Narcolepsy is a chronic sleep disorder. Some narcolepsy symptoms include cataplexy, overwhelming daytime drowsiness, and sudden attacks of sleep.

Narcolepsy (Paroxysmal Sleep)

Overview

Narcolepsy is a neurological disorder that affects a person&rsquo;s ability to sleep and wake up<a href="#accordion">[9]</a>. It is a persistent sleep condition characterised by excessive daytime sleepiness and sleep attacks<a href="#accordion">[10]</a>.

Narcolepsy can seriously disturb an individual&rsquo;s daily life. People with narcolepsy frequently struggle to stay up for extended periods of time. Although the condition itself is not life-threatening, an episode can result in car accident, injury, or other life-threatening scenarios.

The disorder is also known as Gelineau&rsquo;s syndrome, Hypnolepsy, Narcoleptic syndrome, and paroxysmal sleep. 
Narcolepsy usually presents itself in childhood. It does not cause any serious or long-term physical health issues, but it can have a considerable impact on daily life and be difficult to deal with emotionally. 
&nbsp;

Globally, 20-67 per 100,000 individuals suffer from narcolepsy<a href="#accordion">[12]</a>. The symptoms of narcolepsy commonly appear between the ages of 7 and 25, with a majority of them being teenagers<a href="#accordion">[11]</a>. Both males and females are equally affected<a href="#accordion">[11]</a>.&nbsp;However, the condition is frequently overlooked and misunderstood.

Narcolepsy is categorised into the following types<a href="#accordion">[11]</a>: 
&nbsp;

<ol>
	<li>
	<h5>Type 1 Narcolepsy</h5>
	</li>
</ol>

Type 1 narcolepsy was previously known as narcolepsy with cataplexy. This was based on the fact that a person reporting cataplexy along with excessive daytime sleepiness (EDS) on a special nap test was often diagnosed with narcolepsy.

However, not all people with type 1 narcolepsy have episodes of cataplexy. It is also diagnosed if a person lacks hypocretin, a brain hormone. Hypocretin levels fall if an infection triggers an autoimmune disease.

It is simpler to identify type 1 narcolepsy because the other major category &ndash; type 2 &ndash; is narcolepsy without cataplexy. The individual experiences muscle weakness triggered by strong emotions, such as anger, excitement, surprise, grief, or laughter. The duration of these events varies from a few seconds to several minutes.

In addition to EDS and cataplexy, people with type 1 narcolepsy have sleep paralysis, hallucinations, and <a href="https://merisehat.pk/disease/insomnia">insomnia</a>. Due to the low levels of hypocretin<a href="#accordion">[7]</a>, they have difficulty regulating their sleep/wake cycle.&nbsp; 
 
&nbsp;

<ol start="2">
	<li>
	<h5>Type 2 Narcolepsy </h5>
	</li>
</ol>

Also known as narcolepsy without cataplexy, people with this type of the disorder experience excessive daytime sleepiness, but they don&#39;t have the muscle weakness caused by intense emotions that&rsquo;s characteristic of type 1 narcolepsy.

Also, people with type 2 narcolepsy typically have milder symptoms and normal levels of the brain hormone hypocretin. However, they exhibit symptoms of EDS, sleep paralysis, hallucinations, and insomnia as well. 
&nbsp;

<h5>Secondary Narcolepsy</h5>

This occurs in rare instances. In contrast to type 1 and type 2 narcolepsy, secondary narcolepsy has a specific cause: an injury to the hypothalamus, the part of the brain that regulates sleep<a href="#accordion">[13]</a>.

It can also be caused by a brain tumour, <a href="https://merisehat.pk/disease/multiple-sclerosis">multiple sclerosis</a>, or <a href="https://merisehat.pk/disease/encephalitis">encephalitis</a><a href="#accordion">[15]</a>. The individual can show the typical symptoms of narcolepsy; however, they can also have other neurological issues and tend to sleep for longer periods (more than 10 hours) every night<a href="#accordion">[14]</a>. 
&nbsp;

Signs and Symptoms

Narcolepsy affects each person differently in terms of its severity and development. For instance, some can show symptoms on a regular basis, while others will exhibit them less frequently. Similarly, in some cases, symptoms can appear suddenly over a couple of weeks, while in some, the condition develops slowly and signs and symptoms take years to present themselves.&nbsp;

Note: Narcolepsy is a chronic condition, which means it continues for life. 
&nbsp;

<ul>
	<li>Excessive Daytime Sleepiness</li>
</ul>

Narcolepsy causes people to fall asleep unexpectedly, anywhere and at any time. There is an obvious decline in alertness and focus throughout the day. Excessive daytime sleepiness is frequently the most troublesome symptom of narcolepsy.

People with this disorder also experience:

<ul>
	<li>Brain fog</li>
	<li>Poor attention</li>
	<li>Low energy</li>
	<li>Memory lapse</li>
	<li>Tiredness</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression </a>or sadness 
	&nbsp;</li>
</ul>

<ul>
	<li>Sleep Disturbance</li>
</ul>

People with narcolepsy struggle to sleep at night due to factors, like vivid dreams, respiratory issues, or body movements. 
&nbsp;

<ul>
	<li>Cataplexy&nbsp;</li>
</ul>

Cataplexy is defined as acute and sudden muscle weakness affecting the face, neck, and knees. Depending on the muscle involved, some people only experience slight weakness, such as a headache or jaw drop; some collapse to the ground; some experience double vision; some have slurred speech.

Even though this weakness is brief, lasting no more than 2 minutes, it can be dangerous as individuals can sustain serious injuries due to accidents. Reportedly, it occurs once or twice a year; however, individuals with severe narcolepsy daily experience episodes triggered by strong emotions, like surprise, joy, or rage. 
&nbsp;

<ul>
	<li>Automatic Behaviour</li>
</ul>

Tiredness often causes automatic behaviours. That is, a person falls asleep while they&rsquo;re engaged in an activity, like talking or writing, and they continue with that activity even during sleep. When they wake up, they can&rsquo;t remember any of it. While their performance may not be up to the mark, like an illegible scrawl, the episode leaves them feeling fresh.

Again, these are brief episodes that last only a couple of seconds at a time and those who suffer from it will carry out only habitual activities. However, habitual activities also include walking and driving, which implies that a person can get lost or have an accident during this episode.&nbsp; 
&nbsp;

<ul>
	<li>Sleep Paralysis</li>
</ul>

People with narcolepsy usually experience a short-term inability to move or speak while falling asleep or waking up. Normally, it&rsquo;s for a few seconds or minutes. It is terrifying, especially because the person is aware of their condition and can even recall it later, but has no control over it while it&rsquo;s happening.

Sleep paralysis is similar to paralysis during the REM sleep. However, the condition does not affect the person&rsquo;s ability to breathe or move their eyes. Once the episode ends, the individual can function (speak, move, etc.) like before.

Sleep paralysis is occasionally accompanied by disturbing hallucinations.

Note: Not all people suffering from sleep paralysis have narcolepsy. 
&nbsp;

<ul>
	<li>Disturbances In Rapid Eye Movement (REM) Sleep</li>
</ul>

The REM sleep is one of the stages in the human sleep cycle. Generally, REM occurs 90 minutes after sleep. With narcolepsy, REM sleep can occur at any time of day, including daytime naps. Moreover, people with narcolepsy commonly shift to REM sleep more quickly, usually within 15 minutes of falling asleep. 
&nbsp;

<ul>
	<li>Hallucinations</li>
</ul>

Hallucinations are known as hypnagogic hallucinations if they occur during sleep and hypnopompic hallucinations if they occur after the person wakes up. These hallucinations are terrifying since the person is not entirely asleep when they start having these hallucinations and they end up perceiving them as reality.

Most of the time, hallucinations are visual, but they can involve other senses (e.g., auditory, olfactory, and gustatory) as well. People with narcolepsy commonly report a presence in their bedroom, hearing voices, and sensations of being touched. Furthermore, hallucinations accompany sleep paralysis, which is why they are extremely disturbing. 
&nbsp;

<ul>
	<li>Memory Problems</li>
</ul>

People with narcolepsy often have difficulty recalling conversations later because they are not fully conscious at the time. 

Memory lapses occur when individuals feel exhausted and sleepy while doing things that do not require much thought. According to a study, such impairments in the memory domain occur during the process of encoding as a result of disturbed sleep patterns<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/obesity">Obesity</a></li>
</ul>

Many narcolepsy patients gain weight as a result of their inactivity, tiredness, and sleepiness. 
&nbsp;

<h5>Additional Symptoms</h5>

Additional symptoms that some people encounter include:

<ul>
	<li>Tiredness</li>
	<li>Depression and sadness</li>
	<li>Difficulty focusing</li>
	<li>Periodic leg movements</li>
	<li><a href="https://merisehat.pk/disease/sleep-apnea-91">Sleep apnea</a> 
	&nbsp;</li>
</ul>

<h5>Symptoms In Children</h5>

While symptoms are the same for both adults and children, there are some key differences as well.<a href="#accordion">[22]</a>

Even though it is a common condition in children, narcolepsy is often underdiagnosed. This is because EDS, for instance, often comes across as a behavioural problem. Children who suffer from EDS tend to be restless, hence leading to the misinterpretation. Furthermore, it will mostly affect the face instead of the body, which again can be confused for a facial tic.

They will have more body movements during sleep and they will also sleep longer than adults with narcolepsy.

Note: In most situations, overwhelming EDS is the first sign of narcolepsy. Other symptoms, whether alone or in combination, appear months or years after the onset of daytime naps. 
&nbsp;

Causes

Almost all people with narcolepsy who experience cataplexy have extremely low levels of hypocretin, a naturally occurring hormone that regulates wakefulness and REM sleep. Hypocretin levels are frequently normal in patients with narcolepsy without cataplexy.

Although the cause of narcolepsy is unknown, recent research suggests that it may be caused by a combination of factors that work together to generate a deficiency of hypocretin. These factors are: 
&nbsp;

<ul>
	<li>
	<h5>Autoimmune Disorders</h5>
	</li>
</ul>

Cataplexy occurs due to the loss of brain cells that make hypocretin. Although the cause of this cell loss is unclear, it appears to be related to immune system problems. Autoimmune disorders develop when the body&#39;s immune system turns against itself and destroys healthy cells or tissue. Researchers believe that the immune system of people with narcolepsy targets hypocretin-containing brain cells due to a combination of hereditary and environmental factors. 
&nbsp;

<ul>
	<li>
	<h5>Genetic Fault</h5>
	</li>
</ul>

The majority of narcolepsy occurrences are sporadic, which means they occur in people who have no known family history of the illness. However, clusters in families do occur &mdash; up to 10% of those with narcolepsy with cataplexy report having a close relative with matching symptoms<a href="#accordion">[11]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Environmental Toxins</h5>
	</li>
</ul>

Pesticides, heavy metals, and second-hand smoke are all examples of environmental poisons that can lead to narcolepsy. 
&nbsp;

<ul>
	<li>
	<h5>Brain Injuries</h5>
	</li>
</ul>

Narcolepsy can be caused by a severe injury to portions of the brain that regulate alertness and REM sleep; tumours and other disorders in the same areas can also trigger it. 
&nbsp;

<ul>
	<li>
	<h5>Infections</h5>
	</li>
</ul>

Narcolepsy can also be caused by infections. 
&nbsp;

There are currently no screening tests for narcolepsy. 
&nbsp;

Diagnosis

Narcolepsy is usually diagnosed through clinical examination. Since the symptoms are similar to other conditions, such as depression, sleep apnoea, a previous head injury, <a href="https://merisehat.pk/disease/epilepsy">epilepsy</a>, and <a href="https://merisehat.pk/disease/hypothyroidism">hypothyroidism</a>, it can be difficult to diagnose based on symptoms alone.

The doctor will ask for a thorough medical history and order some tests. They will also analyse the patient&rsquo;s sleep pattern and ask the individual to maintain a sleep journal for 1-2 weeks, wherein the time of sleep and any symptoms experienced at the time are recorded. This will help the doctors to rule out other neurological diseases.

However, in order to establish a diagnosis of narcolepsy, there are 2 tests that need to be conducted at a specialist sleep centre<a href="#accordion">[11]</a> <a href="#accordion">[16]</a>: 
&nbsp;

<ul>
	<li>
	<h5>Polysomnogram (PSG Or Sleep Study)</h5>
	</li>
</ul>

The PSG is an overnight test that continuously measures the heart rate, oxygen level, breathing rate, eye and leg movements, and brain waves while the person sleeps. It assesses how quickly the individual falls asleep, how frequently they wake up during the night, and how frequently their REM sleep is disrupted.

Furthermore, it helps determine whether these symptoms are caused by another condition, such as obstructive sleep apnoea. For instance, patients with narcolepsy usually have disrupted sleep patterns, including frequent awakenings; thus, the greater the disturbance, the greater the likelihood of being diagnosed with narcolepsy. 
&nbsp;

<ul>
	<li>
	<h5>Multiple Sleep Latency Test (MSLT)</h5>
	</li>
</ul>

The MSLT examines daytime sleepiness by assessing how quickly a person falls asleep and whether they enter REM sleep.

The day after the PSG, a specialist will ask them to take 5 brief naps after every 2 hours. If the individual falls asleep in less than 8 minutes on average over five naps, it indicates EDS.&nbsp;

If the test observation shows that they entered REM sleep quickly, then it indicates narcolepsy. For instance, if REM sleep occurs within 15 minutes in at least 2 out of the 5 naps, it is most certainly narcolepsy. 
&nbsp;

<ul>
	<li>
	<h5>Epworth Sleepiness Scale (ESS)</h5>
	</li>
</ul>

The Epworth Sleepiness Scale is a brief questionnaire that&rsquo;s used to assess the possibility of having a sleep disorder, such as narcolepsy. 
&nbsp;

<ul>
	<li>
	<h5>The Level Of Hypocretin In Cerebrospinal Fluid</h5>
	</li>
</ul>

According to research, it&rsquo;s also useful to monitor the level of hypocretin in the fluid that surrounds the brain and spinal cord. The doctor uses the lumbar puncture procedure (commonly known as a spinal tap) to get a sample of cerebrospinal fluid and measure the level of hypocretin-1 present in it. In case the patient does not suffer from any significant medical disorders, low levels of hypocretin-1 will indicate type 1 narcolepsy. 
&nbsp;

Treatment

Although there is no known treatment for narcolepsy, it is possible to control the symptoms so that the condition doesn&rsquo;t interfere with daily life. Sometimes, minor adjustments to the sleeping routine will suffice; in most cases, however, where the symptoms are more severe, the patient is prescribed medication to alleviate the condition. 
&nbsp;

<ol>
	<li>
	<h5>Lifestyle &amp; Home Remedies</h5>
	</li>
</ol>

Narcolepsy can be managed with a few lifestyle changes.

<ul>
	<li>Follow a schedule.&nbsp;Every day, especially at weekends, set the alarm for the same time to go to bed and wake up.</li>
	<li>Take naps. Plan a couple of quick naps during the day at periodic intervals. A 20-minute nap at reasonable periods during the day will keep most people fresh for 1-3 hours.</li>
	<li>Quit alcohol and nicotine.</li>
	<li>Don&rsquo;t take medicines late at night as they might worsen symptoms.</li>
	<li>Exercise frequently. Physical exertion throughout the day allows for better sleep at night. The exercises should be of moderate intensity levels and should be done at least 4-5 hours before bed. 
	&nbsp;</li>
</ul>

<h5>Stick To Good Sleeping Habits</h5>

There are several things that can help ease night-time sleepiness and lessen excessive daytime sleepiness

<ul>
	<li>Take regular, short naps. A doctor or sleep specialist can create a specialised sleep schedule for the patient that works around their respective commitments as well as ensure that these naps are properly spaced out throughout the day.</li>
	<li>Maintain a tight bedtime schedule. The patient is instructed to wake up and go to bed at precisely the same time every day.</li>
	<li>Calm down before going to bed. For instance, the patient can take a hot bath if it helps them relax.</li>
	<li>Make sure to have a comfortable sleeping space. For example, the bedroom should not be noisy and there should be no distractions at all. Maintaining a pleasant temperature also helps.</li>
	<li>Avoid caffeine at night. Some of the common sources of caffeine are coffee, tea, and fizzy drinks.</li>
	<li>Quit drinking alcohol and also quit smoking.</li>
	<li>Avoid exercising just before bedtime. It&rsquo;s recommended to avoid it at least 2 hours before sleep so plan accordingly.</li>
	<li>Avoid large meals at night. 
	&nbsp;</li>
</ul>

Don&rsquo;t Self-Medicate

Drowsiness can be a side effect of some medications, including allergy and cold remedies. In case of narcolepsy, it&rsquo;s better to avoid these sorts of medications throughout the day as they may worsen daytime sleepiness.

Always consult a doctor or a pharmacist to know if the medications cause sleepiness, in which case they will be able to suggest another alternative. 
&nbsp;

Talk To Others

Narcolepsy can be challenging to live with. It&rsquo;s also challenging for others to comprehend. Those who are not familiar with the disorder will be terrified when they experience or see first-hand some of the symptoms, like an abrupt loss of muscle control. Don&rsquo;t hesitate to spread awareness; discussing it with friends and relatives proves to be beneficial for both them as well as the patient. 
&nbsp;

Managing At School

If a child has been diagnosed with narcolepsy, inform their instructors. If the teachers know about their student&rsquo;s health, they will not misinterpret their behaviour as being lazy.

&nbsp;

Managing At Work

As long as the workplace is mindful of the individual&rsquo;s condition and accepts to make accommodations for it, such as permitting them to perform during flexible hours or take a scheduled nap, there is no reason why someone with narcolepsy should not be able to work. However, they may not be suited for all professions.

Get in touch with a social worker who can provide counselling and support, as well as guidance on job choices, workplace modifications that could be possible, and any financial or relationship issues. Furthermore, they can help connect with others who are going through a similar experience and can offer tips on dealing with narcolepsy in professional life. 
&nbsp;

<ol start="2">
	<li>
	<h5>Medicine&nbsp;</h5>
	</li>
</ol>

Always consult your healthcare practitioner for treatment.<a href="#accordion">[17]</a>

Stimulants

Depending on the situation, a general practitioner or specialist can recommend a stimulant, such as modafinil, dexamphetamine, methylphenidate, and pitolisant.

It&rsquo;s generally advised to take these meds in the morning to stimulate the central nervous system and ensure the individual stays awake throughout the day.

However, stimulants have numerous side effects, including: headaches, nervousness, nausea, insomnia, irritability, stomach ache, unintentional weight loss. Consult a doctor or a specialist in case a side-effect persists.

 
Modafinil

The patient will be constantly checked throughout therapy for any side effects because modafinil has been related to arrhythmia and high blood pressure.

Pregnant women shouldn&#39;t take modafinil since it can harm the developing foetus.

This means that women should utilise an effective method of contraception during the treatment and even afterwards, i.e., they should avoid getting pregnant for at least 2 months. Modafinil, for instance, can reduce the effectiveness of the pill. So, the female should either switch to an altogether different method of birth control or they should utilise a second method in addition to the pill. Only the doctor who&rsquo;s aware of their condition can advise them in this regard. 
&nbsp;

Sodium Oxybate

A medication called sodium oxybate can aid an unexpected loss of muscle control, promote sleep at night, and lessen daytime sleepiness. However, a number of health organisations do not support it.

2 doses of sodium oxybate are recommended - one before bed and the other 2.5-4 hours later.

Make sure to:

<ul>
	<li>Set an alarm as reminder to consume the medication at the appropriate times</li>
	<li>Take the med 2-3 after eating because food can impact how much medicine is absorbed into the body</li>
	<li>Wait at least 6 hours after the medicine to engage in any activity that calls for mental clarity, such as operating heavy equipment or driving 
	&nbsp;</li>
</ul>

Some of the adverse effects of sodium oxybate are: nausea, headache, dizziness, diarrhoea, vomiting, blurred vision, bedwetting, weight loss. Consult a doctor if these side effects persist. 
&nbsp;

<h5>Antidepressants</h5>

Antidepressants are often used to cure narcolepsy symptoms, such as rapid loss of muscle control, hallucinations, and sleep paralysis.

Even though it&rsquo;s unclear how effective they are, narcoleptic patients have received treatment with a wide range of antidepressants, including:

<ul>
	<li>SSRIs &ndash; selective serotonin reuptake inhibitors, including femoxetine, fluoxetine, and citalopram</li>
	<li>SNRIs &ndash;&nbsp;serotonin-norepinephrine reuptake inhibitors drugs, such as venlafaxine</li>
	<li>TCAs &ndash; tricyclic antidepressants, such as imipramine and clomipramine 
	&nbsp;</li>
</ul>

Their function is to change the concentrations of specific chemicals in the brain and decrease the amount of REM sleep, which is believed to be the cause of several narcolepsy symptoms.

Side effects differ depending on the medication. In general, antidepressants cause uneasiness, constipation, dizziness, drowsiness, insomnia, sexual dysfunction, and visual haziness.

The majority of adverse effects subside in a few weeks. Consult a doctor if they persist or worsen. Do NOT stop antidepressant abruptly without doctor&rsquo;s approval. 
&nbsp;

NOTE: Some people with narcolepsy only face a mild condition. The best way to prevent it from worsening is to work closely with the healthcare provider to address all the symptoms and/or treatment side effects. 
&nbsp;

The following are some of the narcolepsy-related complications: 
&nbsp;

<ul>
	<li>People with narcolepsy frequently experience depression and anxiety. However, it&rsquo;s unclear whether they are actual narcolepsy symptoms or simply a result of the condition&#39;s symptoms impairing a person&#39;s quality of life.</li>
	<li>The social life of people with narcolepsy suffers as a result of severe tiredness and cataplexy. For instance, they struggle to stay awake during social occasions or they become uncontrollably animated while laughing.</li>
	<li>Many narcoleptics are overweight due to reduced activity levels or sluggish metabolisms. On average, adults with narcolepsy weigh 15&ndash;20% more than the average population<a href="#accordion">[18]</a>.</li>
	<li>According to a 2017 study, people with narcolepsy are more likely to engage in suicidal behaviours<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>

The following are some of the risk factors for narcolepsy: 
&nbsp;

<ul>
	<li>Family Background</li>
</ul>

Anyone can have narcolepsy if their first-degree relative (e.g., a parent or sibling) has it. However, it&rsquo;s not a major risk factor since only negligible people have reported cases in their family. 
&nbsp;

<ul>
	<li>Age</li>
</ul>

Narcolepsy cases have the highest incidence rate among individuals aged 15 and 36<a href="#accordion">[7]</a>. However, the condition is frequently misdiagnosed or underdiagnosed. 
&nbsp;

<ul>
	<li>Prior Brain Injury </li>
</ul>

Rarely, severe brain injuries to regions that control alertness and REM sleep result in narcolepsy. Narcolepsy can also result from brain tumours. 
&nbsp;

Given that familial history, brain tumour or brain damage, infections, exposure to toxins, and autoimmune conditions that target hypocretin production and affect sleep-wake cycle are some of the factors that contribute to it, there isn&#39;t anything that can be done to stop narcolepsy from occurring. 
&nbsp;

<ol>
	<li>The loss of orexinergic neurons in the hypothalamus causes narcolepsy type 1. The close relationship between narcolepsy and the gene human leukocyte antigen (HLA-DQB1*06:02) suggests an immunological cause for this condition<a href="#accordion">[19]</a>. 
	&nbsp;</li>
	<li>According to concurrent epidemiological data, the Pandemrix vaccination against the pandemic influenza virus strain from 2009&ndash;2010 has also been linked to an increased prevalence of narcolepsy in Europe<a href="#accordion">[20]</a>. However, it is yet unclear whether there is a possible immunological connection between the Pandemrix vaccine and narcolepsy. Understanding these mechanisms could point to probable routes that are involved in the majority of narcolepsy cases. 
	&nbsp;</li>
	<li>Study reveals that immune cross-reactivity between a vaccination antigen and a neuronal self-antigen can cause an immunopathological process that mimics narcolepsy. The development of the disease depends on the interaction of autoreactive CD4 and CD8 T cells. This research advances our knowledge of the mechanisms and pathways that may contribute to the emergence of a neurological adverse reaction to a vaccination and, most likely, to narcolepsy in general<a href="#accordion">[21]</a>. 
	&nbsp;</li>
</ol>

Key Points

<ul>
	<li>Narcolepsy is a neurological disorder that affects a person&rsquo;s sleep cycle</li>
	<li>A person with narcolepsy frequently falls asleep without meaning to.</li>
	<li>Regular naps can help control mild forms of narcolepsy, but medicine is required for severe cases. 
	&nbsp;</li>
</ul>

[1] Goswami M, Pandi-Perumal SR, Thorpy MJ. Narcolepsy. Springer; 2010.

[2] Anderson T, Bandi M, Bromley KD, Nino M, Terekhov K. Narcolepsy. 2003;

[3] Slowik JM, Collen JF, Yow AG. Narcolepsy. In: StatPearls [Internet]. StatPearls Publishing; 2021.

[4] Mitler MM, Nelson S, Hajdukovic R. Narcolepsy: Diagnosis, treatment, and management. Psychiatr Clin North Am. 1987;10(4):593–606.

[5] Drapeau CW, Nadorff MR. Suicidality in sleep disorders: prevalence, impact, and management strategies. Nat Sci Sleep. 2017;9:213

[6] Evans R, Kimura H, Alexander R, Davies CH, Faessel H, Hartman DS, et al. Orexin 2 receptor--selective agonist danavorexton improves narcolepsy phenotype in a mouse model and human patients. Proc Natl Acad Sci. 2022;119(35):e2207531119.

[7] Narcolepsy. NORD (National Organization for Rare Disorders).

[8] Memory and cognition in narcolepsy - researchgate.

[9] Narcolepsy: Definition, symptoms, causes, diagnosis, treatment. WebMD.

[10] Narcolepsy. Mayo Clinic.

[11] Narcolepsy fact sheet. National Institute of Neurological Disorders and Stroke.

[12] Thorpy MJ. Recently approved and upcoming treatments for narcolepsy. CNS drugs.

[13] Narcolepsy: Symptoms, treatment, and causes. Medical News Today.

[14] Understanding narcolepsy. Understanding Narcolepsy | Narcolepsy.

[15] School MGM. Narcolepsy: Diagnosis & treatment: Neurology, Neurosurgery, spine care: Uthealth neurosciences. Neurology, Neurosurgery, Spine Care | UTHealth Neurosciences.

[16] Lights V. Narcolepsy: Symptoms, causes, treatment, tests, and more. Healthline.

[17] NHS choices. Accessed December 1, 2022.

[18] Getting a diagnosis. Getting a Diagnosis | Narcolepsy. (n.d.). Retrieved December 1, 2022.

[19] U.S. National Library of Medicine. (n.d.). HLA-DQB1 gene: Medlineplus genetics. MedlinePlus. Retrieved December 1, 2022.

[20] Centers for Disease Control and Prevention. (2020, August 20). Narcolepsy following 2009 Pandemrix Influenza Vaccination in Europe. Centers for Disease Control and Prevention. Retrieved December 1, 2022.