Written by Daniel Yetman
Medically reviewed by Meir Kryger, MD, FRCP(C)
Narcolepsy Vs Sleep Apnea
Narcolepsy is a neurological condition that causes problems with your brain’s sleep-wake cycles. People with this condition experience an overwhelming urge to fall asleep that can strike at any time, even during activities such as talking or eating. Sleep apnea is a more common condition where your breathing repeatedly stops while you’re sleeping. It’s most often caused by a physical blockage in the throat, but the underlying cause can be neurological, as well. Despite both Narcolepsy and Sleep Apnea, being sleep disorders, the symptoms and treatments for each condition vary significantly. Read on to learn more about the differences between narcolepsy and sleep apnea.
Types of sleep apnea
Sleep apnea is classified into three categories depending on the underlying cause:
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Obstructive sleep apnea
It is the most common type, affecting as many as 14 percent of men and 5 percent of women. It occurs when there’s a physical obstruction in your mouth or throat when you’re sleeping.
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Central sleep apnea
It occurs when something interferes with the signal from your brain telling your body to take in air.
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Complex sleep apnea
It is a combination of obstructive and central sleep apnea.
Signs & Symptoms of narcolepsy and sleep apnea?
Both Narcolepsy and Sleep apnea can cause daytime sleepiness, but other symptoms are very different.
Sleep apnea Symptoms
Sleep apnea causes pauses in your breathing while you sleep. These pauses can last from seconds to minutes. Other signs and symptoms of sleep apnea are:
- excessive daytime sleepiness and drowsiness
- frequent loud snoring
- gasping for breath while asleep
- waking repeatedly
- dry mouth and headache after waking
- decreased sexual function and low libido
- frequent urination at night
Narcolepsy Symptoms
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Excessive daytime sleepiness
People with narcolepsy experience excessive daytime sleepiness that can come on suddenly. Not only this, but they also experience “sleep attacks,” in which they fall asleep without warning for seconds to minutes.
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Cataplexy
About 10 percent of the time, the first noticeable symptom is a sudden loss of muscle tone called cataplexy. These attacks can be minor, only causing drooping of your eyelids, or can affect your whole body and lead to collapse.
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Sleep paralysis
It’s common for people with narcolepsy to experience sleep paralysis. Sleep paralysis is a temporary inability to move while at the edge of sleep.
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Hallucinations
Some people experience vivid hallucinations, usually visual, as they’re falling asleep and during naps
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Broken sleep
Many people with narcolepsy have difficulty staying asleep at night, despite daytime sleepiness.
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Automatic behavior while sleeping
People with narcolepsy may fall asleep during an activity such as talking or eating and continue for seconds or minutes with no awareness of what they’re doing.
What causes narcolepsy and sleep apnea?
Both sleep apnea and narcolepsy have multiple potential causes.
Sleep apnea causes
Blockages in your throat or neurological problems can cause sleep apnea. Contributing factors include:
- obesity
- large tonsils
- endocrine conditions such as:
- chronic lung diseases such as asthma or chronic obstructive pulmonary disease (COPD)
- heart failure or kidney failure
- some genetic conditions such as Down syndrome or a cleft palate
- neuromuscular conditions such as:
- myotonic dystrophy
- Co-occurring conditions:
Narcolepsy causes
Narcolepsy is divided into type 1 and type 2. People with type 1 experience cataplexy, while people with type 2 don’t.
Almost everyone with type 1 narcolepsy has low levels of the protein hypocretin in the nervous system. This protein helps regulate sleep cycles and promote wakefulness. In some people, as many as 80 to 90 percent of the neurons that produce this protein are lost. A number of factors may contribute to abnormal levels of this protein, including:
- autoimmune conditions
- family history and genetic factors
- brain injuries
The cause of type 2 narcolepsy is still largely unknown.
Can sleep apnea lead to narcolepsy, or vice-versa?
Researchers are still investigating the link between narcolepsy and sleep apnea. However, it appears that people with narcolepsy may be more likely to have obstructive sleep apnea than people without narcolepsy.
Studies have found an association between narcolepsy and an increased body mass index (BMI). Likewise, research has found a positive correlation between obesity and obstructive sleep apnea. A BMI of 30 or higher is considered to indicate obesity, whereas a BMI under 25 is considered to indicate a moderate weight.
Studies published between 2000 and 2013 found that the prevalence of obstructive sleep apnea in people with narcolepsy ranges from 2 to 68 percent. The wide discrepancy is largely due to small sample sizes and varying definitions of obstructive sleep apnea.
In a 2019 study, researchers found that in a group of 141 people with narcolepsy:
- 26 people had type 1
- 65 percent of people with type 1 had obstructive sleep apnea (17 out of 26)
- 115 people had type 2
- 34 percent of people with type 2 had obstructive sleep apnea (39 out of 115)
In a 2018 study, researchers found that obstructive sleep apnea was the most common medical condition observed in 68 people with narcolepsy in Olmsted County, Minnesota.
People with sleep apnea haven’t been found to have higher rates of narcolepsy.
Can you have both narcolepsy and sleep apnea?
It’s possible to have narcolepsy and sleep apnea at the same time. Having both conditions together may make diagnosis more difficult.
Can another condition be causing my tiredness during the day?
Many other conditions can cause tiredness throughout the day. Some of these causes include:
- sleep deprivation
- medications such as:
- hypothyroidism
- insomnia
- frequent nighttime urination
- depression
- anxiety
- malnutrition
- brain injuries
- other sleep disorders such as restless legs syndrome
- neurological conditions such as:
- myotonic dystrophy
Treatment
Read on to learn about treatment options for sleep apnea and narcolepsy.
Diagnosis & Treatment For Sleep apnea
Sleep apnea treatment focuses on improving airflow while you’re sleeping and managing underlying conditions. It may include:
- weight loss
- continuous positive airway pressure (CPAP) therapy
- bilevel positive airway pressure (BiPAP) therapy
- sleeping on your side
- dental appliances
- surgery
- to reduce upper airway obstruction
- to implant a pacemaker-like device to stimulate specific nerves going to the tongue
- managing underlying medical conditions
Medications & Treatment For Narcolepsy
Narcolepsy is treated with lifestyle changes and medications.
Lifestyle habits include:
- taking short naps
- keeping a regular sleep schedule
- avoiding alcohol or caffeine, especially before bed
- avoiding smoking
- daily exercise
- avoiding large meals before bed
- Do relaxing activities before bed
Medications include:
- modafinil
- amphetamine-like stimulants
- pitolisant (Wakix)
- solriamfetol (Sunosi)
- antidepressants
- sodium oxybate
How do doctors diagnose them?
Diagnosis of narcolepsy or sleep apnea begins with seeing your primary healthcare professional. Further, they’ll give you a physical examination and review your medical history. Furthermore, if they suspect a sleep disorder, they may refer you to a specialist for further testing.
The gold standard for diagnosing obstructive sleep apnea is polysomnography. During the test, you’ll sleep at the sleep center or hospital, where the following will be measured:
- changes in blood oxygen levels, as measured by pulse oximetry
- the airflow in front of the nose and mouth
- the effort to breathe
- brain waves, as measured by an electroencephalogram (EEG)
- eye movement, as measured by an electrooculogram (EOM)
- the heart rate and rhythm, as measured by an electrocardiogram (ECG)
- muscle activity, as measured by electromyography (EMG)
Polysomnography is also used to diagnose narcolepsy. Another test used to diagnose narcolepsy is a multiple sleep latency test, which measures how long it takes for you to fall asleep. In some cases, a doctor may withdraw a sample of hypocretin from your cerebrospinal fluid by using a spinal tap.
When to see a doctor
It’s important to visit a healthcare professional if you suspect you have a sleep disorder for proper diagnosis and treatment.
Narcolepsy isn’t considered deadly, but sleep attacks can potentially lead to lethal accidents and injuries. Also, Sleep apnea is linked to several life-threatening conditions.
Takeaway
Both Narcolepsy and sleep apnea are two sleep disorders characterized by excessive daytime sleepiness. The symptoms of the two conditions vary widely. Narcolepsy is characterized by sudden sleep attacks that can occur at any time, whereas, sleep apnea is characterized by disruptions in your breathing while sleeping.
Therefore, it’s important to visit a doctor if you think you have either condition as he is the one who can help you reduce your chances of complications.
