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If you have trouble staying awake during the day, you might expect falling asleep at night to be easy. But that isn’t always the case. People with narcolepsy can have insomnia, a common sleep disorder that makes it hard to fall asleep, stay asleep, or wake up early. Sometimes insomnia is a symptom of narcolepsy.
There are many ways that narcolepsy and insomnia are related, but there are also a few key differences between these sleep disorders.
Narcolepsy and insomnia are both sleep disorders.
Narcolepsy is characterized by excessive daytime sleepiness — the feeling of falling asleep throughout the day, often at inappropriate times. People with narcolepsy have excessive daytime sleepiness (EDS), but they may feel rested when waking in the morning or after a nap.
Other characteristic symptoms of narcolepsy include changes in rapid eye movement (REM) sleep patterns and sleep paralysis, a temporary state at the beginning or end of sleep when individuals are unable to move or speak. Sleep paralysis generally lasts just a few seconds or minutes.
In between sleep attacks, people with narcolepsy usually have a normal level of alertness, especially if they are engaged in stimulating tasks that hold their attention. People with type 1 narcolepsy may also experience cataplexy — sudden, uncontrollable muscle weakness often triggered by strong emotions.
Insomnia is characterized by an inability to fall asleep or stay asleep. It may also take the form of early-morning awakening, where you wake up several hours early and can’t go back to sleep.
Insomnia may also make it hard to remember things or concentrate. This happens because lack of sleep causes daytime tiredness.
Insomnia can be a narcolepsy symptom. However, when it presents without a co-occurring sleep condition, insomnia is often followed by daytime hyperarousal (being overly alert or sensitive to stimulation), rather than the excessive daytime sleepiness that occurs in narcolepsy.
Narcolepsy and insomnia have different causes and contributing factors.
Researchers don’t know exactly what causes narcolepsy, but they have observed that some people with the condition have low levels of a brain chemical known as hypocretin. Hypocretin is a chemical messenger that regulates sleep.
It has been suggested that narcolepsy may be an autoimmune disorder. Researchers believe that in people with narcolepsy, abnormalities in the immune system cause it to selectively attack the brain’s hypocretin-containing brain cells.
Evidence also suggests that family history may be a risk factor for narcolepsy, playing a role in up to 10 percent of type 1 cases. Traumatic brain injuries also sometimes lead to narcolepsy.
Insomnia can occur on its own or alongside other health conditions. Certain mental and environmental factors may lead to chronic insomnia, such as stress, poor sleep habits, a disrupted sleep schedule, mental health disorders (including anxiety and depression), certain medications, and sleep disorders — including narcolepsy.
Because narcolepsy causes excessive daytime sleepiness, people with this condition often have short periods of sleep throughout the day. These are known as micronaps.
Taking multiple micronaps throughout the day can add up and cause a person to have difficulty sleeping through the entire night. They may experience disrupted sleep or, in some cases, insomnia.
Many people with narcolepsy go undiagnosed because they report difficulty sleeping. This leads their doctors to rule out the possibility of a rarer sleep disorder in favor of something more common, such as insomnia.
Getting the right diagnosis for your sleep problem is important so you can receive the correct treatment. Some tests for insomnia and narcolepsy are similar, while others are designed specifically for just one of the sleep disorders.
A diagnosis of primary insomnia (insomnia not caused by a medication, lifestyle factor, or mental health condition) involves ruling out other potential causes of sleep difficulties. These include other health conditions or sleep disorders, medications, mental disorders, and substance use.
Diagnosing insomnia may include the following steps.
Your doctor will start by asking questions about your lifestyle and sleep pattern.
A physical exam is conducted to identify any signs of medical issues that may be causing your insomnia. This may involve blood tests.
Your doctor may ask you sleep-related questions and have you complete a questionnaire about your sleep quality. You may also be asked to keep a sleep journal and record your sleeping habits for a few weeks.
If you have signs of another sleep disorder (such as narcolepsy) or if the cause of your insomnia isn’t certain, your doctor may want to perform a sleep study. A sleep study is not usually necessary for chronic insomnia unless your doctor suspects you may have another, additional sleep disorder.
During a sleep study, you’ll spend a night at a sleep center where a variety of your bodily activities will be closely monitored while you sleep, including your breathing, heartbeat, eye movements, body movements, and brain waves.
Actigraphy may be used to help diagnose insomnia. This is a device that monitors human sleep-wake cycles to collect data about their sleep. It measures your movement during sleep and wake cycles, which can indicate how much you are sleeping and the quality of the sleep you’re getting.
Testing for narcolepsy may also include providing your sleep history and keeping a record of your sleep, along with completing one or more sleep studies.
A diagnosis of narcolepsy usually requires polysomnography, a sleep study that looks at the activity of your brain, heart, muscles, eyes, and lungs during nighttime sleep. When undergoing a polysomnogram test, you will stay overnight at a sleep laboratory and sleep with electrodes attached to your scalp.
To diagnose narcolepsy, you should also receive a multiple sleep latency test (MSLT). A multiple sleep latency test is conducted at a lab during the day, usually the morning after a polysomnogram.
During an MSLT, you’ll be required to take four or five naps, each spaced two hours apart. Sleep medicine professionals will measure how long it takes you to fall asleep and how fast you enter into the REM sleep stage once you are asleep to determine whether you have narcolepsy.
Narcolepsy symptoms can mimic those of other conditions. Therefore, a differential diagnosis is important to determine whether you have narcolepsy or another related sleep disorder, such as idiopathic hypersomnia or obstructive sleep apnea.
Treatments for narcolepsy focus on helping manage the symptoms. Treatments for insomnia, on the other hand, may involve addressing the issues contributing to your inability to sleep, as well as using therapies or medications to help you get a better night’s sleep.
Although there is no known cure for narcolepsy, medications and lifestyle adjustments can help you manage its symptoms.
Narcolepsy treatment can include several different types of medications to help relieve symptoms. These include:
You can manage the symptoms of narcolepsy by following these tips:
Methods used to restore restful sleep for people with insomnia include cognitive behavioral therapy (CBT) and the use of sleep aids.
Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for insomnia. The process involves two sets of techniques to help change negative beliefs (cognitive therapy) and habits (behavioral therapy).
Your doctor may recommend other strategies related to your lifestyle and sleep environment to help you develop habits that promote sound sleep and daytime alertness.
Prescription sleeping pills can also be used to treat insomnia, but doctors generally advise using them for no longer than a few weeks. Some medications are safe for long-term use. Talk to your healthcare provider before trying over-the-counter sleep aids.
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Same here. CBD is helpful as well for the treatment of both. Adding 50 mg a day with my meds have changed my life. (not all CBD is the same and there is still Indica or sativa strands)
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