Narcolepsy is a rare condition that can cause a person to fall asleep without warning. Researchers are still studying the effects of the COVID-19 pandemic and the COVID-19 vaccine on narcolepsy.

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Narcolepsy is a rare, long-term brain condition that prevents a person from regulating sleep and waking patterns. Although it does not cause long-term physical health problems, it can affect an individual’s day-to-day life. Research indicates that the COVID-19 pandemic may have affected these symptoms according to people’s home and work routines.

This article discusses what research says about possible links between narcolepsy and COVID-19 and the effects of the COVID-19 vaccine on this condition.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on the COVID-19 pandemic.

Narcolepsy often results from a person having low levels of the brain chemical hypocretin, also known as orexin. There are two types of narcolepsy: type 1 and type 2.

Symptoms

Narcolepsy symptoms can vary from person to person and may develop over several years or weeks. Everyone diagnosed with the condition will experience daytime sleepiness, but only 10–25% will experience all other symptoms.

Symptoms of narcolepsy include:

  • Excessive daytime sleepiness (EDS): This is the most common symptom and causes excessive sleepiness, regardless of how much sleep the individual gets at night.
  • Sleep attacks: This is where a person falls asleep suddenly and without warning and is a common symptom of narcolepsy.
  • Cataplexy: A sudden temporary muscle weakness or loss of muscular control that triggers due to strong emotional reactions. Typical symptoms include:
    • slurred speech
    • facial drooping
    • legs collapsing
  • Hallucinations and sleep paralysis: Sleep paralysis is a temporary inability to move or speak while falling asleep or waking. It usually only lasts a few seconds, and hallucinations may accompany it. People can quickly recover their movement following an episode.

A person can take stimulants, such as amphetamine, to help keep them awake, or sedatives, such as barbiturates, to help them sleep. Lifestyle adjustments, such as keeping a regular sleep pattern and avoiding smoking and alcohol before bed, can also help ease symptoms.

A 2021 study mentions that during the COVID-19 pandemic, people did not report worsening narcoleptic symptoms after discontinuing narcolepsy medication due to quarantining difficulties. This is down to their ability to have more naps during the day, delaying their rise time and an increased sleep duration at night, improving their symptoms naturally.

A 2022 study further corroborates these findings, suggesting that extended sleep time, circadian delay and teleworking decreased symptoms of central hypersomnias.

Impact of the COVID-19 pandemic

Participants of this 2021 study found that their routines underwent drastic alterations by quarantining. This led to an increase in symptoms, such as:

  • cataplexy
  • sleep paralysis
  • nocturnal awakenings
  • sleepiness

As a result, their sleep and wake times changed, resulting in altered sleeping patterns. Additionally, people in the same study took fewer antidepressants but more stimulants.

However, this 2021 study found that participants who worked from home could manage their daytime sleepiness better, allowing themselves more naps and gaining an increased nocturnal sleep time. However, participants who continued their usual working schedule experienced more frequent nocturnal awakenings.

The COVID-19 pandemic stunted people’s ability to follow a routine through the use of quarantine. This study shows that routine is important to ensure a good quality of life for those with narcolepsy. Working from home during the pandemic improved some people’s routines as they could better regulate their sleeping patterns.

According to a 2021 study, genetic susceptibility to narcolepsy and environmental exposures to bacterial and viral infections may alter or trigger a reaction in a person’s immune system. This may attack the orexin-producing neurons, which help regulate a person’s sleep and wake pattern.

The study further suggests that the inflammatory response due to infection with SARS-CoV-2, the virus that causes COVID-19, may trigger chronic autoimmune and neurodegenerative disorders. These infections can initiate specific conditions in susceptible individuals, such as Parkinson’s disease, multiple sclerosis, and narcolepsy.

Experts have not undertaken any large-scale genome-wide association study on vaccination responses of those with narcolepsy for routinely used vaccines.

However, in this 2021 study, a woman with a history of hypersomnia presented with EDS after having the COVID-19 vaccine. The study found that relapse may have links to an autoimmune mechanism. Therefore, more studies are necessary to protect vulnerable individuals from the side effects of the COVID-19 vaccine.

Similarly, the H1N1 influenza pandemic in 2009 saw associations of the H1N1 vaccine with a several-fold elevated risk of developing narcolepsy in children and young adults throughout Sweden, Finland, and Denmark.

According to this 2020 article, the link between H1N1 response, vaccination, and narcolepsy highlights an important multidisciplinary healthcare opportunity. Further studies are therefore necessary to draw more definitive conclusions.

Studies throughout the COVID-19 pandemic have demonstrated that people with narcolepsy may have benefitted through improved working conditions that match their needs, such as later rising times and the ability to nap during the day.

However, more studies are necessary on the effect of the COVID-19 vaccine on those with narcolepsy and those prone to developing it. Current studies have found that the COVID-19 vaccine may trigger the condition in people at risk.