People with narcolepsy can have other sleep disorders, including insomnia. Insomnia is a common sleep disorder that can cause difficulties with falling asleep, staying asleep, or waking up too early. Insomnia sometimes overlaps with narcolepsy, and may even arise as a symptom of narcolepsy.
This may be surprising, as there is a common misconception that narcolepsy makes a person prone to falling asleep during the day. But the reality is that people with narcolepsy can experience difficulty falling asleep or staying asleep at night.
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 but may feel rested when waking in the morning or after a nap. They may struggle to stay awake throughout the day.
Other characteristic symptoms of narcolepsy include changes in REM (rapid eye movement) sleep patterns and episodes of irresistible sleepiness, in which individuals experience an overwhelming sense of sleepiness. In between these sleep attacks, individuals with narcolepsy have a normal level of alertness, especially if they are engaged in stimulating tasks that hold their attention. People with type 1 narcolepsy also experience cataplexy — sudden, uncontrollable muscle weakness that’s often triggered by strong emotions.
Insomnia is characterized by an inability to initiate or maintain sleep. It may also take the form of early morning awakening, in which the individual wakes up several hours early and is unable to resume sleeping.
Insomnia may also cause difficulties with memory and concentration. This impairment often occurs because insomnia can prevent you from feeling refreshed after a night’s sleep, leading to daytime tiredness.
Insomnia can be a symptom of narcolepsy. However, when it presents without a co-occurring sleep condition, insomnia is often followed by daytime hyperarousal (excessive metabolic rate or alertness), rather than the excessive daytime sleepiness characteristic of narcolepsy.
Narcolepsy and insomnia have different causes and contributing factors.
It’s not known exactly what causes narcolepsy, but researchers 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.
To explain what may cause narcolepsy, it has been suggested that it 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 has also suggested that family history may play a role in up to 10 percent of narcolepsy cases.
Insomnia can occur as a primary problem or alongside other health conditions. Certain mental and environmental factors may lead to chronic insomnia, such as stress, poor sleep habits or a disrupted sleep schedule, mental health disorders (including anxiety and depression), certain medications, and sleep disorders — including narcolepsy.
Because it causes excessive daytime sleepiness, people with narcolepsy often have short periods of sleep intermittently 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 periods of fragmented sleep, 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 this sleep disorder in favor of something more common, such as insomnia.
Receiving the proper diagnosis for your sleep disorder is important to start the right treatment. Some diagnostic tests for insomnia and narcolepsy overlap, and others are specific to just one of the two sleep disorders.
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. For example, these include other health conditions or sleep disorders, medications, mental disorders, and substance abuse.
Diagnosing insomnia may include the following steps.
A physical exam is conducted to identify any signs of medical issues that may be causing your insomnia. This may sometimes involve blood testing.
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, you may be asked to undergo a sleep study. A sleep study is usually not needed just for chronic insomnia unless another sleep disorder is suspected.
During a sleep study, you’ll spend a night at a sleep center where a variety of your bodily activities are 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 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. To diagnose narcolepsy, however, you must also have a multiple sleep latency test (MSLT).
This test is conducted at a lab during the day, usually the day after a polysomnogram.
During an MSLT, you’ll be required to take four to five naps, each spaced two hours apart. Experts in sleep medicine will measure how long it takes you to fall asleep and how fast you enter into the REM stage once you are asleep to determine whether you have narcolepsy.
A diagnosis of narcolepsy usually requires polysomnography alongside an MSLT. For this test, you will have to stay overnight at a sleep laboratory and sleep with electrodes attached to your scalp. The test looks at the activity of your brain, heart, muscles, eyes, and lungs during the night.
The symptoms of narcolepsy 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 and/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.
The following treatment options may be used to treat your narcolepsy.
There are many medications for narcolepsy.
These drugs have a stimulating effect on the central nervous system (CNS) and help individuals stay awake during the day. They include Provigil (modafinil) and Nuvigil (armodafinil).
Methylphenidates (such as Aptensio XR, Concerta, and Ritalin), as well as various amphetamines, may also be effective for narcolepsy, but they can be addictive.
Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) help suppress REM sleep. They are administered to alleviate certain symptoms of narcolepsy, including cataplexy, hallucinations, and sleep paralysis.
These medications include Prozac, Sarafem, and Selfemra (fluoxetine) and Effexor XR (venlafaxine).
These are effective for cataplexy but may cause unwanted side effects, such as dry mouth and lightheadedness. Tricyclic antidepressants include Vivactil (protriptyline), Tofranil (imipramine), and Anafranil (clomipramine).
Xyrem (sodium oxybate) is another effective drug for cataplexy that helps improve nighttime sleep and control daytime sleepiness.
Wakix (pitolisant) is a medication approved to treat excessive daytime sleepiness (EDS) associated with narcolepsy. It is also helpful to control cataplexy symptoms.
Sunosi (solriamfetol) is used to treat daytime sleepiness associated with narcolepsy or obstructive sleep apnea.
You can manage the symptoms of narcolepsy by applying the following 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 a few weeks, at most. Some medications are safe for long-term use. These include:
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