A Narcolepsy itself probably doesn't get worse, but it can aggravate problems that get worse with normal aging. Both narcolepsy and advancing age mean less solid sleep at night and less vigilant alertness during the day. Both older people and people with narcolepsy normally tend to take more naps. Narcolepsy and older age increase the risk of sleep disordered breathing during sleep, which impairs daytime functioning. People can drop things because of clumsiness or cataplexy. A patient of mine had narcolepsy that remarkably had been diagnosed during the 1940's while he was in his 20's. In his later 70's, he distinguished between the depredations of age and narcolepsy, but knew that they mutually reinforced each other.

Q Is there ever a circumstance for ordering just an overnight test for the diagnosis of narcolepsy?

A This would not be a reliable means of diagnosing narcolepsy. A night sleep recording would not measure daytime sleepiness, which is a key symptom of narcolepsy. Only daytime recording of several naps lets doctors see the narcoleptic tendency for REM sleep periods to appear abnormally early. During normal night sleep, the first REM sleep period first appears only after sleep has gradually deepened for about an hour. Recording only night sleep allows only the one opportunity at the beginning of the night to record early-appearing REM sleep. REM sleep periods may appear abnormally soon because of several causes, such as an odd sleep schedule, certain medications, or depression problems, so that the doctor cannot not confidently conclude that narcolepsy is causing it.

By: Quentin Regestein, M.D.
Brigham and Woman's Hospital
Boston, MA
Medical Advisor to Network

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