What to know about narcolepsy without cataplexy

Narcolepsy without cataplexy, often known as narcolepsy type 2, is a condition that causes excessive daytime sleepiness. It does not cause an abrupt loss of muscle tone, unlike narcolepsy type 1.

Narcolepsy is a neurological condition that is classified into two types: type 1 and type 2. Cataplexy is a condition that causes a section of the body to go limp in people with type 1 diabetes.

Depending on the severity of the cataplexy, a person may experience eyelid drooping, an inability to contract specific muscles, or actual collapse.

However, people with narcolepsy type 2 do not experience this symptom. They may feel brief and acute bouts of tiredness, but they do not experience alterations in the way their muscles function. Doctors are baffled as to what causes type 2.

In this post, we will examine narcolepsy without cataplexy in further detail, including symptoms, diagnosis, and treatment.

What is it?

Narcolepsy without cataplexy is a neurological condition that causes excessive daily sleepiness and unexpected sleep bouts. It is also referred to as “type 2 narcolepsy.”

Type 2 narcolepsy, unlike type 1, does not cause an abrupt decrease of muscular tone. The medical word for this is cataplexy. Cataplexy occurs when a person temporarily loses the capacity to use a muscle, usually in response to powerful emotions such as fear, anger, or excitement.

Hypocretin is another trait that distinguishes type 2 narcolepsy from type 1. This is a hormone that affects daytime wakefulness and nighttime rapid eye movement (REM) sleep. People with type 2 narcolepsy have normal levels of this hormone, whereas those with type 1 have low levels.

Narcolepsy is uncommon, but many experts believe that many people with it go undetected.

When to see a doctor

If you suspect you could have narcolepsy or if you have any of the following people, you should see a doctor.

  • sleep issues such as hallucinations or sleep paralysis
  • intense daytime sleepiness, regardless of how well they sleep
  • loss of voluntary muscle control

If you have narcolepsy and are experiencing any of the following people, you should see a doctor.

  • their medication causes side effects that feel intolerable
  • they develop new or worsening symptoms
  • treatment stops working

Symptoms

cataplexy

The sole symptom required for a narcolepsy type 2 diagnosis is daily sleep attacks. During these assaults, a person abruptly enters REM sleep. This is the stage of sleep when dreams occur.

Other signs that a person may observe include:

  • excessive sleepiness during the day
  • fragmented sleep at night or insomnia
  • sleep paralysis, which is when a person wakes from sleep but cannot move
  • hallucinations

Mild narcolepsy

Narcolepsy exists on a scale. Symptoms might be modest or severe, interfering with practically every part of living. However, because narcolepsy causes brief bouts of sleep, most people regard the condition as severe or disturbing.

People may suffer extreme tiredness throughout the day for a variety of reasons, including narcolepsy. Other conditions that may look like narcolepsy but do not cause cataplexy include:

  • mental health conditions, such as depression
  • substance misuse
  • shift work sleep disorder
  • a longer daily sleep requirement than is typical, especially when paired with inadequate sleep
  • inadequate sleep
  • sleep apnea
  • medication-induced sleepiness

Diagnosis of Narcolepsy Type 2

A doctor may begin by taking a medical history if a person is experiencing symptoms that could indicate narcolepsy type 2. They will inquire about a person’s symptoms, including when they began and how frequently they recur.

They may also check at their medical records to see what medications they are taking, as well as any preexisting diseases, to see if these can explain the symptoms.

They may next ask the individual to keep a sleep diary for two weeks. A doctor cannot diagnose narcolepsy in someone who gets less than 6 hours of sleep each night, according to a 2021 article, because sleep deprivation can also cause daytime sleepiness.

If a person is obtaining more than 6 hours of sleep each night and still experiencing symptoms, the doctor may advise a polysomnogram (PSG) and several sleep latency tests (MSLT). A PSG is a sleep study in which doctors observe a patient overnight. This can help rule out other possible causes of fatigue, such as sleep apnea.

Doctors can perform the MSLT the morning following a PSG. This entails taking planned naps throughout the day, during which doctors will assess how quickly a person enters REM sleep.

According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, a person must have at least one of the following symptoms to be diagnosed with narcolepsy:

  • REM sleep that begins less than 15 minutes after the beginning of sleep, or two or more periods of sudden REM sleep where it takes 8 minutes or less to fall asleep
  • episodes of cataplexy that occur several times each month
  • low or absent hypocretin

Because people with narcolepsy type 2 do not exhibit cataplexy and typically have normal hypocretin levels, finding rapid REM sleep with an MSLT is an important step in confirming a diagnosis.

Treatment for Narcolepsy Type 2

Narcolepsy has no known cure. Instead, treatment focuses on symptom management.

The predominant symptom of narcolepsy without cataplexy is excessive tiredness. A variety of drugs can assist a person in remaining awake. Most doctors advise starting with modafinil (Provigil) or armodafinil. Amphetamine-like stimulant medications, such as methylphenidate, are used as a second-line treatment.

The Food and Drug Administration (FDA) has not authorized these medications for use in children due to a lack of evidence regarding their safety.

In addition to drugs, some people with narcolepsy find that experimenting with behavioral adjustments might help them manage their symptoms. Among the strategies are:

  • avoiding bright lights and screens before bed, and keeping them out of the bedroom
  • maintaining a consistent sleep schedule at night
  • taking strategic 15–20-minute naps during the day
  • having a relaxing bedtime routine

People can help their circadian rhythm as much as possible during the day by waking up at the same time every day, obtaining safe exposure to natural daylight, and remaining active.

Work and school accommodations may be beneficial, especially if a person has not yet found a medication that alleviates their symptoms.

Living with narcolepsy

Narcolepsy type 2 might be difficult to manage. Excessive drowsiness during the day might make it difficult to work or keep up with other commitments. In some cases, it can also be harmful to one’s health. Activities such as driving or operating machinery, for example, might be hazardous for persons who suffer from sleep attacks.

As a result of this, living with narcolepsy can necessitate major adaptations. A person may need to avoid particular activities or circumstances, rely on others for transportation, and plan their job and social life around their fatigued periods.

It is important to have enough assistance. This may entail seeking assistance from a narcolepsy specialist, as well as from friends and family, and, if necessary, a therapist or counselor. Mental health assistance can assist someone in coming to terms with their diagnosis and coping with the challenges of living with a chronic condition.

Conclusion

Narcolepsy is a neurological condition that can have a lot of implications. It causes extreme and overpowering tiredness that can come at any time during the day.

Narcolepsy type 2 is a subtype of narcolepsy that does not include cataplexy. It signifies that someone has narcolepsy symptoms like tiredness and other symptoms, but not cataplexy, which is an abrupt loss of muscle tone.

Narcolepsy can only be diagnosed and treated by a medical practitioner. People who think they might have this condition should see a sleep expert or a neurologist.

Narcolepsy can be managed with the correct combination of medicines and lifestyle adjustments. Support for social and mental health is equally important.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371435/
  • https://rarediseases.org/rare-diseases/narcolepsy/
  • https://www.medicalnewstoday.com/articles/narcolepsy-without-cataplexy
  • https://www.ncbi.nlm.nih.gov/books/NBK459236/