by Amanda Gipson

Created on: September 11, 2007

Narcolepsy is a chronic and debilitating sleep disorder. Often misunderstood to be a mental illness, narcolepsy is in fact a neurological condition, and arises from a deficit of certain neurotransmitters that would normally regulate the sleep-wake cycle. Although certain symptoms may lead to a suspicion of narcolepsy, a sleep physician will often undertake investigations involving sleep electroencephalogram (EEG) and other tests to rule out sleep apnea and other disorders. Blood tests may also be used to determine whether a particular genetic marker is present, as this is common to the majority of narcoleptics, but is much less common in the general population. For the most stringent diagnostic test, a lumbar puncture may be used. A small amount of cerebrospinal fluid is removed from the patient's spinal column, and analyzed for levels of the neurotransmitter orexin, also known as hypocretin. These chemical levels are abnormally low in narcoleptics, sometimes as far as to be undetectable.

The most well known symptom of narcolepsy is excessive daytime sleepiness. Most people have at one time or another experienced fatigue, perhaps after a late night. Narcoleptics, however, suffer overwhelming bouts of sleepiness several times a day, making it impossible to stay awake. These sleep attacks often arrive with no warning, and result in the sufferer falling asleep quite suddenly and involuntarily. Some people will be unable to work because of this, and for others working is made difficult by feelings of shame and embarrassment. Colleagues and employers often find such sleepiness difficult to understand, and think of the sufferer as lazy or disinterested.

Some sufferers also experience catalepsy. This symptom has been misdiagnosed as fainting and epilepsy, but is quite different to both. Catalepsy is a sudden loss of muscular tone, leading to jaw sagging, neck and shoulders dropping, buckling of the knees and sometimes full bodily collapse. Despite appearances - and the episode may resemble a faint - the cataleptic does not lose consciousness, but remains fully aware, able to see and hear everything around them but completely helpless to move or respond. This incapacitation usually lasts from a few seconds to a few minutes, although prolonged attacks have been documented. In narcolepsy, catalepsy is characterized by having particular triggers, often feelings of sudden or intense emotion. Laughter and anger are the most common feeling that can bring on a cataleptic attack.

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