Pulmonary, Sleep, and Critical Care Medicine
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Narcolepsy

What is narcolepsy?

Narcolepsy is a chronic brain disorder that involves poor control of sleep-wake cycles. People with narcolepsy experience periods of extreme daytime sleepiness and sudden, irresistible bouts of sleep that can strike at any time.  These “sleep attacks” usually last a few seconds to several minutes.

Narcolepsy can greatly affect daily activities.  People may unwillingly fall asleep while at work or at school, when having a conversation, playing a game, eating a meal, or, most dangerously, when driving or operating other types of machinery.  In addition to daytime sleepiness, other major symptoms may include cataplexy (a sudden loss of voluntary muscle tone while awake that makes a person go limp or unable to move), vivid dream-like images or hallucinations, as well as total paralysis just before falling asleep or just after waking-up.

Contrary to common beliefs, people with narcolepsy do not spend a substantially greater proportion of their time asleep during a 24-hour period than do normal sleepers.  In addition to daytime drowsiness and uncontrollable sleep episodes, most individuals also experience poor sleep quality that can involve frequent waking during nighttime sleep, and other sleep disorders.

For most adults, a normal night’s sleep lasts about 8 hours and is composed of four to six separate sleep cycles.  A sleep cycle is defined by a segment of non-rapid eye movement (NREM) sleep followed by a period of rapid eye movement (REM) sleep.  The NREM segment can be further divided into increasingly deeper stages of sleep according to the size and frequency of brain waves.  REM sleep is accompanied by bursts of rapid eye movement along with sharply heightened brain activity and temporary paralysis of the muscles that control posture and body movement.  When subjects are awakened, they report that they were “having a dream” more often if they had been in REM sleep than if they had been in NREM sleep.  Transitions from NREM to REM sleep are controlled by interactions among groups of neurons (nerve cells) located in different parts of the brain.

For normal sleepers a typical sleep cycle is about 100 to 110 minutes long, beginning with NREM sleep and transitioning to REM sleep after 80 to 100 minutes.  People with narcolepsy frequently enter REM sleep within a few minutes of falling asleep.