When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Narcolepsy

Last reviewed: 4 Apr 2025
Last updated: 31 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • excessive daytime sleepiness
  • cataplexy
  • hypnagogic/hypnopompic hallucinations
  • sleep paralysis
Full details

Other diagnostic factors

  • chronic fatigue or tiredness
  • poor performance at work
  • poor memory and concentration
  • car accidents
  • slurred speech
  • blurred vision
  • irregular breathing pattern
  • sleep attacks
  • fragmented nocturnal sleep
  • symptoms of other sleep disorders
  • obesity
  • status cataplecticus
  • hepatomegaly
  • paresis
Full details

Risk factors

  • low cerebrospinal fluid hypocretin
  • human leukocyte antigen (HLA)-DQB1*0602
  • Prader-Willi syndrome
  • Niemann-Pick disease type C
  • linkage to 4p13-q21
  • genes on chromosome 6 or chromosome 21
  • hypothalamic tumors
  • hypothalamic infarct/hemorrhage
  • head trauma
  • central nervous system infection
  • central nervous system arteriovenous malformations
  • multiple sclerosis
  • myotonic dystrophy
Full details

Diagnostic tests

1st tests to order

  • actigraphy and sleep diary
  • overnight polysomnography
  • multiple sleep latency test (MSLT)
Full details

Tests to consider

  • HLA typing
  • cerebrospinal fluid hypocretin-1 level
  • maintenance of wakefulness test
Full details

Treatment algorithm

ONGOING

adults with excessive daytime sleepiness (EDS)

adults with cataplexy

children with excessive daytime sleepiness (EDS)

children with cataplexy

Contributors

Authors

Octavian C. Ioachimescu

Associate Professor

Emory University

Atlanta VA Medical Center

Atlanta

GA

Disclosures

OCI is an editor of a book cited in this topic.

Peer reviewers

Medical Doctor

Sleep Disorders Center

Department of Psychiatry

Cleveland Clinic

Cleveland

OH

Disclosures

KB declares that he has no competing interests.

Associate Professor

Psychiatry and Behavioral Science

Stanford University School of Medicine

Stanford

CA

Disclosures

SN declares that he has no competing interests.

Professor of Medicine

Director

Center for Sleep Disorders Research

Professor of Anatomy

Department of Medicine

Case Western Reserve University

Cleveland

OH

Disclosures

KPS declares that he has no competing interests.

Consultant Neurologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

PR declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Full text

Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2018 Jul 15;14(7):1231-7.Full text  Abstract

Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Sep 1;17(9):1881-93.Full text  Abstract

Bassetti CLA, Kallweit U, Vignatelli L, et al. European guideline and expert statements on the management of narcolepsy in adults and children. Eur J Neurol. 2021 Sep;28(9):2815-30.Full text  Abstract

Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021 Sep 1;17(9):1895-945.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Untreated sleep apnea
    • Periodic limb movements of sleep
    • Restless legs syndrome (RLS)
    More Differentials
  • Guidelines

    • Recommended protocols for the multiple sleep latency test and maintenance of wakefulness test in children: guidance from the American Academy of Sleep Medicine
    • The AASM manual for the scoring of sleep and associated events
    More Guidelines
  • Patient information

    Sleep apnea in adults (obstructive)

    Insomnia

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer