Falling Asleep on the Job: The Story of Narcolepsy

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Biology 202
2001 Third Web Report
On Serendip

Falling Asleep on the Job: The Story of Narcolepsy

Claire Walker

Have you ever pulled two all nighters in a row? If you have then you know that afterwards, during the day, you drift off to sleep very easily. You feel physically and mentally exhausted and your body tells you that you need to rest. This is a normal reaction by the body to the lack of sleep. This however is something that people suffering from narcolepsy must deal with on a daily basis even when they have had a full nights sleep. One of the major symptoms they suffer from is overwhelming daytime sleepiness.

Imagine you are in a boring lecture and you start to drift to sleep, usually you can manage to force yourself to wake up. This may be common occurrence but try to imagine falling asleep while driving or walking. These situations seem more rare. A narcoleptic’s body doesn’t care what it is doing when it goes into these paralyzed sleeping episodes. The sudden overwhelming feeling drives the narcoleptic person to fall asleep. One type of episode that they experience is called cataplexy, which is usually caused by some stressful situation or other common activities such as laughing or running (6). During these periods the person suffers from muscle weakness and paralysis. Although the person appears to be sleeping, they are still conscious, but unable to move. They can hear and feel but cannot react to stimulation. For this reason narcolepsy is a very dangerous condition to have without receiving treatment because serious vehicle accidents can result as well as an general inability to succeed in school (6).

Another major symptom that affects narcoleptics is called hypnagogic hallucinations, which they experience when they are falling asleep. These hallucinations can include vivid images accompanied by sounds which are often frightening to the person. This symptom can be experienced by non-narcoleptics, but it is so common in narcoleptics that they don’t know if what they experienced was a dream or if they actually experienced the situation (10). A related symptom is called automatic behavior, which is when the person will not remember doing familiar or boring tasks after they have been done.

Although narcolepsy is a very common disorder, affecting between 1 in 1000 and 1 in 2000 people in the United States, there is still no cure and the only medications available mask some of the symptoms, but they are only effective for a short time (6). Though their is no cure, scientists have been trying to solve this problem since the ‘discovery’ of the disease 120 years ago. At this point they have a few possible areas that they are studying which have been connected to the disease. The suggestions that have been made so far are causes such as neuronal degeneration, a genetic mutation or an autoimmune disease (6). These possible causes are varied and have been proven to cause narcolepsy in other animals, but not humans specifically.

Neuronal and axonal degeneration has been seen in narcoleptic canine brains during the onset of the symptoms but no evidence has been seen in humans. Scientists believe that the process of degeneration does take place in the brain, but they do not know the exact cause of it. The degeneration may take place at the onset of the disease with no previous abnormalities in the brain, or the degeneration could actually take place early in development and be triggered by another hormonal or degenerative process, which cause the symptoms to start later in life (6). Further studies are being performed to try and understand the brain better.

The focus of narcoleptic research is on the periods of sleep that normal people experience as compared to what narcoleptics experience. Every night the normal sleep pattern involves the shift from non-REM sleep to REM sleep. This shift takes place many times throughout the night and the two stages are very distinct. When someone first falls asleep they normally experience non-REM sleep for 90 minutes, when the muscles are relaxed but maintain tone, the brain’s consumption of energy is minimal and breathing is consistent (6). The shift into REM (rapid eye movement) sleep is marked by an increased heart and breathing rate, maximum energy consumption by the brain and rapid eye movements (6).

This sleep pattern is common for any person without narcolepsy but for those suffering from the disease, they often skip non-REM sleep and go straight into REM sleep. Scientists have also found that narcoleptics also suffer from loss of muscle tone and severe hallucinations during there sleep, which leads the scientists to believe that there might be a faulty trigger in their REM sleep pattern (6). When narcoleptics fall asleep during the day they usually slip straight into REM sleep, as well.

One of the animals of most interest to the scientists is the dog. Dogs also suffer from narcolepsy but they seem to pass the trait through recessive genes. So if two narcoleptic dogs are bred, the result is a litter of narcoleptic puppies. This allows the scientists to study fairly large groups of dogs who experience similar narcoleptic problems. The puppies in studies often experience cataplexy when they were excited, as at feeding time, which would cause them to fall stiffly to the ground until they recovered, after a few minutes (6). The interesting comparison to be made regarding humans, is that most narcoleptics do not have any relatives who also suffer from narcolepsy. Also narcolepsy does not show up in humans until the teens or twenties, which is very different than the experiences that dogs and horses have with the disease (6).

Some adult horses are afflicted by the disease but the more common occurrence is that foals seem to experience narcoleptic symptoms, usually growing out of them as they age. This disease in horses is scary because “narcoleptic horses have been known to go limp and topple over while being ridden (5). ” These different experiences with narcolepsy suggest that environmental conditions may play a much more significant role in causing narcolepsy to start, especially since the percentages of people suffering from narcolepsy varies considerable all over the world. In Japan the incidence of this disease is 1 in 600 people, while in Israel the disease affects 1 in 500,000 people (6).

One study that was performed on the puppies involved electrophysiological studies, to try and figure out what caused the symptoms of narcolepsy (6). By placing tiny electrodes on the neurons in the brain stem, it was possible to measure the electrical impulses being produced when the cells communicated to one another. From an earlier study done in the 1940’s by Horace W. Magoun of Northwestern University, these scientists knew that when the medial medulla was stimulated with an electrical impulse, the muscle tone vanished and movement was prevented, like during cataplexy (6).

After the discovery of REM sleep in 1953, scientists were able to make a connection between the medulla and the lack of movement during REM sleep. This area of the medulla was a suppressing area, which was the most active during REM sleep, to prevent sympathetic movement during dreams, but was inactive during the day when the animal was moving (6). Another area of the brain, the locus coeruleus, was found to act similarly in daily activities. The cells in this part of the brain stem release a chemical used by neurons to communicate, known as norephinephrin, which helps the sympathetic nervous system react to emergency situations (6). As would be expected, the release of norephinephrin is isolated to times when the animal is active and thus is inactive during REM sleep. The studies in the dogs showed that their locus coeruleus was inactive at the time of cataplexic events, which further backs up the claim that narcoleptics frequently fall into REM sleep immediately (6).

The main area of the brain on which studies are being focused, is activated during REM sleep. This area of the brain, the amygdala, is in the frontal lobe and has been shown to be involved with emotional reactions to situations. The amygdala interacts with the dorsolateral pontine cholinergic and noradrenergic cell regions of the brain, which are involved in the production of REM sleep in animals (9). The overall activation of the amygdala causes increases in the Electrocardiogram output and other general changes that also appear at the beginning of a cataplexy event (2). These changes in the signals in the brain show where some of the narcoleptic symptoms originate.

The most recent studies of narcolepsy have led to fairly conclusive data as to the cause of the disease. A group of people at UCLA studied the postmortem brains of four narcoleptics and compared them to twelve brains from people who did not suffer neurological diseases during life. The focus of the study was on a group of brain cells, located in the hypothalamus, which contained hypocretin/orexin. The study found that in the brains of the narcoleptics 85-95% of these cells were not present. In the normal brains they found 70,000 of these cells, whereas the narcoleptic brains had between 3,000 and 10,000 of these cells (7).

There are a couple of reasons that could cause these cells to die, but the most likely cause is that the immune system kills these cells. Why would the immune system kill these cells, if they are important to the functioning of the body? A study in Tokyo isolated a particular molecule, one of the human leukocyte antigens (HLAs), which was found in over 100 narcoleptic patients. Although this molecule was found in some of the normal population, it is believed to cause a predisposition for narcolepsy (6). These molecules are responsible for showing different proteins to the immune system, which is then able to destroy any viruses that are detected. The scientists believed that this one HLA molecule could cause the immune system to attack healthy cells, “because those HLA types when linked to particular antigens may look like naturally occurring proteins in the body (6). ”

These studies give suffers of narcolepsy some hope for future cures, because at least in theory if hypocretin was administered to people with narcolepsy the symptoms could disappear. There is support to this theory because some preliminary studies have been carried out on narcoleptic dogs and when hypocretin was injected, the daytime sleepiness was reduced and the sleep during the night was more continuous (7). Although this study did not ultimately find a cure, as of right now, the finding that narcolepsy is definitely a neurological problem affecting cells in the hypothalamus, will help human suffers break free from the misconceptions that they suffer from psychological problems.

A narcoleptic person has to deal with many problems in everyday society, that can make them worry about there ability to lead a normal life. Luckily, if two narcoleptics are planning to have children, the chance of having affected children is only 1 to 2 %, which is 10 to 40 times higher than the normal public, but is still a low percentage (4). Also the treatments that many narcoleptics depend on to counteract some of their symptoms, may have an adverse affect on a fetus. Narcoleptics have to choose what is more important to their life and future, which can cause a dilemma for them (3). Hopefully safe treatments will be available within the next ten years, so that narcoleptics can live ‘normal’ lives.

This disease makes many connections to the ideas that we covered during class and may contradict some of the conclusions that we suggested. An interesting idea is the issue of the I-function and its seemingly non-existent role in REM sleep. Narcolepsy seems to go against all of the beliefs that we have about these two ideas. The conscious mind, or I-function, is not supposed to be able to function during REM sleep, but when narcoleptics have cataplexic events they slip straight into REM sleep and have reported that they can feel, hear and sense people around them. They even report being embarrassed if they have these events when their friends are around. Is it possible to feel embarrassed without involving the I-function? You have to be aware of who you are to experience embarrassment.

If we still want to hold onto our ideas about the I-function then we have to question the experiences that narcoleptics endure. Do they actually slip into REM sleep or are the connections in their brains’ different than non-narcoleptics? Maybe what scientists see as the patterns for REM sleep are just reworked in the narcoleptic brain, so that they no longer can fully experience REM sleep. Many studies of the sleeping patterns of narcoleptics has shown that they do not experience much REM sleep during their nighttime sleep, which accounts for some of their sleepiness during the day. Is it possible that even during the cataplexic events, their body does not experience REM sleep? Many studies still need to be done, but it is unlikely that scientists will ever know what is actually occurring in the brain. As you have said before, we are just trying to get it progressively less wrong.

WWW Sources

1) Narcolepsy: Questions and Answers, Has a lot of useful beginner information about narcolepsy

2) Sleep States attenuate the Pressor response to central amygdala stimulation, Neurol, 1984, Volume 83, pp 604-617, Very specific information about the influence of one part of brain on symptoms of narcolepsy

3) Narcolepsy Network: section about Stimulants: Basic mechanisms and Pharmacology, Principal and Practice of Sleep Medicine, Very interesting

4) Narcolepsy Network section on ‘Pathophysiology of Narcolepsy’. Principal and Practice of Sleep Medicine, A nice little explaination

5) Zzzz...What does you horse need to sleep well? Maybe not what you think, say equine behavior experts, Practical Horsemen, September 2000, p. 98., Horses experience narcolepsy as well.

6) Narcolepsy: Althogh people with the disorder do not fall face-first into their soup as in the movies, narcolepsy is still a mysterious disease. But science has new leads., Siegel really knows what he is talking about.

7) Mystery of Human Narcolepsy Solved, He is the master of these studies

8) University of Pennsylvania Narcolepsy Research Project, A nice summary

9) Organization of amygdaloid projections to brainstem dopaminergic, noradrenergic and adrenergic cell groups in the rat, Brain Res Bull, 1992, volume 28, pp 447-454, Very detailed info

10) Living with Narcolepsy, Go info about the lives of Narcoleptics


amos gregory's picture

fired from falling asleep due to narcolepsy

i was recently fired from my job because i was falling asleep. my job was security and my shift was overnight. i also have problems staying woke while watching my kids, playing my game, or just from watching television. i can even doze off while im on the computer filling out applications. dont know if i have narcolepsy. i dont have medical to find out if i have it. is there any other way to find out if i have narcolepsy?

Serendip Visitor/Tiena's picture

Narcolepsy - I'm gonna get fired!

I was dx with narcolepsy after almost a year and a half of being exhausted all the time. I was at the bottom of the barrell and sinking. Mr work was suffering and I was miserable.

So -finally I get the tests and the doctor says i have narcolepsy. They've started medications which help a little but not enough. Medications are still being adjusted. The doctor put me on work restrictions which my employer will not accommodoate - so I'm still working and trying to do 12 hours of work in 8 hours without making too many mistakes. They've writtem me up now and I'm going to get fired if it doesn't get better.

Now to make things even worse, Friday nite I was pretty tired and I was getting ready for bed -I fell asleep standing up and fell. I hit my head on the toilet - nice goose egg really hurts, bruises on hips, chest, knees, twisted my wrist. This is very scarey and now I'm almost afraid to go into the bathroom -what if it happens again? I got lucky this time.

I think I'm an odditity though -- I turned 54 in April. I don't remember having chronic fatigue and the mind numbing, soul destroying exhaustion in the past. I underwent a very traumatic event in October 09 - and after that I started having problems. Can tauma somehow trigger this condition or does it just bring it to the surface with a person who was possibly marginal before.

I'm so frustrated and tired. I'm spending almost $200.00 a month on just the co-pay for the medication -- and I'm still having problems!

Serendip Visitorkim's picture

Narcolepsy and pain?

I was diagniosed with narcolepsy back in 1998, it's a hard road, and at times, almost impossible to deal with. If that isn't enough, I was also diag. w/ spinal stenosis in 09, and have had 2 lamenectomies. I still have sciatic pain and tingling. I have now began suffering w/ extreme heel pain, and wonder if it's stenosis related? I am currently on a statin drug and take co-q 10, which has really helped alot with aches and pains in my shoulder and neck. Then somthing was said in the news about women with severe sleep disorders being at higher risk for fibromyalgia, which now makes me wonder, all the aches and pains, could they be that? My heels are killing me, They hurt even when I lay down. Anybody got a clue? Thanks for your help!

Serendip Visitor's picture

sleep apnea

Sorry about your situation. I was fired from two excellent engineering positions because I was told I was falling asleep in front of clients during training. I also experience constant pain in my heels that I don't understand. Have you discovered anything?

Anonymous's picture


well my name is kell.....im 17yrs. and i think i have Narclepsy.. i cant treally sleep at night. when i wake up and start my day i get right back sleepy in like an hour.....i cant stay awake for nothing, i can be having a conversation with my friends and i would fall asleep on them... im constly sleepy ill fall asleep anywhere... i jus can help it ... my body starts feeling weak and my eyes just close.....its been times when my body will be stuck i cant move,talk, but i can hear and feel everything....its weird and i need to know

Anonymous's picture


Sounds like narcolepsy. Many aren't diagnosed for years after the onset of symptoms. Get yourself to a sleep specialist. Be prepared for a diagnosis and then the eventual disappointment when you find that the drugs basically color the symptoms without treating the source. I made it with coffee and determination for a decade before going to meds. They hardly work on me now. I have quit my job and am looking into disability. Wish you the best.

Karen's picture







Serendip Visitor's picture


I am experiencing the same problem falling asleep while working at my desk and while driving particularly in the morning. I will nod off for what seems like a few seconds and wake up to find myself in the wrong lane or a near accident. Heat seems to make it worse for me as well, however even with the windows down and music blaring I am still falling asleep!!!!

Anonymous's picture

Falling Asleep Ater 6 hours of physical hard work

My normal sleep is about 6 and 1/2 hours. Started a new job, where I work from 4am till 11am , doing physical work. Normally get about 5 hours sleep per night with new job.
When I get home, read a newspaper paper and cannot stay awake, without taking an energy drink. Is this normal?

How can I prevent falling asleep or taking a nap in the afternoon, without increasing my sleep time. Seem when I'm working, have no problem being alert and awake, but once I stop that motion, my body says to go and get more sleep.

Anyone have any thoughts, could it be due to an excess of vitamin C that I take, that I'm falling asleep in the afternoons. Or shortly after I get home from work.

Serendip Visitor's picture

A 14 Year Old's Breif Story, Living With Narcolepsy.

Hi Everyone,
i'm Raquel Hill. i Live in MN.
i Was Recently Diagnosed With Narcolepsy And Alse REM Behavior Disorder.
The Sleep Clinic i Go To Now is The Only Place in Minnesota That Will Treat Me.
Sounds Unbeleive-able ? Yes, Well it's True. i'm 14 Years Old And The Youngest Patient With These Problems That They've EVER Had !
Sadly, it's Life Long, it's A Struggle, and it's Taking Away My Life. Narcolepsy is The Last Thing i Thought i'd Get Diagnosed With When i Went in For My Sleep Study.
i Lived Tired And Depressed My Whole Life, i Honestly Thought it Was Normal. i Just Want To Have Fun, And Be Normal For A Day. Although i Admit My Medication Has Helped Me Alot, But Never Fully. My Dose's Keep On Getting Raised Higher And Higher. i'm Building A Tolerance For My "Miracle Drugs" . i'm Becoming Addicted To Adderall.
it's Hard To Deal With Everything, Emotionally And Physically.
Theres No Support Groups in My Area Either.. if Your Reading This Reach Out To Narcoleptics. it's So Misunderstood, So Misleading To People.
i Tried Getting My Point Across, Not Sure if i Did.
Narcolepsy is A Living Nightmare, We're Not Lazy.
We're Constantly Exaughsted.
Narcolepsy Has Stoped Me From Reaching Goals..
isolated Me From The Things i Use To Love..
Stolen My Childhood..
Leaving Me Left in The Dark, And Feeling Alone..

Narcolepsy Took Away The Person i "Could Have" Been..

i'm 14. i'm Raquel & Everyday is A Struggle..

Serendip Visitor's picture

My son is 6 and was diagnosed

My son is 6 and was diagnosed with Narcolepsy at the age of four. They told me at the time that he is one of the youngest people to be diagnosed with the disorder. I understand what you are talking about when you refer to building a tolerance to your Miracle Drug. My son is on 15 mg of Dexadrine Extended Release which is up by 10 mg the past two years. It is now time to up the dosage once again. He ends up tired, sleepy and irritable about an hour after he takes it. At 14, I know its a struggle even with medication but at least you have a little bit more understanding about the disorder and why you are sleepy alot. My son is only 6 and we have been struggling with it the past two years. He is not able to fully understand why he is tired or irritable. Hopefully in a couple years he will be able to understand. Although academically he is in the top of his class his behavior the past 2 or 3 weeks has declined. I feel that it is because he is tired and is doing whatever he can to stay awake. Even if it means disrupting the class. Keep pressing on Raquel and know that you are not by yourself. There isnt alot that is known about Narcolepsy but hopefully the will do more studies and increase the awareness regarding this disability.

Mother of a 6 year old with Narcolepsy.

StephAnie Dream's picture

feeling your pain

Dear Raquel,
i just really want to let you know your not alone out there.
i have Narcolepcy, psychiatric Insomnia, and Fibromiyalgia. (and obviously im half high off my meds write now trying to type to you so dont mind the mystakes)
just needed to say wour not alone, i use to dress in black an was, no way around it, i was suicidal..storie for another day (been dealing with this stuff about 4years) but so much gets you threew, an you grow up and end with more maturity and a respect for life that you never would have thought possible.
an hey i hear ya, missunderstood, and all. well i need for the love of god to get off line (i wont remember i did this in the morning bc meds+sleepingpills)
ur not alone if ya ever wanna tlk (anyone else is opn to) sorry i was just a rant nxt time im just gonna stay lookin at the cool lines on media player
good night thanks an sorry.

KEN's picture


I have read some of the stories and advice on here. My wife has narcolepsy and has struggled with it for a long time now. We have been apart for a little over 8 months and we are finally talking again. I am wanting to get involved and help and I am making her a web site since it would take alot out of her and it is something she has wanted for a long time now. In doing so I was wondering if all or any of you would mind if I took some of your notes, or information to ad it to the site and some of your letters. Please let me know this means the world to her and she means the world to me. I am also making a ribbon, I know the color is black already but it doesnt do justice and black is also the color of about 50 other things. Its not fair and it should be alone and recongnized like cancer and all the other diseases that are well know.


Julie's picture

Fibro and Narcolepsy

I was diagnosed with Fibromyalgia a few years ago. The symptoms come and go but when they are present they limit me. I recently went for a sleep study to find out why I sleep for 8-10 hours every night but still wake up fatigued and often stay so sleepy though the day that I have to take a nap. It was found that I do not have sleep apnea which can be associated with fibro and my "scores" showed that I was borderline narcoleptic. The doctor perscribed provigil and it works very well. Even though the doctor said he could not give me the diagnosis of narcolepsy, can it be that I do have the disorder? Are there real connections between the two disorders? Fibro is a CNS disorder and Narcolepsy is auto immune, correct? Also, I'd like to know if either disorder could possibly be associated with the fact that I had Rheumatic fever 9 years ago. Any information would be greatly appreciated. Julie

Anne Norris's picture

Narcolepsy & Fibromyalgia!!!

First I want say, it is so disheartening to read the ages of the above articles; However, maybe they have a better chance at a good life, than I did. As all research, and doctors still DO NOT know what they are talking about...as far as living with the disorder.

Yes, I've diagnoised with fibromyalgia, and it's many other names. I am 51 years old. Bad, Doctors, Bad Doctors! Narcolepsy is so difficult to prove. First of all it looks like you are faking it. Doesn't matter most indicators would be that you end up a recluse. As people are mean, so I do not wish this on anyone, and if you do have it...stay away from abusive people. Anyone that would trigger you for a joke or whatever is abusive.

Secondly, I can tell you I have PTSD from IT, enough said!!!!! There is no way you would get me into a sleep study. Like I said people are mean, doctors, nurses, are people too. You can be so easily taken advantage of that if YOU do have this, please, and you are young, arange your life so you live safely, and if you are fortune to have great parents, let them help figure a life plan for you. There is no cure.

I totally believe this is auto-immune, from experience...I totally do not believe in Fibromyalgia. It's been too long with no answer. So basically, 25 years, I was misdiagnoised, and of course treated badly and if something doesn't fit in a physicians boxed/labels they swear you are making it up.

Nonetheless, you couldn't get me to do a sleep study for a million dollars. I'm pretty sure the full blown narcolepsy people would agree. First, think about it's actually an oxy-moronic study for a person with narcolepsy. I'm just going to be staring at them staring at me.

Well, tests, are tests, if you are trying to prove disability. I don't know what possibly could be more frustrating than being called a borderline narcoleptic. It means you must have it, otherwise you wouldn't be on the border. These test have numbers....doctors are lazy.

With either way, sounds like life has to be plan according to the fact that you have something. I just wished I had read this and planned my life better.

Peace A

Tania's picture

Fibromyalgia and Narcolepsy

I was diagnosed with Narcolepsy 8 years ago and after 5 years of chasing was diagnosed with severe Fibromyalgia 18 months ago, and it's horrible. They feed off each other, because they both affect the REM sleep. Some days are better than others. You are in constant sleep deprivation mode and feel like you have been hit by a truck. But having said that the severity is different for everyone, so don't think that if you get diagnosed with both that you will be the same as me or the next person.

Thank you Dinah, to know that there are other people out there with both of these frustrating things.

brandon's picture

falling asleep

I think i have narcolepcy every day doesnt matter how much sleep i get there are sertain times of the day were i cant stay awake. iv fallin asleep in meetings in front of my boss when i was trying my hardest to pay attension, at my desk numerous times. and i have tryed every thing energy drinks, 5 hour energy, vitimines, 12 hours of sleep, washing my face over and over and nothing works

what els can i do ?

C Wilson's picture


I suffer from fibromyalgia but my main problem is not the pain but the extreme tiredness. I get up in the morning and an hour later my eyes are just closing and I have to go to bed. This seems to go on several times a day. I always seem to be exhausted. Is this narcolepsy or is it coming from the fibromyalgia.

Thank you

Dinah's picture

Fibromyalgia and Narcolepsy

Sorry to hear you suffer from Fibromyalgia. That must be very frustrating for you, along with always feeling tired. It is possible that you could have Narcolepsy, along with Fibromyalgia.

I was diagnosed with Fibromyalgia, treated for a year, then started getting so tired that I couldn't leave my house. About a month later a new doctor pointed out that it sounded like I had Narcolepsy, too. I was shocked! Sure enough, I did. Great, I thought. Two conditions to deal with! It's not so bad after all. Getting treatment was the best thing I have ever done. Good luck to you!

Jeanne's picture

Falling asleep

Hello, a good friend of mine is always feeling sleepy, he wakes up with the feeling of a hang-over. My concern is that he is not perticually house-proud. The house is full of dust and mould. Could this be a link to the problem??

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