What is Narcolepsy Tetrad?

Narcolepsy can be described as an irresistible daytime sleep.

Narcolepsy patients may also experience cataplexy, sleep paralysis, and hypnagogic hallucinations.

These four symptoms make up the term “narcolepsy tetrad.”

Excessive Daytime Sleepiness

In the middle of a conversation, while driving, or while eating a meal, narcolepsy sufferers may fall asleep unintentionally. Because of their excessive sleepiness, sometimes they are unable to remember much of what they do during the day.

They may suddenly “black out” while driving a car, forget that they performed specific tasks, or forget that they made certain phone calls.

These people have difficulty performing quality work during dull and monotonous activities. The sleepiness is sometimes alleviated by taking short naps throughout the day.

This magnitude of sleepiness often has undesirable consequences. Narcolepsy sufferers have difficulty in keeping jobs, friends, and personal relationships.

It is not because that sufferers of narcolepsy are sleepy because they are lazy, bored, or unmotivated, but rather because they have an underlying physiological problem.

Cataplexy

In addition to daytime sleepiness, about 70% of narcolepsy patients experience cataplexy. Cataplexy is a sudden muscular weakness, total loss of muscle tone, or paralysis brought on by strong emotions such as anger, fear, hearty laughter, or crying.

Cataplectic attacks often involve weakness in a particular body parts. Weakness of the limbs may result in wobbly movements or dropping of objects. Weakness in the lower facial muscles may cause slurring of words.

Some narcolepsy patients may experience severe attacks and become altogether weak, limp and fall to the floor. Narcolepsy patients often avoid certain situations that may bring on intense emotional reactions because these episodes are preceded by moments of emotional excitement.

Cataplectic attacks usually do not last more than a few minutes. Patients are conscious during the attacks and are aware of everything that is going on around them.

The frequency of the attacks varies from patient to patient. Some cataplexy attacks may occur once a month or less, while other patients experience it several times a day.

Sleep Paralysis

Sleep paralysis occurs just as the narcoleptic patient begins to fall asleep. The patient is paralyzed except for respiration and eye movements.

About 20% to 30% of patients with narcolepsy experience the full narcolepsy tetrad. 40% to 65% undergo sleep paralysis and 50% to 70% undergo hypnagogic hallucinations.

Hypnagogic Hallucinations

Hypnagogic hallucinations may occur at the same time as the sleep paralysis. The hallucinations are usually short-lived and end abruptly. Auditory hallucinations may involve a range of sounds, from music to human voices.

Narcolepsy patients may report “seeing things,” which can range from simple shapes to pictures and scenery. The emotional qualities of hypnagogic hallucinations commonly involve intense fear and anxiety.

Hallucinations involving intruders are often reported. Both the sleep paralysis and the hypnagogic hallucinations can be very terrifying experiences that some patients are scared to go to bed.