What Is Cataplexy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Here are some important things to know about why cataplexy happens, its connection to narcolepsy, and how to manage the potentially debilitating symptoms.

These episodes often occur after a strong feeling of sadness, excitement, joy, or other emotion and can cause someone’s knees to buckle or their head to bob or cause them to fall down if they are standing and lose control of their leg muscles, explains Shelley Hershner, MD, clinical associate professor of neurology at the University of Michigan in Ann Arbor.

“Some people may avoid swimming, climbing a ladder, or taking a bath,” says Dr. Hershner.

Cataplexy can cause muscle weakness in any part of the body, though it commonly affects the limbs and hands. This may lead to symptoms such as:

• Hands dropping items they’re holding
• Knees buckling
• Legs collapsing
• Eyelids drooping
• Speech slurring
• Head nodding

It’s also worth noting that most people who are diagnosed with narcolepsy have cataplexy, too. But this typically pertains to people with type 1 narcolepsy. In some cases, type 2 narcolepsy — the one without cataplexy, which has milder symptoms — may develop into narcolepsy with cataplexy, says Eric Olson, MD, a sleep medicine specialist at the Mayo Clinic in Rochester, Minnesota.

But these cycles malfunction in people with narcolepsy. They may enter REM sleep right away when they fall asleep, and then wake up and bypass the NREM stage altogether. This can occur during the night as well as during daytime naps, blurring the lines between wakefulness and sleep.

Cataplexy episodes resemble the loss of muscle control that naturally happens during REM sleep, but they occur when someone is awake rather than during sleep. Research, however, has suggested that positive emotions may lead to muscle weakness (feeling weak with laughter, for instance). But the brain chemical hypocretin (the one absent in people with narcolepsy) prevents that loss of muscle tone from being anything more than a brief event.

If you feel the sudden urge to sleep during the day even after a night of good sleep, doze off at inappropriate times (when working or talking to a friend), have dream-like hallucinations just before falling asleep, or experience momentary paralysis while awake, it can be helpful to get tested for narcolepsy with cataplexy.

If your sleep history, sleep diary, and actigraph data suggest you may have narcolepsy, your doctor will have you spend the night at a sleep center to undergo a series of tests. These tests can help determine the severity of your narcolepsy or identify other possible causes for your symptoms.

• Polysomnography Using electrodes attached to your scalp, this test measures the electrical activity of your brain and heart, as well as the movement of your muscles and eyes during sleep. This test requires an overnight stay at a medical facility.
• Multiple Sleep Latency Test Also known as a daytime nap study, this full-day test evaluates excessive daytime sleepiness by measuring how quickly you fall asleep during the day. It is the standard tool used to diagnose narcolepsy.
• Hypocretin Level Measurement This test measures your hypocretin levels. People with low or no hypocretin are classified as having type 1 narcolepsy. However, because this test requires your physician to remove cerebrospinal fluid (a fluid that protects your brain and spinal cord) from your lumbar spine, it is rarely used.

Without proper diagnosis and treatment of narcolepsy, symptoms such as cataplexy can be dangerous and “life-restricting,” notes Dr. Olson. “Someone may stop competing to avoid winning something, or avoid laughing, or even engaging in intercourse,” says Olson.

However, while narcolepsy with cataplexy is a lifelong condition, there are medications that can help you manage the symptoms.

Medication Options for Cataplexy

The primary treatment options are medications that allow people to stay awake during the day and push them to sleep at night, says Lois E. Krahn, MD, a professor of psychiatry in the Mayo Clinic College of Medicine who is based in Phoenix.

Alternative and Complementary Therapies for Cataplexy

In addition to medications, cognitive behavioral therapy (CBT), or learning techniques to improve behavior, may help people manage several symptoms of narcolepsy, including cataplexy.

CBT techniques for narcolepsy vary but can involve helping patients recognize conditions and emotions that trigger their cataplectic attacks and teaching them how to respond in ways that prevent an attack from occurring. Another potential CBT technique known as stimulus satiation is a procedure in which the patient is repeatedly exposed to the trigger that prompts cataplectic episodes until its effect is lost. However, most studies have looked at CBT for other sleep disorders, and more research on the application of CBT for narcolepsy is needed.

Prevention of Cataplexy

• Get enough sleep or plan strategic naps. You may be more likely to experience a cataplectic attack when you’re sleep-deprived. “If someone is exhausted, they are more vulnerable to an emotional trigger, so being well-rested is important,” Dr. Krahn says. If you’re unable to get a good night’s sleep or you’re bothered by excessive daytime sleepiness, try to take short, scheduled naps at times when you tend to feel sleepiest. “Naps don’t have to be terribly long — a person with narcolepsy can benefit from a 20-minute nap,” Krahn says.
• Get up and move. Regular physical activity may indirectly help with cataplexy by keeping daytime sleepiness at bay, according to Krahn. So if you start feeling sleepy and can’t take a quick nap, go for a walk.
• Get help from friends, family, and coworkers. Let people know if your cataplexy is triggered by strong emotions or specific situations. If you sense an attack is coming, encourage people to avoid these triggers if possible. Though you may not want to avoid strong emotions or specific situations, it may be preferable to an attack — especially if an attack is about to occur at an awkward time (like during a meal or work meeting).

Cataplexy can also interfere with relationships and daily life. As many attacks are triggered by intense emotions, like anger and joy, people with cataplexy may withdraw from emotional interactions or avoid social situations.

While not everyone with type 1 narcolepsy experiences cataplexy, estimates show that roughly half of all people with narcolepsy also have cataplexy. However, because narcolepsy is often unrecognized or misdiagnosed, the actual number may be higher.

• Narcolepsy This is a chronic neurological disorder that affects the brain’s sleep-wake cycles.
• Excessive Daytime Sleepiness (EDS) One of the most obvious symptoms of narcolepsy is excessive daytime sleepiness, or the overwhelming need to sleep, regardless of how much sleep you may have gotten the night before. Some people are more likely to experience a cataplectic attack when sleepy.
• Sleep Paralysis This common narcolepsy symptom resembles cataplexy, except it occurs during sleep.