Mahowald explains narcolepsy in similar terms-as a 'boundary control problem.' At night, sleep is fragmented people with narcolepsy awaken frequently. He drinks coffee from a huge ceramic mug on which the sun and moon have been fashioned into a sleep specialist's version of the Chinese yin-yang symbol.ĭr. Mahowald works on the sixth floor of Hennepin County Medical Center, a sprawling public complex on the edge of downtown Minneapolis.

Other major symptoms include: sleep paralysis, which is the inability to move while falling asleep or waking up and hallucinations, which are in essence waking dreams that typically occur when a person is either falling asleep or waking up.ĭr. Laughter is most common: When Mary Ann B.'s head collapsed onto the table, she was unwittingly experiencing a cataplectic attack. Cataplexy is usually triggered by a strong emotion. Since excessive daytime sleepiness is also present in other conditions, the addition of cataplexy allows for a textbook diagnosis of narcolepsy. Its second major symptom is cataplexy-a sudden loss of muscle control. As a result, people with narcolepsy sleep in snatches that can last for mere seconds. 'They enter REM sleep far too early,' says neurologist Michael Silber, M.D., co-director of the Mayo Clinic Sleep Disorders Center in Rochester, Minn. In contrast, people with narcolepsy fall quickly into REM sleep-at times, within just a few minutes. Both REM and non-REM sleep, properly coordinated, are essential to the feeling of restfulness that follows a good night's sleep. A healthy person sleeps in cycles that typically last 100 to 110 minutes, with REM (rapid eye movement) sleep-the phase in which we dream-occurring for relatively brief periods of 10 to 30 minutes at the end of each cycle. The root of the problem is a brain abnormality that disrupts the body's normal sleep cycles.

Thus a person with narcolepsy often stays awake when active but falls asleep when doing something quiet, such as reading, studying or, most ominously, driving. 'Most people with narcolepsy feel all day, every day, the way the rest of us feel after staying up all night,' explains neurologist Mark Mahowald, M.D., director of the Minnesota Regional Sleep Disorders Center in Minneapolis, not far from Mary Ann's Hennepin County home. Another test monitors a patient through several naps over the day. The defining symptom of narcolepsy is excessive daytime sleepiness, ranging from sleep attacks to persistent drowsiness. At least, as Mary Ann learned, it's a condition that is manageable, though still not cured. To doctors in the burgeoning field of sleep medicine, however, her tale-its onset in adolescence and its loss of muscle control brought on by laughter-is a classic presentation of what can be a baffling and frustrating condition. Her personal physician referred her to a neurologist, who performed a battery of tests and diagnosed her malady: narcolepsy. Mary Ann was in her late 30s at the time, three decades ago. 'I knew then something was wrong,' she says. Mary Ann awakened to see they were careening toward a gas station. Her young son, who was about 4 at the time, hit the back of her head. At the grocery store, she would find strange items in her shopping cart.Īnd then, while Mary Ann was driving one day, her mind drifted. 'I could not lift my head until I was done laughing.'Īs a young wife and mother, Mary Ann routinely fell asleep after dinner. 'My head would go down on the table,' she recalls. If she laughed hard, she lost control of her body. In high school, she failed written tests she'd studied for, yet did well when they were given as oral tests. realizes her illness began to affect her when she was a teenager. With the advantage of hindsight, Mary Ann B. Wake-up Call: Treating Narcolepsy as a Serious Sleep Disorder

Cataplexy episode