A fiery discussion is in progress during an office meeting, with active participation from everyone. Right in the middle of this heated exchange of ideas, one person dozes off. Within no time, the points discussed, the counterarguments, the rapid-fire exchange of ideas… everything becomes secondary. The meeting’s focus now shifts to the one person who has dozed off. But instead of asking what, why or how, the mockery follows.Now, let’s follow the man home. The scene shifts to him dozing off, this time in the middle of an argument with his partner or during an important family gathering. How much time would it take for that person to become the laughing stock?While this is no excuse for someone not fulfilling their responsibilities, what we often miss is the chance to recognise that excessive sleepiness may not always be a normal response to circumstances. There is a possibility that an underlying medical condition, Narcolepsy, is being ignored and mocked because of our own lack of awareness.Narcolepsy is a condition in which a person’s sleep-wake cycle is disrupted, interrupting their day with excessive sleepiness and other symptoms.
Narcolepsy is a chronic sleep disorder in which a person has difficulty regulating their sleep-wake cycle. It is usually associated with excessive daytime sleepiness (EDS), along with other symptoms and difficulties. According to the Narcolepsy Network, more than three million people worldwide are affected by the condition, while around 50 per cent of people with narcolepsy go undiagnosed. Even among those who are diagnosed, it can take years to identify the condition, highlighting the lack of awareness surrounding it.According to the National Institute of Neurological Disorders and Stroke, people with narcolepsy feel sleepy throughout the day, even when they have had adequate sleep. They may also experience fragmented sleep.Rapid eye movement (REM) sleep, the stage in which most dreaming occurs, normally begins about 60–90 minutes after falling asleep. In people with narcolepsy, REM sleep may begin much earlier, sometimes within 15 minutes of falling asleep. They may also experience cataplexy — sudden muscle weakness or loss of muscle control while remaining conscious — as well as sleep paralysis, sudden sleep attacks and vivid dream-like experiences around the transition between sleep and wakefulness.
People with narcolepsy experience symptoms differently, and their severity can vary. The condition is chronic, but its symptoms can often be managed with treatment and lifestyle changes.Excessive daytime sleepiness (EDS): One of the most common symptoms of narcolepsy is EDS. People may fall asleep during the daytime, sometimes for a few minutes or longer, with the severity varying from person to person. Sleep attacks can occur with little warning during a conversation or while carrying out a task, and can be particularly dangerous while driving. These episodes may recur even after adequate sleep at night.Cataplexy: This involves sudden episodes of muscle weakness, often lasting from a few seconds to several minutes. It can be triggered by strong emotions such as laughter, excitement, fear, anger or stress. Some people experience cataplexy rarely, while others may experience it several times a day. It can sometimes be mistaken for a seizure disorder because it may involve drooping eyelids, difficulty moving or speaking, or difficulty keeping the eyes open. However, the person remains conscious during a cataplexy episode.Sleep paralysis: This is a brief experience of being unable to move while falling asleep or upon waking. It may be accompanied by intense dream-like experiences, including frightening visual, auditory or tactile hallucinations.Insomnia: Although people with narcolepsy may be excessively sleepy during the day, many also have difficulty falling asleep or staying asleep at night. Their sleep may be disrupted by vivid dreams, dream enactment, sleep apnoea and recurrent leg movements, among other factors.REM sleep behaviour disorder: Some people with narcolepsy may experience dream enactment, in which they move, kick, punch, shout or otherwise physically act out their dreams. Such episodes can sometimes disturb or injure the person sleeping beside them.
There is no significant gender difference associated with narcolepsy, and it can affect people of any gender. Symptoms can begin during childhood or adolescence, although they may also develop later. As the symptoms are often mistaken for other neurological or sleep-related conditions, diagnosis can take time.Although the exact causes of narcolepsy are not fully understood, many people with narcolepsy, particularly those with type 1 narcolepsy, have very low levels of a brain chemical called hypocretin, also known as orexin. No single factor can be identified as the sole cause. A combination of factors, including autoimmune processes, genetic influences and, in some cases, brain injury, may play a role.With advances in sleep medicine, specialised tests such as polysomnography (PSG), or a sleep study, and the multiple sleep latency test (MSLT), along with other assessments, can help qualified medical professionals diagnose the condition. Doctors may prescribe medications and recommend therapies to help manage the symptoms and improve quality of life.
Follow a regular sleep schedule and maintain good sleep hygiene.Take regular, short planned naps when recommended.Avoid caffeine, smoking and alcohol close to bedtime.Cognitive behavioural therapy (CBT) may be considered on the advice of a qualified therapist.Exercise regularly.Avoid heavy meals at night.Avoid driving if excessive daytime sleepiness or sudden sleep attacks make it unsafe, and adjust travel schedules where possible.
(Compiled by Shyama Sarangadharan)