Self Help

Narcolepsy can be described as an irresistible urge to sleep during the day. Patients with narcolepsy may also experience cataplexy, sleep paralysis, and hypnagogic hallucinations. These four symptoms make up the term “narcolepsy tetrad.”

People with narcolepsy may fall asleep unintentionally in the middle of a conversation, while driving, or while eating a meal. Sometimes they are unable to remember much of what they do during the day because they are so sleepy. They may suddenly “black out” while driving a car, forget that they made certain phone calls, or forget that they performed specific tasks. These people have difficulty performing quality work during dull and monotonous activities. The sleepiness is sometimes alleviated by taking short naps throughout the day.

This magnitude of sleepiness often has undesirable consequences. Individuals with narcolepsy have difficulty keeping jobs, friends, and personal relationships. People suffering from narcolepsy are not sleepy because they are lazy, bored, or unmotivated, but rather because they have an underlying physiological problem.

In addition to daytime sleepiness, about 70% of patients with narcolepsy experience cataplexy. Cataplexy is a sudden muscular weakness, total loss of muscle tone, or paralysis brought on by strong emotions such as anger, fear, hearty laughter, or crying. Cataplectic attacks often involve weakness in a specific part of the body. Weakness in the lower facial muscles may cause slurring of words. Weakness of the limbs may result in wobbly movements or dropping of objects.

Some patients with narcolepsy may experience severe attacks and become altogether weak, limp and fall to the floor. Since these episodes are preceded by moments of emotional excitement, patients with narcolepsy often avoid certain situations that may bring on intense emotional reactions. Cataplectic attacks usually do not last more than a few minutes. Patients are conscious during the attacks and are aware of everything that is going on around them. The frequency of the attacks varies from patient to patient. Some cataplexy attacks may occur once a month or less, while other patients experience it several times a day.

About 20% to 30% of patients with narcolepsy experience the full narcolepsy tetrad. 40% to 65% undergo sleep paralysis and 50% to 70% undergo hypnagogic hallucinations. Sleep paralysis occurs just as the narcoleptic patient begins to fall asleep. The patient is paralyzed except for respiration and eye movements.

Hypnagogic hallucinations may occur at the same time as the sleep paralysis. The hallucinations are generally short-lived and end abruptly. Patients with narcolepsy may report “seeing things,” which can range from simple shapes to pictures and scenery. Auditory hallucinations may involve a range of sounds, from music to human voices. The emotional qualities of hypnagogic hallucinations commonly involve intense fear and anxiety.

Hallucinations involving intruders are often reported. Both the sleep paralysis and the hypnagogic hallucinations can be very terrifying experiences that some patients are scared to go to bed.