Narcolepsy is one of the most misunderstood of all sleep disorders. In simple terms, narcolepsy is a breakdown of normal boundary control of Rapid Eye Movement (REM) sleep. REM sleep is loosely known as dream sleep. Normal adults go through brainwave cycles every ninety minutes while asleep. REM sleep occurs at the end of each nightly sleep cycle but normal people would not have REM sleep during daytime naps. Narcoleptic patients often fall asleep during the daytime and will have REM sleep during these naps.

Normal REM sleep involves paralysis of the body, so that one does not act out their dreams. This paralysis occurs for most of the muscles of the body but does not occur for the muscles that control eye movements and the diaphragm which is a trampoline like muscle dividing the abdomen and the chest. The diaphragm contracts during inspiration pulling down on the lungs, inflating them, and thus allowing inspiration to occur. The diaphragm is not paralyzed during REM so that breathing can continue while one is dreaming.

Cataplexy is a symptom of narcolepsy. Cataplexy is the loss of muscular control that may occur with strong emotions, such as laughter, crying, or anger. This may result in the knees buckling, an arm going weak, or even weakness of the face. The weakness usually lasts for several minutes but the person with narcolepsy experiencing it is fully conscious during this time. Cataplexy may seem like an odd symptom for a narcoleptic to have, but it is really the paralysis that would normally occur during nighttime REM sleep except that it is occurring during the daytime. About forty to sixty percent of patients with narcolepsy have cataplexy.

Sleep paralysis is another symptom that may be seen in narcolepsy. Sleep paralysis is also a symptom that about half of the normal population will experience at least once or twice during their lifetimes. Have you ever awoken in the morning to know that you were awake but you couldn’t move your body? This is sleep paralysis. It is a blending of both wakefulness and REM sleep. The brain knows that it is awake, but the part of the brainstem that allows the paralysis to occur is still in REM sleep. This is just another example of how narcolepsy is a breakdown of REM sleep boundary control.

Patients with narcolepsy often have vivid daytime dreams, although some patients will not remember them. Some patients will go into a vivid dream directly from wakefulness. This can be problematic if they happen to be driving a car at the time.

Symptoms of narcolepsy can begin abruptly, and usually begin in the teens or twenties but may occur at any age. There is an increased risk of getting narcolepsy if there is a positive family history for it. Much recent research suggests that it is an autoimmune disorder, like multiple sclerosis or rheumatoid arthritis.

You should be checked for narcolepsy if: 

• you have severe daytime sleepiness, even after having had a full night's sleep.
• you fall asleep when you do not intend to, such as while having dinner, talking, driving, or working.
• you collapse suddenly or your neck muscles feel too weak to hold up your head when you laugh or become angry or surprised.
• you find yourself briefly unable to talk or move while falling asleep or waking up.