Narcolepsy and Depression: What You Should Know

Is there a link between Narcolepsy and Depression?

Narcolepsy is a chronic neurological condition, and its main symptom is imbalanced sleep and wake cycle.

The problem is that some other disorders have similar manifestations, making it easier for a patient to get a wrong diagnosis.

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One of them is depression.

So, this article will cover the main similarities and differences between narcolepsy and depression – plus the links between them.

How Common Is Narcolepsy?

According to the Narcolepsy network, every 1 in 2,000 people suffers from narcolepsy, which makes about 200,000 people in the US and 3 million around the world.

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Thus, this condition is relatively rare. 

Typically, narcolepsy manifests itself between 10 and 30 years, with the peak falling on childhood and early adulthood.

However, it can be triggered at any age by different factors, such as chronic stress or hormonal changes.

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Causes and Main Symptoms of Narcolepsy

Most symptoms that define narcolepsy aren’t specific to this disorder only, which is why it’s often confused with ADHD, depression, epilepsy, and personality disorders.

In fact, only 38% of patients received their narcolepsy diagnosis correctly at their first visit to the healthcare provider.

You may suspect that you have narcolepsy if you notice the following symptoms:

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  • Excessive daytime sleepiness. People with this disorder may wake up refreshed and full of energy, but chances are they will feel a strong urge to sleep just a couple of hours later.
  • Insomnia and less restorative sleep. Surprisingly, fragmented sleep and insomnia episodes are common among narcolepsy patients.

    This might be a direct result of frequent daytime naps, although there’s no evidence that supports this theory yet.
  • Hypnagogic hallucinations. 59% of narcoleptics with cataplexy experience hypnagogic hallucinations (those that may occur when you are falling asleep or waking up).

    Also, people with narcolepsy are more prone to having vivid dreams and nightmares.
  • Sleep inertia. Sleep inertia happens when a person wakes up from the deep sleep stage. Its main symptoms include the feeling of disorientation, slow reaction, and impaired cognitive abilities.

    In some cases, sleep inertia can last the whole day, which will surely affect a person’s productivity.

Now, the most specific narcolepsy symptom is cataplexy.

Cataplexy is a sudden loss of muscle tone that can happen when a person experiences strong emotions, such as extreme happiness, euphoria, or anger.

Also, cataplexy can be triggered by cough episodes or sneezing.

This symptom allowed to distinguish two types of narcolepsy.

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People with type 1 narcolepsy don’t experience cataplexy, whereas for individuals with type 2 narcolepsy it’s a common symptom.

Cataplexy affects both men and women equally, and the episode itself rarely lasts more than two minutes.

A person remains fully conscious during the entire episode, so it’s not to be mistaken for fainting.

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Now, let’s outline the main causes of narcolepsy:

  • Traumas or brain injuries. If you have experienced severe concussions, swelling, or any other brain injuries, this can be a risk factor for narcolepsy.
  • Family history. If your close relative suffers from narcolepsy of any type, chances of developing this condition are higher for you.
  • Chemical imbalance. A 2011 study conducted on animals discovered that narcolepsy (both type 1 and type 2) is caused by the deficiency of orexin-producing neurons in the brain.
  • Gene mutations. Mutation in certain genes can also affect your ability to produce orexins, and hence, make you more prone to developing narcolepsy.

The Center for Disease Control and Prevention also reported multiple cases of narcolepsy which followed the vaccination against H1N1 flu during the pandemic in 2009. 

How Does Narcolepsy Mess with Your Sleep?

To answer this question, let’s get a closer look at human sleep.

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So, our typical sleep cycle consists of two stages:

  • Non-Rapid Eye Movement (NREM). We spend nearly 75% of the night in this sleep phase, going through light, moderate, and deep sleep. This is the stage during which we restore energy. 
  • Rapid-Eye Movement (REM). The remaining 25% of sleep is spent in the REM phase.

    During this phase, our brain activity is at its highest point and resembles the state of being awake, but the rest of the body remains completely paralyzed.

    In REM sleep, our brain processes information and forms memories. Also in this sleep stage, we see most of our dreams.

People with narcolepsy have less distinct boundaries between these two sleep stages and the state of wakefulness.

Their sleep and wake cycles may mix together easily and cause them to suddenly enter the REM-sleep stage during the day — which is another trigger for a cataplexy episode.

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How Is Narcolepsy Usually Diagnosed?

As mentioned above, there’s only one symptom specific to narcolepsy — it’s cataplexy.

Because of that, individuals who don’t experience this symptom, or have a mild form of narcolepsy, often get a wrong diagnosis.

That’s why this condition requires a more precise approach from clinicians.

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So, the main accessible ways to find out if you have narcolepsy are the following:

  • Self-reports. The easiest thing you can do is monitor your condition and sleep quality with the help of a wearable device or a sleep log.

    Keep doing this for about a week to define the main patterns in your sleep schedule.

    You need to pay attention to sudden urges to nap that appear even when you’ve had enough sleep at night.

    Also, look out for such symptoms as insomnia episodes, inability to resist falling asleep during the day, and weakening of knees during intense emotions.
  • Polysomnogram (or sleep study). Polysomnogram is a lab-made test that records brain activity during sleep.

    Its main goal, when it comes to narcolepsy, is to define how fast a person enters the REM stage and whether they have any signs typical of narcolepsy, such as jaw weakening during sleep.
  • Multiple Sleep Latency Test (MSLT). MSLT is needed to measure the duration of sleep cycles.

    A person will be given four naps during the day with 2-hour breaks between each nap.

    During each nap, a doctor will measure their sleep cycles, and if the transition between sleep stages occurs too quickly, he may suspect that they have narcolepsy.

Finally, a doctor can perform physical examinations and use questionnaires.

Typically, the Epworth Sleepiness Scale is used to measure daytime sleepiness, one of the main manifestations of narcolepsy.

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But if a person scores less than 10 points on this scale, a doctor may turn to the Swiss Narcolepsy Scale.

This questionnaire addresses five main signs of narcolepsy:

  • inability to fall asleep at night;
  • feeling not rested in the morning;
  • frequent naps during the day;
  • sagging jaw during laughter episodes or anger;
  • knees weakening during laughter episodes or anger.

A person needs to rank each question from 1 (never experienced) to 5 (always experienced). After that, a doctor will calculate the final score and give an individual diagnosis based on the result.

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The Swiss Narcolepsy Scale allows your healthcare provider to determine whether you have type 1 or 2 narcolepsy, as well as its severity.

It’s incredibly important to receive the right diagnosis and treatment because narcolepsy is a disabling disorder that affects your work productivity or academic performance and decreases the overall quality of your life. 

Similarities and Differences Between Narcolepsy and Depression

Due to certain difficulties with making a correct diagnosis, narcolepsy is often confused with depression.

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No wonder, as these two conditions do have many similarities:

  • Depression is also caused by a chemical imbalance. Although the cause of depression is still not clearly known, a chemical imbalance in the brain is considered one of the main possible causes.

    And the effectiveness of certain antidepressants than bring serotonin levels back to normal supports this theory.
  • One of the main signs of depression is daytime sleepiness, too. Hypersomnia is a common complaint in patients with depression.

    Moreover, it can aggravate the manifestations of depression and make a person resistant to treatment and more likely to relapse.
  • Psychotic hallucinations in people with depression and hypnagogic visions in those with narcolepsy are very similar.

    Both psychotic and hypnagogic hallucinations are very vivid and realistic, so one can easily mistake them for each other.
  • Some cases of narcolepsy can be treated with antidepressants. Certain SSRI antidepressants, as well as tricyclic antidepressants, have a better effect on improving sleep latency and decreasing the frequency of cataplexy episodes, compared to standard drugs used for managing narcolepsy.

With all of that being said, both narcolepsy and depression also affect your cognitive abilities and can adversely impact the quality of life.

However, these conditions still aren’t identical. 

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The main difference between narcolepsy and depression is how the periods of sleepiness are distributed during the day

Typically, a person with narcolepsy wakes up pretty refreshed, but the excessive daytime sleepiness kicks in after several hours.

A person with depression, on the other hand, finds it extremely hard to get up from bed in the morning.

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However, depressive patients typically feel a slight energy boost as the evening approaches.

Also, people with depression have a different sleep structure than individuals with narcolepsy.

According to polysomnogram studies, depressed people have longer sleep onset and an increased percentage of REM sleep during the night, while narcoleptics fall asleep and get into the REM-sleep stage faster.

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Can You Have Both Narcolepsy and Depression?

You definitely can. These two disorders frequently occur together.

Since narcolepsy is a progressive and disabling condition, it can affect a person’s achievements in social and work interactions and may even lead to job loss.

Deterioration in social and cognitive functions, in turn, can contribute to developing depression, anxiety, and other mood disorders.

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Along with that, poor quality of sleep, which a person with narcolepsy typically has, is another major risk factor for depressive episodes.

A British study based on self-reported questionnaires has shown that almost 57% of people with narcolepsy suffer from depression-like symptoms or develop a major depressive disorder. 

That’s why, along with addressing the main symptoms of narcolepsy, an individual should be examined at the psychiatrist’s office.

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This will help define if a person has any mood disorders and if they need any corresponding treatment for them.

How to Address Treatment Based on Your Problems?

Today, there’s no direct treatment for narcolepsy.

Furthermore, most recommendations are symptomatic and address only the most common manifestations of this pathology.

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Here’s what you can do to make the most of your treatment:

  • Find out if you have any comorbid disorders. If your narcolepsy occurs along with depression or any other mood disorder, address it too.
    Typically, after treating a comorbid condition, you may expect a significant improvement in your narcolepsy treatment as well.
  • Develop a consistent sleep routine. Falling asleep and waking up at the same time creates positive associations with sleep in your brain and helps avoid the stress of instability.

    This will also allow you to improve your sleep quality and be less sleepy during the day.
  • Schedule naps right. If you have an urge to take a nap, do it properly — that is, your daytime nap shouldn’t last longer than 30-40 minutes.

    This way, you won’t enter into the deep sleep phase and will wake up without sleep inertia.

    Also, note that taking a nap when it’s less than two hours before your actual bedtime isn’t recommended.
  • Incorporate physical activity into your life. Physical activity is a natural way to get tired, and hence, get deeper sleep at night.

    Also, it can trigger the production of endorphins, which improve mood during the day and make you more alert.
  • Cut out caffeine. Caffeine will surely help you stay awake during the day, but it will also mess with your sleep structure if you consume it after 4 pm.

    The half-life of caffeine in your system is about 4-6 hours, and when the bedtime approaches, your brain may be too alert to fall asleep naturally.