Understanding Narcolepsy: Inside the Main Types of Narcolepsy

Narcolepsy is a neurological sleep disorder in which the brain struggles to control sleep-wake cycles. People with narcolepsy may experience extreme daytime sleepiness, involuntary “sleep attacks,” cataplexy (sudden muscle weakness), or stressful sleep paralysis or hallucinations. The most common cause of narcolepsy is a lack of hypocretin, a brain hormone that regulates wakefulness. Medical professionals use a polysomnogram (PSG) and multiple sleep latency test (MSLT) to diagnose narcolepsy.

In general, there are two main types of narcolepsy:

• Type 1: Type 1 narcolepsy is a diagnosis for an individual who experiences cataplexy and other common symptoms, including excessive daytime sleepiness and sleep attacks. People with type 1 narcolepsy often have low levels of a brain hormone called hypocretin (orexin), which regulates wakefulness. The low levels may result from the person’s immune system mistakenly destroying the hypocretin-producing neurons in the hypothalamus. Healthcare professionals may test a sample of the patient’s cerebrospinal fluid for hypocretin levels to diagnose type 1 narcolepsy.
• Type 2: Type 2 narcolepsy is a diagnosis for an individual who experiences many symptoms of narcolepsy, including daytime sleepiness and sleep attacks, but not cataplexy. Typically, people with type 2 narcolepsy have normal hypocretin levels, a brain hormone that regulates wakefulness.

A person with narcolepsy may experience one or more of the following symptoms:

1. 1. Excessive daytime sleepiness. Even after a full night’s sleep, a person with narcolepsy can often feel extremely tired throughout most of the day. Recurring daytime drowsiness is the most common symptom of narcolepsy.
2. 2. Involuntary sleep episodes. Someone with narcolepsy may experience periodic involuntary sleep episodes (sometimes called “sleep attacks”), in which they unwillingly lapse into sleep during the day—even in the middle of an activity, such as talking or driving.
3. 3. Cataplexy. Some people with narcolepsy occasionally experience cataplexy, or sudden loss of muscle tone, causing them to lose muscle control. A cataplexic episode can range in severity from going slightly limp to experiencing total body collapse. For people with type 1 narcolepsy, cataplexy can be brought on by strong emotions, such as anger, fear, or even laughter. The presence of cataplexy in a person’s list of symptoms is what differentiates between type 1 narcolepsy and type 2 narcolepsy.
4. 4. Stressful sleep experiences. Some people with narcolepsy report reduced nighttime sleep quality. These stressful sleep experiences can include hypnagogic hallucinations (which occur as a person falls asleep), hypnopompic hallucinations (which occur as a person wakes up), extremely vivid dreams, or sleep paralysis. People with narcolepsy may reach rapid eye movement sleep (REM sleep) much quicker than the average person—sometimes within 15 minutes instead of 60 to 90 minutes, the average timeframe.

While there is no cure for narcolepsy, there are several treatment options that can alleviate narcolepsy symptoms. Consult a medical professional before beginning a new treatment regimen.

1. 1. Medication. Medication is the most common way to treat narcolepsy. Central nervous system stimulants can potentially reduce daytime sleepiness and increase general alertness; antidepressants have been used to reduce the frequency of cataplexy.
2. 2. Scheduled naps. Some people with narcolepsy schedule short naps into their day at times when they feel sleepiest. Napping can reduce excessive sleepiness and the possibility of falling asleep at inconvenient times.
3. 3. Sleep hygiene. Good sleep hygiene can help those with narcolepsy sleep better during the night and feel more well-rested during the day. Common tactics include maintaining a consistent sleep schedule, avoiding caffeine, nicotine, and alcohol before bedtime, and turning off electronics to encourage melatonin production.
4. 4. Physical exercise. Healthcare professionals may recommend physical activity to reduce the symptoms related to sleep disorders. Daily exercise can help make you feel more alert during the day and more exhausted near bedtime. Learn more about how exercise affects sleep quality.

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