Narcolepsy in adults
Reviewed by Narcolepsy is a rare neurological sleep disorder that affects your ability to regulate sleep and wakefulness. It can disrupt rapid eye movement (REM) sleep and cause excessive daytime sleepiness (EDS).
Narcolepsy in adults requires ongoing management, but with the right treatment and support, you can live a full and active life. Understanding how the condition may affect you can help you manage symptoms, address safety concerns, and prepare for conversations with your healthcare team.
How does narcolepsy affect adults?
Narcolepsy symptoms often begin during adolescence or early adulthood, although they can develop at any age. Studies have reported that receiving an accurate diagnosis may take upward of 15 years after symptoms begin. Some research suggests there may be a smaller second peak in symptom onset around age 35.
Symptoms may also change as you get older. For some people, EDS becomes less severe in older adulthood, while nighttime sleep becomes more fragmented. Responsibilities such as working, driving, caring for others, and managing a household may create additional challenges.
Common symptoms of narcolepsy in adults
There are two types of narcolepsy: type 1 and type 2. Narcolepsy symptoms in adults can vary from person to person and may include:
Scroll horizontally to view all columns -->
| Symptom category | Details |
|---|---|
| Excessive daytime sleepiness: You may struggle to stay awake and alert during the day, even when you get enough sleep at night. Short naps may temporarily help you feel refreshed. Periods of unavoidable sleep (sleep attacks) may overwhelm you as well. | Seen in both type 1 and type 2 narcolepsy, but can be seen in other sleep disorders such as sleep apnea. |
| Cataplexy: If you have type 1 narcolepsy, strong emotions may trigger a sudden, brief loss of muscle tone while you remain conscious. | Seen only in type 1 narcolepsy. |
| Sleep paralysis: You may temporarily be unable to move or speak while falling asleep or waking up. | Seen in both type 1 and type 2 narcolepsy; can be seen in other sleep disorders including insufficient sleep. |
| Sleep-related hallucinations: You may experience vivid, dreamlike images, sounds, or sensations as you fall asleep or wake up. Often coincides with sleep paralysis, but not always. | Otherwise known as hypnagogic (going to sleep) or hypnopompic (waking up from sleep) hallucinations. Seen in both type 1 and type 2 narcolepsy and other sleep disorders including insufficient sleep. |
| Disrupted nighttime sleep: You may wake frequently during the night and have difficulty maintaining restful sleep. | Seen in both type 1 and type 2 narcolepsy, but can be seen in other sleep disorders including sleep apnea and insomnia. |
| REM sleep behavior disorder: You may act out dreams during sleep. | Can be seen in both type 1 and type 2 narcolepsy, but in other sleep disorders as well. |
Anxiety, depression, and other mental health conditions also may occur alongside narcolepsy, but they are not defining symptoms of the disorder.
What sleep attacks can feel like
The term sleep attack is commonly used to describe a sudden or overwhelming need to sleep. However, these episodes are not always completely unexpected. You may notice increasing drowsiness before you fall asleep.
EDS in adults may be especially noticeable during passive activities, such as reading, watching television, attending a meeting, or riding in a car. However, sleepiness also can interfere with more active tasks.
You may sometimes continue a familiar activity, such as writing, typing, or driving, with reduced awareness. This is known as automatic behavior. You may perform the activity inaccurately and have little or no memory of it afterward.
Uncontrolled sleepiness can create safety risks while driving or operating machinery. Talk with your doctor about whether your symptoms are adequately controlled and what steps you can take to stay safe.
Cataplexy, sleep paralysis, and vivid hallucinations
Narcolepsy can best be thought of as sleep instability. In other words, when you’re awake, you may feel the urge to sleep. On the other hand, when you’re trying to sleep, you might not be able to do so well. Narcolepsy can disrupt the boundaries between wakefulness and REM sleep. As a result, features of REM sleep may occur while you are falling asleep, waking up, or awake.
REM sleep should typically occur in adults within approximately 90 to 120 minutes of falling asleep. This is a period of sleep when you are paralyzed but also dreaming. In narcolepsy, this line is blurred, and your REM sleep becomes unstable. This means the paralysis or the dream content may intrude into your wake period, resulting in symptoms of sleep paralysis, hallucinations, and unusually detailed or realistic dreams.
If you have type 1 narcolepsy, you may also experience cataplexy. Cataplexy in adults is a sudden, brief loss of muscle tone triggered by strong emotions. Laughter is a common trigger, but excitement, surprise, anger, or fear also may cause an episode.
Cataplexy can cause subtle symptoms, such as drooping eyelids, slurred speech, jaw weakness, or buckling knees. In more severe episodes, much or all of your body may become weak. You remain conscious during the episode. Cataplexy may be present when other narcolepsy symptoms begin, or it may develop later.
How narcolepsy is diagnosed in adults
A narcolepsy diagnosis in adults usually begins with a discussion of your symptoms, sleep habits, medications, and medical history. Your doctor may ask you to keep a sleep diary or use a wrist-worn device called an actigraph to track your sleep-wake patterns.
Before testing you for narcolepsy, your doctor may evaluate you for other possible causes of daytime sleepiness, including insufficient sleep, sleep apnea, medication side effects, or another medical or mental health condition.
A sleep specialist may use two main tests:
- Overnight polysomnography: This sleep study records your brain activity, breathing, heart rate, eye movements, and muscle activity while you sleep.
- Multiple sleep latency test: This is performed the day after an overnight sleep study. It measures how quickly you fall asleep during several scheduled naps and whether you enter REM sleep unusually quickly.
Prior to this, your sleep doctor may also track your sleep using detailed sleep logs or wristwatch actigraphy. In other situations, your doctor may recommend a maintenance of wakefulness test. This test measures your ability to remain awake in a quiet environment. It may help assess treatment response or alertness during safety-sensitive activities, but it is not used to diagnose narcolepsy.
Treatment options for adult narcolepsy
Narcolepsy treatment for adults usually combines medication with behavioral and lifestyle strategies.Â
Your treatment plan should be based on your symptoms, daily responsibilities, overall health, and personal preferences.
Strategies your doctor may recommend include:
- Taking planned naps: Short naps at scheduled times may help you manage daytime sleepiness.
- Following a regular sleep schedule: Going to bed and waking up at consistent times may support better nighttime sleep.
- Creating a healthy sleep environment: A cool, dark, and quiet bedroom may help you sleep more comfortably.
- Using medication: Different medications may help manage EDS, cataplexy, disrupted nighttime sleep, or other symptoms.
Talk with your doctor about the potential benefits, risks, and side effects of each treatment. Do not stop or change a medication without first consulting your healthcare team.
Some narcolepsy medications may not be recommended during pregnancy or while breastfeeding. If you are pregnant, planning a pregnancy, or breastfeeding, talk with your doctor about the safest way to manage your symptoms.
Managing narcolepsy at work
Managing narcolepsy at work can be challenging, particularly if your job involves driving, operating machinery, working long or irregular shifts, or attending lengthy meetings.
If your symptoms substantially limit a major life activity, you may be eligible for reasonable workplace accommodations under the Americans with Disabilities Act. Eligibility and appropriate accommodations depend on your individual circumstances and job responsibilities.
Possible accommodations may include the following:
- a modified or flexible work schedule
- a private space for planned naps
- additional rest breaks
- remote or hybrid work arrangements when appropriate
- adjustments to shift schedules
- reassignment of nonessential driving duties
- written instructions or recorded meetings to support concentration and memory
The Job Accommodation Network offers information about workplace accommodations and can help you prepare for a conversation with your employer.
Tips for living with narcolepsy
Living with narcolepsy as an adult may feel frustrating or isolating, but support from your healthcare team and the people around you can help.
Consider these strategies:
- Track your symptoms: Note patterns you can discuss with your doctor.
- Plan around sleepiness: Schedule demanding activities when you tend to feel most alert.
- Prioritize safety: Avoid driving or other hazardous activities when you feel sleepy.
- Explain your needs: Help trusted people understand narcolepsy and how they can support you.
- Connect with others: Consider mental health support or a narcolepsy support group.
Resources are available through patient advocacy organizations such as Wake Up Narcolepsy and Narcolepsy Network.
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.
