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Key Features

  • A disorder of excessive sleepiness, manifesting in "sleep attacks"

  • Disorder begins in early adult life

  • Affects both sexes equally

  • Severity levels off at ~30 years of age

Clinical Findings

  • Tetrad of symptoms

    • Sudden, brief sleep attacks during any type of activity

    • Cataplexy, a loss of specific or generalized muscle tone

    • Sleep paralysis: a flaccidity of muscles with full consciousness while falling or waking from sleep

    • Hypnagogic hallucinations, preceding sleep or occurring during a sleep attack

Diagnosis

  • Sleep study

    • Attacks are characterized by abrupt transition into REM sleep, a necessary criterion for diagnosis

Treatment

  • Dextroamphetamine, 10 mg orally each morning

  • Modafinil, 200 mg orally each morning

    • Mechanism of action is unknown, but risk of abuse is thought to be lower than with stimulants

    • May reduce the efficacy of cyclosporine, oral contraceptives, and other medications by inducing their hepatic metabolism

    • Common side effects include headache and anxiety

  • Imipramine, 75–100 mg once daily orally, is effective in treatment of cataplexy but not narcolepsy

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