Symptoms

There are two major symptoms that accompany narcolepsy: sleepiness and cataplexy. Sleepiness tends to be the first symptom that develops, with cataplexy developing in 10-15% of patients after about 10 years of the onset of sleepiness (Passouant & Billiard, 1976; as cited in Aldrich, 1990).

Sleepiness can be defined as spontaneous sleep that is apparent in boring or sedentary situations and is quite refreshing. It differs from normal sleep in that it cannot be fully relieved by any amount of sleep. These sleep attacks usually last between 15 and 20 minutes and are followed by a "refractory period of 1 to several hours before the next episode occurs" (Guilleminaut, 1994).

In about 60% of people with narcolepsy, hallucinations accompany the onset of the sleep (hypnagogic hallucinations) or awakening period (hypnopompic hallucinations) of the sleep attack. These hallucinations may be visual, auditory, or kinetic (i.e.: feeling of flying) and last for a few seconds to a few minutes and terminate spontaneously (DSM-IV, 1994). In addition, approximately 30-50% of individuals with narcolepsy experience sleep paralysis (DSM-IV, 1994). When sleep paralysis occurs, it may last up to 10 minutes. "During an episode of sleep paralysis, the patient is powerless to move the extremities, to speak, or to open the eyes, although being fully aware of the condition and able to recall it completely afterward" (Guilleminaut, 1994, p. 339).

The second major symptom of narcolepsy is cataplexy. Cataplexy can be defined as muscular weakness usually brought on by excitement or emotion with about 6-10% of patients having cataplexy initially (Aldrich, 1990). It can occur in the form of a severe attack or a partial episode. Laughter, anger, or sadness can trigger a cataplexy attack although laughter is usually the most common trigger. Even thinking about a highly emotional event or listening to music can trigger an episode of cataplexy. A severe cataplexic attack involves complete paralysis, except for the respiratory muscles, and partial episodes result in patients falling down or dropping items (Aldrich, 1990). Prolonged episodes tend to be associated with hallucinations.

Although sleepiness and cataplexy are the most common symptoms, there are other symptoms which are indicative of narcolepsy including automatic behavior, disrupted nocturnal sleep, and disturbances of memory and vision (Aldrich, 1990).

The following is a checklist of symptoms, discussed above, which are commonly involved in narcolepsy. If any or all of these symptoms indicate your present situation, contact a physician.

• Frequent daily sleep attacks. Lasting 20 minutes to 1 hour.
• Muscular weakness. Frequent dropping of items as well as occurrences of falling down without cause (i.e.: slip on ice).
• Falling asleep during what would normally be high stimulation times. If you find yourself falling asleep -- for no apparent reason -- while driving a car or carrying on a conversation, it may indicate a medical problem.
• Hallucinations before and/or after sleep. These may be visual, auditory, or kinetic.
• Difficulty sleeping. Interrupted night sleep accompanied by repeated awakenings and sometimes by terrifying dreams.