Narcolepsy with Sleep Apnea: What You Need to Know
Narcolepsy and sleep apnea are sleep disorders that can seriously impair quality of life. Both disorders cause excessive daytime sleepiness, yet they are two distinct health issues.
While narcolepsy is relatively rare, affecting 1% of Americans, it is possible to have narcolepsy with sleep apnea. Having both disorders can make diagnosis harder due to overlapping symptoms, but narcolepsy and sleep apnea are treated separately.
What Are the Similarities Between Narcolepsy and Sleep Apnea?
The main similarity between these two chronic sleep disorders is excessive daytime sleepiness.
Narcolepsy causes uncontrollable daytime sleep episodes regardless of your environment. With sleep apnea, sleep deprivation from breathing pauses that force you to wake for air leads to fatigue and daytime sleepiness.
Both disorders place you at an increased risk of accidents at work, at home, and when driving as you could fall asleep at any given moment.
Symptoms
The two conditions share some similar symptoms, including:
- suddenly falling asleep during an activity
- a need for short naps
- difficulty concentrating
- memory issues
- hallucinations, although this is more common with narcolepsy
Risk Factors
As well as sharing symptoms, the two disorders also share risk factors. One of these is weight.
Obesity is a major contributing risk factor for obstructive sleep apnea, the more common form of sleep apnea. Excess tissues in the neck due to obesity increase the risk of the airways becoming blocked and causing the breathing difficulties that disrupts sleep.
Reduced levels of a chemical in the brain called hypocretin are often seen in people with narcolepsy. Hypocretin helps regulate the sleep/wake cycle but when levels are low it can also lead to a slower metabolism. This increases the risk of obesity as managing your weight is more difficult. Therefore, while obesity may not be a primary contributing risk factor, like sleep apnea it can be an indicator of narcolepsy.
Genetics
Genetics can also play a role in both disorders. A family history of either condition increases your risk of developing these chronic sleep disorders.
Narcolepsy Versus Sleep Apnea: What are the Differences?
Narcolepsy is a chronic neurological disorder that affects your sleep/wake cycle. As mentioned above, it is associated with low levels of the hormone hypocretin, while obstructive sleep apnea is caused by a mechanical obstruction of the upper airways.
There are differences in who is more at risk of developing these disorders. Obstructive sleep apnea tends to be more prevalent in men, although this evens out once women reach menopause. Narcolepsy affects men and women equally.
Age matters too. Obstructive sleep apnea is more common over the age of 40, while the symptoms of narcolepsy may begin to display before the age of 30. Children as young as 10 can also struggle with narcolepsy.
While some symptoms are similar for both disorders, others are more indicative of sleep apnea or narcolepsy.
For obstructive sleep apnea, these include:
- frequently waking for air
- waking gasping for air
- dry mouth in the morning
- morning headaches
- loud snoring
For narcolepsy, these include:
- the sudden loss of muscle tone, known as cataplexy
- quicker onset of the REM stage of sleep
- sleep paralysis, where you cannot move or speak just before falling asleep or just after waking
Can You Have Both Narcolepsy and Sleep Apnea?
Yes, you can have both disorders, and having narcolepsy increases the risk of developing another sleep disorder like sleep apnea. Approximately 25% of those with narcolepsy also suffer with another sleep disorder, which is often sleep apnea. However, more research is required to establish any link between the two disorders.
Due to the similarity of symptoms, particularly daytime sleepiness, the presence of both disorders can be overlooked. This is more so when someone with narcolepsy does not present with cataplexy which can be a prime indicator of the disorder.
Screening for Narcolepsy and Sleep Apnea
A healthcare provider who suspects a sleep disorder will conduct a physical examination and ask about your family’s medical history. A study like a polysomnography may then be recommended that measures variables including airflow, blood oxygen levels, heart rate, and muscle activity as you sleep.
Weight is another determining factor, as obesity makes you more likely to develop both narcolepsy and obstructive sleep apnea.
If you are diagnosed with obstructive sleep apnea you may be prescribed positive airway pressure (PAP) therapy to keep the airways clear of obstruction. However, if such a device does not have a significant effect on your daytime fatigue and tendency to fall asleep regardless of the activity you are pursuing, then you may have narcolepsy as well and you should consult your healthcare provider.
Treatments
Even if you are diagnosed with both narcolepsy and sleep apnea, each disorder needs to be treated independently of the other. That said, as obesity can be a factor in both disorders, lifestyle changes aimed at weight loss could benefit both conditions.
Treatments for sleep apnea aim to improve and maintain airflow to the lungs during sleep. Narcolepsy is more often caused by lifestyle factors and is often treated with medication.
Managing both conditions to reduce their respective symptoms is the aim of a treatment plan for each disorder.
Treatments for obstructive sleep apnea include:
- continuous positive airway pressure (CPAP) therapy
- oral appliances that aid airflow
- positional therapy to help sleep on your side
- surgery to remove an obstruction of the airway like enlarged adenoids
- lifestyle changes
Treatments for narcolepsy include:
- lifestyle changes
- sleep pattern changes including developing a regular sleep schedule and napping when appropriate
- medications, including modafinil, antidepressants, and amphetamine-style stimulants
It is important to consult your healthcare provider if you suspect any sleep disorder, as without diagnosis and treatment, disorders like sleep apnea increase your risk of developing further serious and potentially life-threatening health complications.