Your Guide to Stress, Narcolepsy, and Stress-induced Narcolepsy

Can stress, anxiety, or trauma cause narcolepsy? 

Narcolepsy is diagnosed as type 1 or type 2 and is caused by a combination of genetic, immune system, and environmental factors that impact the way the body responds to certain chemicals and hormones that affect alertness.

Stress has not been considered the main cause of narcolepsy, but it can be a trigger.

Stress, according to a 2019 review, is one environmental factor that may lead to sudden or “acute” narcolepsy. In such cases, narcolepsy symptoms develop rapidly over the course of a few days or weeks following the triggering event.

The authors of the review describe this as the “multiple-hit model of narcolepsy.” According to the model:

• A person may be born with a genetic predisposition to narcolepsy.
• A bacterial or viral infection in early life may then alter their immune system in a way that adds to their risk of developing narcolepsy.
• Later in life, stress or some other triggering event reactivates the immune response. This triggers the destruction of neurons that produce the sleep-wake hormone, “hypocretin.”
• As the hypocretin neurons die off, they cause narcolepsy symptoms that may progress over the course of days, weeks, or even years.
• Eventually, the mass destruction of hypocretin neurons causes an imbalance in brain regions involved in the sleep-wake cycle. This results in fully developed narcolepsy with cataplexy.

Stress as a trigger for narcolepsy symptoms

It could make sense to say that stress has many effects on sleep, and if you already have narcolepsy, it’s likely to make the symptoms worse.

Some sleep-related issues that stress can cause or contribute to include:

• Fragmented sleep and insomnia: Sleep reactivity refers to the extent to which stress disrupts a person’s sleep. As a 2018 review explains, people with high sleep reactivity tend to experience severe sleep disturbances when stressed, while people with low sleep reactivity experience far fewer sleep disturbances in response to stress.
• Excessive daytime sleepiness (EDS): Stress can lead to difficulties falling asleep or staying asleep or may cause you to wake too early, which can lead to daytime sleepiness.
• Sleep paralysis: As a 2022 study notes, chronic stress, anxiety, and post-traumatic stress disorder (PTSD) are common triggers of sleep paralysis.

Can stress, anxiety, or trauma make narcolepsy worse?

Stress, anxiety, trauma, or any other type of strong emotion may trigger cataplexy in a person with Type 1 narcolepsy. Research suggests that some of these triggers may also worsen narcolepsy over the long term.

As a 2018 review explains, narcolepsy often occurs alongside mental health issues like stress, anxiety, and depression. This makes it difficult for researchers to determine whether mental health issues may worsen narcolepsy or vice versa.

Some researchers believe there’s a bidirectional relationship between the two, while others believe that mental health issues and narcolepsy actually share the same underlying mechanisms.

According to the 2018 review, rates of depression among people with narcolepsy may be as high as 57%.

In an additional 2017 study, more than 50% of people who had a diagnosis of both narcolepsy and depression had received the depression diagnosis prior to the narcolepsy diagnosis, suggesting that depression may either cause narcolepsy or that underlying genetic factors could cause both conditions.

The 2018 review notes that anxiety may affect as many as 53% of people with a narcolepsy diagnosis. The reviewers add that the likelihood of an anxiety disorder occurring before or after the narcolepsy diagnosis depends on the type of anxiety disorder.

Panic disorder and phobias are anxiety disorders that most often follow a narcolepsy diagnosis. However, obsessive-compulsive disorder (OCD) and social phobia (SP) are anxiety disorders that most often precede a narcolepsy diagnosis.

Treating stress and narcolepsy together

Treatments for stress-induced narcolepsy involve treating the underlying stress as well as the narcolepsy itself.

Treatments for narcolepsy

Some lifestyle changes that may help to treat narcolepsy include:

• taking regular, short naps at times when you feel especially sleepy
• going to bed and waking up at the same time each day, even on weekends
• avoiding stimulants like caffeine, alcohol, and nicotine before bedtime
• avoiding large, heavy meals immediately before bedtime
• exercising for at least 20 minutes per day and stopping within 4 or 5 hours of bedtime to avoid overstimulation
• sleeping in a cool, dark, quiet room
• engaging in relaxing activities before bedtime, such as:
  • having a warm bath
  • reading
  • listening to relaxing music

If you have narcolepsy, your doctor may also recommend medications to help control the condition. Examples include:

• Modafinil: A central nervous system (CNS) stimulant that can help to boost daytime alertness and decrease EDS.
• Amphetamine-like stimulants: Doctors may recommend these for narcolepsy that does not improve with modafinil. An example is methylphenidate.
• Antidepressants: Tricyclic antidepressants and selective serotonin and noradrenergic reuptake inhibitors are two classes of antidepressants that can help to control some types of narcolepsy.
• Sodium oxybate or “gamma hydroxybutyrate” (GHB): A tightly-regulated drug that is FDA approved for treating narcolepsy and EDS in people with narcolepsy.
• Pitolisant: A histamine 3 receptor antagonist/inverse agonist that is FDA approved as a treatment for EDS and some types of narcolepsy in adults and children over 6 years of age.

Treatments for stress

Some tips that could help you to manage your stress levels include:

• Limiting contact with stressors: If possible, try to limit your contact with the things that are causing you stress. This may mean taking breaks from the news and social media or avoiding situations that cause you stress.
• Taking time to unwind: Some activities that may help you to relax and unwind include:
  • deep breathing exercises
  • meditation
  • yoga or gentle stretching
  • creating art or another relaxing hobby
• Connecting with others: Try setting aside some time to meet with friends and connect with your community-based or faith-based organizations.
• Talking with people you trust: Try reaching out to trusted friends and family members about the things that are causing you stress. Simply talking about the problem can help reduce its impact on your mental and physical health. Other people may also be able to help you come up with suitable solutions or coping strategies.
• Seeking professional help: A therapist can help you to identify situations or behaviors that are contributing to your stress. They can also provide you with tools and techniques to help you manage your stress more effectively.

Takeaway

Narcolepsy is a chronic neurological disorder that affects the sleep-wake cycle. Research suggests that stress can be a trigger for narcolepsy in individuals who are predisposed to the condition and may also trigger cataplexy in people with Type 1 narcolepsy.

Stress can also cause or worsen some of the symptoms of narcolepsy, including insomnia, sleep paralysis, and excessive daytime sleepiness.

Research also suggests that stress, anxiety, or trauma can play a role in narcolepsy, though it is not always clear whether these mental health issues worsen narcolepsy or vice versa. It may be that they exacerbate one another or that they share similar underlying mechanisms.

The treatment for stress-induced narcolepsy involves treating the underlying stress as well as the narcolepsy itself.

Treatment options for stress include engaging in relaxing activities, confiding in trusted friends and family members, and receiving talking therapy. The treatment for narcolepsy may involve lifestyle changes in combination with medications to help control the condition.