be alarming, especially if the person feels like they are suffocating. However, once the episode is over the person returns to their normal ability to move and speak.1-2

About 20 percent of the general population also have a rare episode of sleep paralysis 1 to 2 times a year. In people who do not have narcolepsy, these episodes are thought to be caused by severe lack of sleep, sleep apnea, circadian rhythm disorders, and anxiety.3

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