Is It Fatigue or Do You Really Have Narcolepsy?

Almost everybody feels unusually tired or drained at times, and that’s normal. But could your lack of energy be a sign that something else is going on? Two possibilities for your weariness are fatigue and narcolepsy.

You may have heard the words, but there’s a lot of confusion about the particulars of these two very different conditions.

Nurse practitioner Jennifer Brubaker, PhD, APRN, explains more.

Fatigue: A struggle to keep going

• Lack of energy. Fatigue is a self-reported lack of physical or mental energy. People with fatigue do not usually complain of excessive daytime sleepiness. But when they do sleep or rest, it often fails to boost their energy levels.
• Difficulty staying active. You may have a hard time getting yourself going, and once you start an activity you may struggle to keep going.
• Trouble with memory and mood. Some people find that it’s difficult to concentrate or remember things. Some people struggle with emotional stability.

Narcolepsy: Sleep intruding on your days

Narcolepsy is a disorder of sleep-wake control — sleep intrudes into wakefulness and wakefulness intrudes into sleep. There are specific signs that point to narcolepsy:

• Excessive daytime sleepiness. Many people with narcolepsy are unable to stay awake and alert during the day. There are times when they have an irrepressible need for sleep, or unintended lapses into sleep. This is more severe at times and is more likely to happen when you’re sedentary or in a boring or monotonous situation, such as when you’re watching TV or driving a vehicle.
• Hallucinations. Some people have vivid, often frightening visual, tactile, or auditory hallucinations as they fall asleep, referred to as hypnagogic hallucinations.
• Sleep paralysis. Some people are completely unable to move for one or two minutes after they wake up or just before they fall asleep.
• Sudden loss of muscle tone. Cataplexy is a sudden loss of muscle tone that leaves you weak in reaction to strong emotion, especially laughter and excitement. The muscle weakness often affects only parts of the body — often the face, neck and knees. You likely will not lose consciousness, but often are temporarily unable to respond. Not everyone with narcolepsy has cataplexy.
• Most people wake up refreshed after sleeping, but begin to feel sleepy again prematurely. Staying active may help you fight the urge to sleep.

What’s behind these disorders?

For fatigue: There is often an underlying cause. Here are some possibilities:

• Medication side effects.
• Depression or anxiety.
• Thyroid disease.
• Rheumatologic disease.
• Cancers.
• Heart and lung diseases.

For narcolepsy: The exact cause is uncertain, but may relate to a loss of orexin signaling for some people. (Orexin is a neurotransmitter that helps regulate your sleep and wake states.) The hypothalamus in the brain releases orexin to help stimulate other brain regions to help keep you awake. If there is not enough orexin, normal sleep and wake patterns sometimes blur.

Other possible causes of narcolepsy include:

• Genetic factors.
• An autoimmune response.
• Rare brain lesions from tumors or strokes.

How are these conditions treated?

For fatigue: Since it is likely a sign of another problem, your healthcare provider will focus on finding and treating that.

If a primary cause is not found, your healthcare provider may recommend:

• Cognitive behavioral therapy. It challenges beliefs and awareness of your fatigue, helping you control symptoms and change behavior that may make your condition worse.
• Graded exercise therapy. It helps with underlying deconditioning, starting with low-intensity activity like walking or stretching and building from there.

For narcolepsy: Your healthcare provider likely will recommend a sleep study, encourage changes in behavior, such as strategic napping and caffeine intake. However, you may need prescription medications to help stay awake during the day or improve sleep quality at night.

It’s important to have a good psychosocial support system. Talking to your family about your condition or working with a counselor or a support group can help a lot.

A help for both conditions: Get better rest

Good sleep hygiene is important whether you’re dealing with fatigue or narcolepsy.

Here are some tips:

• Allow adequate time for sleep at night and keep consistent bed/wake times.
• Keep your bedroom comfortable, cool, dark and quiet.
• Arrange for a wind-down period of time before bed to calm your mind and body.
• For best results, remove electronics from your bedroom and avoid all screens for one hour before you go to sleep. TVs, phones, tablets and computers all can disrupt your sleep.
• Daily exercise can also improve sleep quality at night.

If you feel tired all the time or have trouble staying awake in meetings or at other times during the day, talk to your healthcare provider. They can help you pinpoint the cause and find a way to treat it.