Sleep Disorders

12 January 2018

Why some people fall asleep in weird places

Many of us feel sleepy at times during the day but manage to stay awake. Some people, however, suffer from a condition called narcolepsy where they are unable to fight off the urge to sleep.

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Some of us might remember the 1991 movie My Own Private Idaho where the character Mike, played by the late River Phoenix, has unexpected attacks of deep sleep in the strangest places and situations.

No control

Most of us experience the odd daytime episode when we can hardly keep our eyes open. This may happen when we didn’t sleep well the night before or after a really big meal. In most cases, however, this isn’t a big issue and a cup of strong coffee or a walk around the block usually gets us going again.

But for some people, this isn’t so easy as they have no control over where and when they might lose consciousness.

The condition is called narcolepsy and affects an estimated 1 in every 2 000 people in the United States and approximately 3 million worldwide. It is however estimated that only 25% people who have narcolepsy have been diagnosed and are receiving treatment.

Narcolepsy has been described as: "It’s more like overwhelmingly bad jet lag. Like you can’t possibly stay awake, no matter how hard you try."

Famous narcoleptics include Curt Cobain, Winston Churchill, Thomas Edison, Nastassja Kinski and Louis Braille.

What is narcolepsy?

According to NHS Choices narcolepsy is a rare long-term brain disorder that causes a person to suddenly fall asleep at inappropriate times. It doesn't cause serious health problems, but can cause difficulties on a day-to-day basis.

A previous Health24 article lists four classic symptoms of the disorder:

  • Excessive sleepiness/drowsiness during the day and sudden sleep attacks  
  • Cataplexy – a temporary loss of muscle control resulting in weakness and sometimes collapse
  • Sleep paralysis – the inability to move or speak when waking up or falling asleep
  • Hypnagogic hallucinations – excessive dreaming (and waking up) during the night

Cause of narcolepsy

Narcolepsy can be caused by a lack of the brain chemical hypocretin which regulates wakefulness, but it doesn't explain all cases.

Possible triggers may include hormonal changes during puberty or menopause, psychological stress and infections like swine flu.

Diagnosis

It's not easy to diagnose narcolepsy because symptoms like fatigue are common to many conditions. The condition is diagnosed by means of a sleep study which requires an overnight stay in a sleep lab.

Misdiagnosis of narcolepsy is common and it may be mistaken for depression, insomnia and obstructive sleep apnoea.

Treating narcolepsy

Narcolepsy cannot be cured, but improving sleeping habits and taking the correct medication can help to lessen the impact of the condition on one's daily life.

Frequent, brief naps throughout the day can help to manage excessive daytime drowsiness.

Going to bed at the same time each night can make a big difference.

There are medications that can help reduce daytime sleepiness, prevent cataplexy attacks and improve nighttime sleep.

Image credit: iStock

 

Ask the Expert

Sleep disorders expert

Dr Alison Bentley is a general practitioner who has consulted in sleep medicine and sleep disorders, in both adults and children of all ages, for almost 30 years. She also researches and publishes on a number of sleep-related topics both in formal research journals and lay publications including as editor of Sleep Matters, an educational newsletter on sleep disorders for doctors.

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