Narcolepsy, Hypersomnia and Excessive Daytime Sleepiness

Sleepiness that is more than being tired

Feeling sleepy in the day can come from not allowing enough time for sleep, or from a true sleep disorder. [1] Hypersomnia is the term for extreme daytime sleepiness, and it includes narcolepsy. [1] If you fall asleep at times you do not intend to, see a clinician. Nearly 40 percent of US adults report falling asleep during the day without meaning to at least once a month, so a single episode is not a diagnosis, but regular episodes deserve evaluation. [2]

Narcolepsy

Narcolepsy is a chronic disorder that makes people very sleepy during the day and disrupts sleep at night. People with narcolepsy can fall asleep without warning during daily activities such as eating, working or driving. [3] The NHS describes it as rare. [4]

Common features:

• Suddenly feeling very sleepy in the day, sometimes called a "sleep attack". This wording describes a symptom, not a separate disorder. [3]


• Waking often at night, hallucinations and sleep paralysis when falling asleep or waking. [3] See Sleep paralysis.


• Type 1 narcolepsy includes cataplexy, a sudden loss of muscle control that emotions such as laughter, fear, anger or excitement may trigger; type 2 does not. [3]


• Symptoms usually start in children and young adults. [4]

Causes. The cause is not known, but narcolepsy happens when the brain cannot control sleeping and waking normally. [4] People with cataplexy have low levels of the wake-promoting brain chemical hypocretin (orexin). [3]

Evaluation. The NHLBI says half of people with narcolepsy never receive a diagnosis, and diagnosis may come years after symptoms appear. Tests can include a multiple sleep latency test (how quickly you fall asleep), the Epworth Sleepiness Scale, sleep studies and a hypocretin test. [3] The NHS notes a sleep specialist is involved and a diary of symptoms helps. [4] Up to 33 percent of people with narcolepsy also have sleep apnea. [3] See Sleep apnea.

Established care. There is no cure, but treatments and lifestyle changes can help manage symptoms. [4] Sleep management includes a regular bedtime and wake time, planned daytime naps and getting enough night sleep. [4] Medicines can help you stay awake or prevent sudden muscle weakness. [4] Avoiding alcohol and medicines that worsen sleepiness may help. [3]

Idiopathic hypersomnia

Idiopathic hypersomnia is a rare chronic neurological condition that may involve excessive daytime sleepiness, prolonged night sleep and sleep inertia (difficulty waking). Its mechanisms and diagnostic boundaries are poorly defined, and there is no definitive biomarker. [5] Diagnosis relies heavily on the multiple sleep latency test, which has limits, and therapy options are limited. [5] This is an area where proper evidence not found for consumer-level self-care beyond general sleep habits and clinical care; plain-language agency pages on this condition were not available to read.

Excessive daytime sleepiness: other explanations

Sources mention not allowing enough time for sleep [1], sleep apnea [6], and restless legs syndrome, which can bring daytime sleepiness. [7] See Why am I so tired? for the wider picture, and How sleep works.

Safety and driving

Narcolepsy is not usually harmful in itself but can cause accidents or injuries. Avoid activities at home or work that could be dangerous if you sleep or fall unexpectedly. [4] In the UK you must tell the DVLA if you drive and have narcolepsy. [4] Talk with your provider about safety, including car accidents. [3] Insomnia medicines such as orexin receptor antagonists are not recommended for people who have narcolepsy. [8] See Sleep safety and drowsy driving.

Natural and complementary approaches

Proper evidence not found in the sources read for herbs or supplements treating narcolepsy or idiopathic hypersomnia. Do not replace prescribed medicine with supplements, and check any product with your clinician; see Medicine interactions.

When to get help

See a doctor if you feel tired all the time for no reason, fall asleep suddenly in the day, or have sleep problems that worry you or affect your life. [4] Cataplexy can cause depression and suicidal thoughts; if you have these, discuss them with your provider. [3] In the US call or text 988 in a crisis.