Conditions to get screened for after a narcolepsy diagnosis
Fact-checked by Certain medical conditions are more common among people with narcolepsy than in the general population. After your narcolepsy diagnosis, your doctors will recommend a monitoring plan to screen for those conditions based on your symptoms, medical history, and individual risk factors.
Health conditions associated with narcolepsy include other sleep disorders, mental health concerns, cardiovascular diseases, and hormonal imbalances. Some people also experience problems that affect the body’s use of energy (metabolic disorders).
These overlapping conditions, also called comorbidities, can sometimes complicate the narcolepsy treatment process and negatively affect your overall health, which is why it’s important to work with your care team on a proactive monitoring plan even when you feel well.
Why another condition can coexist with narcolepsy
It isn’t always clear why certain narcolepsy comorbidities occur with the disease, and these relationships are often complex.
Sometimes the underlying biological causes of narcolepsy may independently raise the risk of other diseases. This is most clearly established in narcolepsy type 1, which is caused by autoimmune attacks on nerve cells that produce the signaling molecule orexin. [here]
Beyond sleep, orexin also helps regulate other automatic bodily processes, including appetite and heart rate. As such, low orexin levels in narcolepsy may in part explain why the disease overlaps with conditions such as obesity and cardiovascular disease. The core dysregulation of sleep-wake cycles in narcolepsy could also contribute to other sleep problems.
In other cases, narcolepsy symptoms can affect functioning in ways that make people more vulnerable to additional concerns, such as mental health challenges.
Potential narcolepsy comorbidities
Conditions linked to narcolepsy can include:
- other sleep disorders
- mental health and psychiatric concerns
- metabolic conditions
- cardiovascular disease
The possible explanations for these vary, as do best practices for monitoring or testing.
Other sleep disorders
Narcolepsy can coexist with other sleep disorders, including the following:
- Obstructive sleep apnea (OSA): interruptions to breathing during sleep because of blockages in the upper airway
- Parasomnia: abnormal behaviors or events that disrupt sleep, such as sleepwalking and sleep talking, sleep terrors, or acting out dreams
- Insomnia: difficulty falling or staying asleep
- Restless legs syndrome: a strong urge to move the legs when resting
Narcolepsy and sleep apnea have a particularly strong link — between one-quarter and one-half of people with narcolepsy type 1 also have OSA. Though the reasons for this overlap aren’t entirely clear, narcolepsy can lead to weight gain and obesity, which is a leading risk factor for OSA.
There is no routine monitoring schedule for OSA, but your doctor will likely order a sleep study to assess it if you are having relevant symptoms — such as heavy snoring or increasingly unrefreshing sleep at night — or if you’ve gained weight or have other risk factors.
If OSA develops before narcolepsy, it may need to be treated before a narcolepsy diagnosis can be reached, as apnea-related breathing issues can complicate the results of diagnostic tests.
Psychiatric and mental health concerns
The most common psychiatric comorbidities in narcolepsy include:
- depression
- anxiety disorders
- attention-deficit/hyperactivity disorder (ADHD)
The relationship between narcolepsy and depression is especially complex, as mood can affect narcolepsy symptoms and vice versa. The diagnosis can also be complicated, as excessive sleepiness is sometimes a symptom of depression or a side effect of medications.
Your doctor may regularly screen you for mental health problems at follow-up appointments.
ADHD causes difficulty paying attention, along with hyperactive or impulsive behaviors, and is particularly linked to narcolepsy type 1. Sometimes the symptoms of narcolepsy may be misdiagnosed as ADHD, particularly among children.
Metabolic conditions
A loss of orexin in narcolepsy type 1 can affect appetite and metabolism, contributing to obesity and weight gain.
People with narcolepsy may also be at risk of metabolic conditions, including high blood sugar or diabetes, high blood pressure, and high cholesterol, although the reasons for this link aren’t fully clear.
As part of routine monitoring, your doctors may track your weight and blood pressure and run blood tests to check levels of things like cholesterol and blood sugar.
Cardiovascular disease
Narcolepsy and cardiovascular risk are often linked, making people with narcolepsy more vulnerable to stroke, heart disease, and high blood pressure. Potential explanations of this connection include the following:
- Altered sleep cycles can affect heart function.
- Low orexin levels may affect blood pressure and heart rate during sleep, ultimately putting more strain on the heart and raising cardiovascular risk.
- Some narcolepsy treatments can affect cardiovascular function.
Because of the heightened risk, people with narcolepsy may require regular cardiovascular monitoring, particularly if they are on a medication that can also contribute to the potential problems.
Other health conditions and narcolepsy
Studies have found a variety of other health conditions associated with narcolepsy , including:
- migraines
- epilepsy
- pain
- autoimmune disorders
- allergies
- digestive problems
- skin conditions
- genital and urinary conditions
Autoimmune disorders and allergies, which are also related to the immune system, are more common in narcolepsy type 2. This type of narcolepsy is not explicitly an autoimmune disease, but some scientists believe these comorbidities suggest an underlying immune problem.
Your doctor may not routinely monitor you for these problems, but it’s important to always let them know if you’re having any unexpected symptoms so they can run more tests.
When thyroid or other medical testing may be considered
Like narcolepsy, some types of thyroid problems can cause fatigue. Thyroid testing is often part of the narcolepsy diagnostic process to rule out a hormonal imbalance as a possible explanation of symptoms.
If excessive sleepiness persists despite narcolepsy treatments, or other signs of a hormone imbalance emerge, a doctor may recommend thyroid or other medical testing to see if another condition besides narcolepsy is present.
Which conditions may affect children and teenagers
Many disorders that affect adults with narcolepsy can also affect children and teenagers. These include anxiety, obesity or weight gain, and other sleep disorders.
Additionally, some children with narcolepsy may experience precocious puberty, meaning puberty-related changes begin happening earlier than expected.
How other conditions may affect narcolepsy symptoms and treatment
It can be difficult to tell exactly how other conditions affect narcolepsy symptoms, particularly when there is overlap. Symptom overlap may result in exacerbated or obscured symptoms. For example, depression or thyroid issues can make you feel even more tired during the day.
Some comorbidities affect narcolepsy treatment options. For example:
- kidney or liver dysfunction may affect how the body clears drugs, making certain medications unsafe.
- medications that increase cardiovascular risk may not be safe for people with existing cardiovascular vulnerabilities.
- medications for other conditions can interact with certain narcolepsy medications, which may limit your options.
When deciding on a narcolepsy treatment plan, your sleep specialist will make sure your prescribed treatments will not interact unsafely with your other medications and health conditions. They’ll also assess whether medications you’re using for other conditions might affect your sleep patterns.
Having other health conditions with narcolepsy can be challenging. Comorbidities aren’t always stable and may shift over time, affecting your symptoms and treatment in ever-changing ways. Adhering to your doctor’s recommended follow-up and monitoring schedule is key for tracking these changes and making necessary adjustments.
Narcolepsy News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
