Narcolepsy and insomnia are sleep disorders. One possible cause of both conditions is how much of the chemical messenger orexin a person produces. Insomnia could mean they may have too much — or an inappropriate release — of orexin at night, while someone with narcolepsy may not have enough.
Narcolepsy is associated with “sleep attacks” that can happen at unexpected times, such as while a person is walking or performing other physical activities. Episodes of falling suddenly asleep, excessive daytime sleepiness, and sudden muscle weakness is a characteristic of narcolepsy. There are two types of narcolepsy: type 1 and type 2.
Insomnia also causes excessive daytime sleepiness and is characterized by the inability to fall or stay asleep. It can also cause a person to wake early in the morning, several hours earlier than necessary. Someone with insomnia may struggle with functional impairment during the day due to a lack of sleep.
This article examines whether a person can have both narcolepsy and insomnia, the link between the two, similarities and differences, and how to treat each condition.
Narcolepsy and insomnia share a chemical messenger called orexin in common. This peptide plays a role in activating parts of the brain that promote wakefulness.
People with narcolepsy may have fewer than normal nerve cells that produce orexin, while those with insomnia may have too much orexin or an inappropriate release of orexin at night. Too little orexin may cause sleepiness, and too much can cause an inability to sleep.
It is also possible that a person with narcolepsy may experience insomnia as one of their
A person can have both narcolepsy and insomnia. While the two conditions represent opposite ends of the sleep disorder spectrum, a person with narcolepsy — who may experience extreme tiredness during the day — will also
Insomnia and narcolepsy share some common symptoms, such as excessive daytime sleepiness. Both conditions can lead to difficulty concentrating and functioning throughout the day due to tiredness. However, they also differ in several ways, which we outline below.
- Narcolepsy is a rare, long-term brain condition that causes a person to fall asleep suddenly, often at inappropriate times.
- Narcolepsy can cause cataplexy — a temporary loss of control over muscles that can result in weakness and collapse. This often happens in response to a person showing strong emotions, such as during an angry outburst or laughing. Narcolepsy with cataplexy is type 1 narcolepsy. Narcolepsy without cataplexy is type 2.
- Narcolepsy causes sleep attacks, where a person falls asleep suddenly, without warning.
- Narcolepsy may cause vivid dreams – known as hypnogogic hallucinations as a person falls asleep, and hypnopompic hallucinations while waking.
- Narcolepsy can cause sleep paralysis, a temporary inability to speak or move while falling asleep or waking.
- The cause of narcolepsy is a lack of orexin, a brain chemical that regulates wakefulness.
- People with narcolepsy generally fall asleep rapidly but can spontaneously awaken several times during the night and have difficulty returning to sleep. This sleep maintenance insomnia seems paradoxical in a disorder characterized by daytime sleepiness and may result from a person having a low threshold to transition from sleep to wakefulness.
- Insomnia is a condition where people regularly find it difficult to fall asleep and stay asleep.
- Insomnia can cause a person to wake throughout the night.
- Insomnia can cause a person to wake up too early.
- Insomnia may cause tiredness even after sleeping.
- Insomnia can cause irritability and tiredness throughout the day.
A doctor may treat narcolepsy and insomnia differently. If insomnia is a symptom of narcolepsy, treating narcolepsy may help reduce insomnia.
Treatment of narcolepsy
There is no cure for narcolepsy. However, a person may be able to treat the condition by making changes to improve their sleeping habits and taking medication.
A person can try:
- taking brief naps often throughout the day
- following a strict bedtime schedule and going to bed at the same time
- creating a good sleeping environment, such as a quiet, comfortable room with no distractions
- avoiding caffeine and alcohol before bedtime
- relaxing before bed
A doctor may prescribe medication for narcolepsy. This can include stimulants such as dexamphetamine, methylphenidate, or modafinil to address excessive daytime sleepiness. Non-sedating antidepressants such as citalopram or fluoxetine may help with some of the possible accompanying symptoms of narcolepsy, including cataplexy. Sodium oxybate can address both excessive daytime sleepiness and cataplexy.
Treatment of insomnia
As with narcolepsy, people with insomnia should aim to practice good sleep habits, such as keeping to a sleep schedule, relaxing before bed, and creating a good sleep environment.
Cognitive behavioral therapy (CBT)
CBT may help a person feel less anxious about sleeping and develop more positive thinking.
These include melatonin receptor agonists, benzodiazepines, which can be habit-forming, benzodiazepine receptor agonists, and orexin receptor antagonists, such as suvorexant.
Over-the-counter (OTC) medications
OTC medications for insomnia are mainly antihistamines, such as diphenhydramine and doxylamine. Chronic use of antihistamines can be associated with dementia, so a person should inform their healthcare provider about any OTC or natural treatments they are taking for insomnia.
Natural treatments may include melatonin, lavender, magnesium, and valerian root.
Other possible causes of insomnia may include:
- uncomfortable sleeping environment
- anxiety, depression, and stress
- caffeine, nicotine, and alcohol
- jet lag
- shift work
- recreational drugs, such as ecstasy or cocaine
Certain conditions, and medications to help treat these conditions, can also cause insomnia:
- mental health disorders, such as bipolar disorder
- restless leg syndrome
- Parkinson’s disease
- Alzheimer’s disease
- overactive thyroid
Possible causes of narcolepsy may include:
- Problems with the immune system: Many researchers hypothesize that an autoimmune process selectively kills orexin neurons. This results in less orexin production, which leaves the brain less able to regulate sleep cycles. Additionally, the onset of narcolepsy appears highest during spring, suggesting that a winter infection may be a trigger. One possible infection is streptococcal pharyngitis — anti-streptococcal antibodies are sometimes elevated, especially in the first year after the onset of narcolepsy.
- Pandemrix vaccine: In 2013, researchers found a link between narcolepsy and the flu vaccine Pandemrix in children. The vaccine was in use during the 2009–2010 swine flu epidemic. However, the risk is minimal, with the chance of developing narcolepsy after the vaccine estimated at 1 in 52,000.
Other triggers for narcolepsy may include:
- a genetic problem inherited from family
- psychological stress
- changes to hormones, such as during menopause or puberty
- a change in sleep patterns
Some other conditions that can also present with hypersomnia and excessive daytime sleepiness include:
Obstructive sleep apnea: This is a common sleep disorder characterized by interruptions in breathing during sleep. This may result in sleepiness during the day, irritability, poor concentration, loud snoring, and interruption to sleep.
Kleine-Levin syndrome: This is a rare disorder in which a person requires excessive amounts of sleep, up to 20 hours a day. A person may also need excessive food and may experience behavioral changes, such as an unusually uninhibited sex drive.
Idiopathic hypersomnia (IH): This is a chronic condition characterized by episodes of extreme sleepiness and fatigue for no identifiable reason. A person with IH does not experience cataplexy, as with type 1 narcolepsy.
A person with narcolepsy may also experience:
- excessive daytime sleepiness
- vivid dreams and hallucinations
- sleep paralysis
- cognitive problems
Although narcolepsy and insomnia are at opposite ends of the clinical spectrum, a person can have both conditions. Insomnia is also sometimes a symptom of narcolepsy.
The two share the chemical orexin in common. People with insomnia may have an inappropriate release of orexin at night, which helps regulate wakefulness, while those with narcolepsy may have too little. There are also various other triggers for each condition.
Change to: “The two conditions both cause daytime sleepiness and fatigue, but also share differences. Narcolepsy — particularly type 1 — is characterized by cataplexy. Insomnia is usually characterized by difficulty falling asleep.
People with both sleep disorders can benefit from creating a healthy, comfortable sleeping environment and following a regular sleep schedule. A doctor may prescribe different medications to treat each condition.