Narcolepsy

Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People living with narcolepsy can fall asleep without warning during daily activities such as eating, working, or driving.

Overview

Narcolepsy is a chronic neurological disorder that makes people very sleepy during the day and disrupts sleep at night. People with narcolepsy may feel rested after waking but then feel very sleepy throughout much of the day. Many individuals with narcolepsy also experience fragmented sleep at night, meaning they can’t stay asleep for long periods of time.

Signs and Symptoms

Once narcolepsy develops, the person will have it for the rest of their life. Symptoms usually begin between ages 7 and 25 but can start at any age. Symptoms differ among individuals and can improve over time but will never go away completely. Even when symptoms are severe, they do not result in permanent dysfunction, and after episodes end, people rapidly recover.

The most typical symptoms include:

Excessive Daytime Sleepiness (EDS)

All individuals with narcolepsy have periods of EDS, often the most obvious symptom. EDS causes severe daytime sleepiness that does not improve even after getting enough sleep at night. Sleepiness in narcolepsy often resembles a “sleep attack,” where an overwhelming feeling of sleepiness comes on quickly. Between sleep attacks, individuals can have normal levels of alertness, particularly when doing activities that keep their attention.

Cataplexy

This symptom leads to sudden episodes of muscle weakness, often triggered by strong emotions such as laughter, fear, anger, stress, or excitement. Cataplexy may appear weeks or even years after the onset of EDS. Some people may have only one or two attacks in a lifetime, while others may experience many attacks a day. In about 10% of cases of narcolepsy, cataplexy is the first symptom to appear. Episodes usually last a few seconds to several minutes and resolve on their own. Attacks may be mild and involve only brief, minor weakness in a few muscles, such as a slight drooping of the eyelids. The most severe attacks result in a total body collapse during which individuals are unable to move, speak, or keep their eyes open. Even during the most severe episodes, people remain fully conscious. This characteristic makes cataplexy different from fainting or seizure disorders. While scary, the episodes are not dangerous as long as the individual is in a safe place.

Children

If you notice that your child’s face suddenly goes slack, their eyelids droop, or their tongue sticks out, they may have “cataplectic facies.” This symptom is unique to children with narcolepsy.

Sleep Paralysis

This temporary inability to move or speak while falling asleep or waking up usually lasts only a few seconds or minutes. Very vivid, dreamlike, and sometimes frightening visual, auditory, or tactile hallucinations can accompany sleep paralysis.

Fragmented Nighttime Sleep and Insomnia

While individuals with narcolepsy are very sleepy during the day, they usually also experience difficulty staying asleep at night. They may wake up several times each night for 10 to 20 minutes, which can worsen daytime sleepiness. Sleep may be disrupted by insomnia, vivid dreaming, sleep apnea, acting out dreams, and periodic leg movements.

REM Sleep Behavior Disorder (RBD)

Usually, when people dream, the body’s muscles become temporarily paralyzed, preventing them from physically acting out their dreams. People with RBD do not experience this paralysis and might punch, kick, shout, or grab while asleep, disturbing their sleep and the sleep of people around them. RBD can be a problem on its own or a sign of another neurological disorder like narcolepsy.

Narcolepsy can greatly affect daily activities. If narcolepsy is not diagnosed or treated, it can interfere with emotional well-being and social interactions. It can also affect the ability to think clearly, which can affect school, work, and social life.

In addition, people with narcolepsy have an increased risk for:

Additionally, cataplexy can cause depression and suicidal thoughts.

Causes and Risk Factors

Narcolepsy affects the brain’s ability to control sleep-wake cycles. In a normal sleep cycle, people enter rapid eye movement (REM) sleep after about 60 to 90 minutes. REM sleep is the stage during which people do the most dreaming, and the brain keeps the person’s muscles limp to prevent them from acting out their dreams.

In people with narcolepsy, the regulation of the sleep and waking cycle is disrupted. The boundaries between wakefulness and sleep are less distinct, and elements of sleep and wakefulness can mix. People with narcolepsy frequently enter REM sleep much more quickly, often within 15 minutes of falling asleep, and can experience muscle weakness or dream activity of REM sleep while awake.

Although the causes of narcolepsy are not completely understood, current research suggests it may result from a combination of factors working together to cause a lack of a brain chemical called hypocretin, also known as orexin. Hypocretin helps you stay awake and controls REM sleep.

There are two major types of narcolepsy:

  • Type 1 narcolepsy (previously known as narcolepsy with cataplexy)—Type 1 narcolepsy is diagnosed in two ways. One way is detecting low levels of hypocretin (also known as orexin), a natural chemical that helps you stay awake and controls REM sleep. The other way is when a person has cataplexy and shows excessive daytime sleepiness during a special nap test.
  • Type 2 narcolepsy (previously known as narcolepsy without cataplexy)—People with this condition experience excessive daytime sleepiness but usually do not have cataplexy. They usually also have less severe symptoms and normal hypocretin levels. 

Factors that may contribute to a lack of hypocretin include:

  • Autoimmune disorders: When cataplexy is present, the cause is most often the loss of brain cells that produce hypocretin. Researchers believe that in individuals with narcolepsy, the body’s immune system selectively attacks the hypocretin-containing brain cells because of a combination of genetic and environmental factors.
  • Genetics: Most cases of narcolepsy are sporadic, meaning the disorder occurs in individuals with no known family history. However, clusters in families sometimes occur. The gene HLA-DQB1*06:02 has been linked to narcolepsy and increases the chance of developing the condition, particularly type 1 narcolepsy. Most people with narcolepsy have this gene variation.
  • Infections and environmental triggers: Narcolepsy follows a seasonal pattern and is more likely to develop in the spring and early summer after the winter season. Individuals with narcolepsy have high levels of certain antibodies, indicating an immune response to a recent bacterial infection such as strep throat.
  • Brain injuries: Rarely, narcolepsy results from traumatic injury to parts of the brain that regulate wakefulness and REM sleep, or from tumors and other diseases in the same regions. This is known as secondary narcolepsy. In addition to experiencing the typical symptoms of narcolepsy, individuals with secondary narcolepsy may also have other severe neurological problems and sleep for long periods (more than 10 hours) each night.

Diagnosis

Half of people with narcolepsy never receive a diagnosis. Even when they do, their diagnosis may happen years after the symptoms appear. People with narcolepsy are often misdiagnosed with other conditions like psychiatric disorders. For example, doctors may diagnose cataplexy late in children because their symptoms are similar to other disorders, such as epilepsy or syncope. However, half of people with narcolepsy have symptoms before they reach 18 years old.

To diagnose narcolepsy, a doctor will need to perform a clinical exam and take a detailed medical and family history. Individuals may be asked to keep a sleep journal noting the times of sleep and symptoms over a one- to two-week period. A physical exam can rule out or identify other neurological conditions that may be causing the symptoms. It is often necessary to visit a sleep medicine specialist for an accurate diagnosis.

Two specialized tests, which can be performed in a sleep disorders clinic, are required to establish a diagnosis of narcolepsy:

  1. Polysomnogram (sleep study): This overnight test records brain activity, muscle movements, breathing, and eye movements during sleep. It helps determine if REM sleep happens too early in the sleep cycle and checks for other conditions like sleep apnea.
  2. Multiple sleep latency test: This test measures how quickly a person falls asleep and whether they enter REM sleep.

Additional diagnostic tools include:

  • The Epworth Sleepiness Scale, which measures daytime sleepiness
  • A hypocretin test, which measures hypocretin level to determine if a person has cataplexy

Many people with narcolepsy also have sleep apnea. If someone also has sleep apnea, narcolepsy can be diagnosed only after a person has been treated for sleep apnea by a continuous positive airway pressure (CPAP) machine.

Treatment and Management

Although there is no cure for narcolepsy, some symptoms can be managed with a combination of medicines and lifestyle changes. Treatments target a person’s symptoms rather than the underlying disease, and it often takes a long time to find the right combination of treatments.

Many people with narcolepsy take multiple medicines to help manage symptoms. Your provider may prescribe medicines to help you stay awake during the day, treat excessive daytime sleepiness and cataplexy, or improve nighttime sleep.

  • Orzeyful (oveporexton) tablets, approved by the U.S. Food and Drug Administration (FDA) in 2026, is the first medicine to treat the full range of narcolepsy type 1 symptoms in adults. This medicine targets the cause of the disorder instead of just masking symptoms.Wake-promoting agents are usually the first choice for treatment to reduce daytime drowsiness and improve alertness. They are less addictive and have fewer side effects than previously used stimulants.
  • Amphetamine-like stimulants may be prescribed when wake-promoting agents are not effective. These medicines must be carefully monitored for serious side effects.
  • Antidepressants can be effective in controlling cataplexy. These include tricyclics and selective serotonin and noradrenergic reuptake inhibitors.
  • Sodium oxybate, also known as gamma hydroxybutyrate (GHB), is a drug that has been approved to treat cataplexy and excessive daytime sleepiness in individuals with narcolepsy. Due to safety concerns, the distribution of sodium oxybate is tightly restricted.
  • Pitolisant is the only product for treating excessive daytime sleepiness and cataplexy in adults with narcolepsy that is not a controlled substance regulated by the U.S. Drug Enforcement Administration (DEA). It has also been approved to treat excessive daytime sleepiness in children 6 years of age and older.

In addition, cognitive behavioral therapy (CBT), a form of talk therapy, can help people with narcolepsy sleep better, feel less sleepy during the day, and improve their overall health.

Living With Narcolepsy

Many individuals with narcolepsy take short, regularly scheduled naps at times when they tend to feel sleepiest. They can also follow tips to help improve sleep that work for everyone, such as exercising, avoiding alcohol and caffeine before bed, creating a restful sleeping environment, and maintaining a regular schedule for eating and sleeping.

Taking steps to stay safe, especially when driving, is important for people with narcolepsy. Avoiding driving when sleepy is one way to stay safe. The Americans with Disabilities Act (ADA) requires employers to allow adults with narcolepsy to ask for work adjustments, like flexible schedules for naps or doing challenging tasks when they are most awake. Children and teens with narcolepsy can also work with their schools to adjust schedules, take medicine during the day, and use other strategies to manage their condition.

Even with treatment, people with narcolepsy may still have daytime sleepiness. Therapy, education, and counseling may also help with symptom management. Cataplexy can cause depression and suicidal thoughts; both conditions improve with cataplexy treatment. If you experience any of these conditions, discuss ways to manage them with your healthcare provider.

Because research has shown that people with narcolepsy are at a higher risk for heart disease, their heart health should be monitored regularly by a doctor and taken into consideration when selecting medicines or other therapies.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on narcolepsy.

Community Support

Support groups can help people with narcolepsy and their families develop connections and share stories and strategies with others living with the same condition. Some resources for people with narcolepsy include:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH supports research to create fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease for all people. NIH supports research on narcolepsy and other sleep disorders through grants to medical institutions across the country.

Current research areas include:

  • Genetics and biochemicals: NIH-sponsored researchers are conducting studies to understand the wide range of genetic and environmental factors that may cause narcolepsy. Other investigators are using animal models to understand how hypocretin and other biochemicals may play a key role in regulating sleep and wakefulness.
  • Immune system: NIH scientists have demonstrated the presence of unusual immune system activity in people with narcolepsy. Researchers are working to understand why the immune system destroys hypocretin neurons in narcolepsy.
  • Sleep biology: NIH continues to support investigations into the basic biology of sleep, such as examining the brain mechanisms involved in REM sleep and other sleep behaviors. Researchers are also examining how brain circuits function in the body and contribute to sleep disorders like narcolepsy.
  • Orexin-based therapies: Researchers are investigating how new medicines, like orexin-based therapies, may help manage narcolepsy. These treatments focus on the orexin system in the brain, which helps control how awake, alert, and hungry we feel. Current trials are also being done to understand immune pathways and how medicines like clarithromycin reduce sleepiness for narcolepsy.

NIH’s NeuroBioBank is a resource for scientists studying neurological disorders, including narcolepsy. Donating tissue from individuals with narcolepsy can help researchers better understand the disorder. NIH also supports genetic and immunological research in narcolepsy at the Stanford University Center for Narcolepsy, where blood samples from individuals with narcolepsy can be sent by mail.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.