Retrospectively, Rachel felt that her sleepiness began in high school. She would fall asleep in class and while doing her homework. She attributed her sleepiness to “burning the candle at both ends.” She would get up by five each morning to catch the bus by six. Her afternoons were spent doing homework, practicing lacrosse, or participating in drama class. Bedtime was rarely before 11. For Rachel, sleepiness was just the consequence of her busy schedule.
In college, she continued her busy class and activity schedule and found herself falling asleep at any hour of the day. One morning she had a terrifying experience. She awoke with the telephone ringing. She could not, however, move. About two minutes later, she felt as if a huge weight lifted off her body, she was able to move about normally. Rachel shrugged the event off and did not seek medical attention.
A few years later, Rachel was working as a computer programmer. She was falling asleep at her computer and behind the wheel. She has been “written up” several times for tardiness after oversleeping. One day her co-worker told her a joke. Rachel started to laugh out loud. Suddenly, her legs gave out on her and she crumpled to the ground. For a few seconds she could not move, then she got up. It was this spell that brought Rachel to medical attention. After hearing her symptoms, her doctor suspected she was suffering from a condition known as narcolepsy. Rachel was referred to a sleep center where a sleep test continued the diagnosis.
Narcolepsy is a genetically inherited sleep disorder. Although not common, the disorder is not rare. It occurs in about one out of every 2,500 Americans. The most prominent symptom of narcolepsy is usually excessive daytime sleepiness. Narcolepsy is a sleep disorder in which features of “rapid eye movement” (REM) sleep intrudes into wakefulness. REM sleep is the stage of sleep in which we dream. Our muscles become completely paralyzed during REM sleep so we do not act out our dreams. In addition to the sleepiness of REM sleep, narcolepsy is characterized by episodes of sleep paralysis in which the person awakens from sleep unable to move. Sleep paralysis lasts a few minutes and resolves spontaneously. Rarely, this occurs in normal individuals.
The muscular paralysis of REM sleep can occur in attacks called cataplexy. These attacks are typically triggered by a strong emotional response such as laughing, crying, or getting bad news. Finally, the dreamlike images of REM sleep can intrude into consciousness as a person is falling asleep in the form of hallucinations, which the person has difficulty discerning from reality.
Rachel’s doctor prescribed a medication that helps her stay awake at work, and while driving. She continues to have attacks of cataplexy and sleep paralysis occasionally, but knowing the nature of these attacks and avoiding the triggers whenever she can has helped her minimize them.
If you suffer from inappropriate sleepiness, or any of the symptoms described above, see your doctor of contact your local sleep disorders center. For more information about narcolepsy and other sleep disorders, contact the National Sleep Foundation at http://www.sleepfoundation.org.