How narcolepsy presents
Narcolepsy is more than just being tired. It is a neurological condition characterized by excessive daytime sleepiness and dysregulated REM sleep — sometimes with cataplexy (sudden muscle weakness triggered by emotion), hypnagogic hallucinations, and sleep paralysis.
Diagnostic criteria
- Excessive daytime sleepiness present daily for at least three months
- Cataplexy (when present) — sudden, brief loss of muscle tone triggered by strong emotion
- Mean sleep latency ≤ 8 minutes on the Multiple Sleep Latency Test
- Two or more sleep-onset REM periods on MSLT
- Symptoms not better explained by another condition
Our evaluation
- Detailed sleep and clinical history; differential diagnosis
- Overnight polysomnogram followed by next-day MSLT
- HLA typing in select cases
- Evaluation for coexisting sleep apnea or movement disorder
Treatment
- Scheduled napping — short, planned naps reduce daytime symptom burden
- Stimulant medication — modafinil, methylphenidate, and others, matched to severity
- Cataplexy-specific therapy — sodium oxybate or selective REM-suppressing agents when indicated
- Lifestyle and safety counseling — driving restrictions during titration, sleep schedule stability
Narcolepsy is one of the most life-altering sleep diagnoses to miss — and one of the most rewarding to treat correctly.— Dr. Han Jin-Kyu