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Can you have narcolepsy and periods of insomnia too at the same time?

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Posted on Fri, 14 Jun 2019
Question: A few years ago I began falling asleep at inappropriate times. I was so sleepy that I had to quit my teaching job because I would fall asleep in the middle of teaching a lesson, reading a story, grading papers, in the middle of lunch, etc. I underwent a sleep study and was diagnosed with idiopathic hyper somnolence. The study did not show dream activity that usually occurs with narcolepsy. However I do experience what I call waking dreams. I can be engaged in an activity such as reading and do not think I have fallen asleep until I realize my thoughts are making no sense. While teaching a math lesson I continued teaching but was on a totally nonexistent math problem. My neurologist says that what I have is a form of narcolepsy. I have fallen asleep while driving without realizing it until I run off the road or suddenly wake to realize I have had no memory of part of the trip. I have undergone tests for epilepsy and a mri of the brain which didn't show any abnormalities. I was put on 250mg of nuvigil which has been effective in reducing the number of waking dreams and falling totally asleep although I still occasionally have these episodes. The odd thing is while I have sleep attacks that happen randomly, I also have episodes of insomnia. That doesn't make sense to me. In your opinion is this narcolepsy? I'm confused because two different doctors diagnosed two different kinds of sleep disorders. Can you have narcolepsy and periods of insomnia too?
doctor
Answered by Dr. Kaushal Bhavsar (52 minutes later)
Brief Answer:
Do you have a stressful life?

Detailed Answer:

Hello,

Narcolepsy itself is less likely to be the cause of insomnia.
But if it is associated with excessive stress and anxiety then this can cause insomnia.

You are also suffering from bipolar mood disorder.

So please let me know-
1. Are you dealing with a lot of stress?
2. Is your bipolar disorder under control?

Please let me know the details of the above-asked questions so that I can guide you better. I will be happy to help you further.

Wish you good health. Thanks.

Regards,
Dr. Kaushal Bhavsar
Pulmonologist
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Kaushal Bhavsar (1 hour later)
In answer to your questions yes the bipolar is being controlled by medication and I've not had serious depression or mania in a very long time. I don't feel my life is very stressful at all. I'm retired and have good family relationships and no real worries. (Other than the ones we all have living in this world today). I guess it's possible that bipolar can effect one who has it in ways they may not be aware of as I believe it is a physiological illness. Consciously I don't feel there is an emotional reason for the episodes of insomnia. My other question was do you think that my sleep disorder is narcolepsy or ideopathic hyper somnolence or are they the same thing? Also I wanted to say that my insomnia is not prolonged episodes of wakefulness but a series of sleep of a short duration of 15-30 minutes at a time followed by several hours of wakefulness.
doctor
Answered by Dr. Kaushal Bhavsar (3 hours later)
Brief Answer:
No, Both are not the same.

Detailed Answer:

Hello,

No both are not the same. Narcolepsy is has cataplexy as the most characteristic feature. This is absent in idiopathic hypersomnolence.

Sleep disturbances are commonly seen with Narcolepsy. So please let me know:
1. Do you have cataplexy while sleeping episodes?
2. Do you have sleep disturbances daily?

Please reply me answers of above asked questions, so that I can guide you better.

I will be happy to help you further. Wish you good health. Thanks.

Regards,
Dr. Kaushal Bhavsar
Pulmonologist
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Kaushal Bhavsar (4 hours later)
Before I began talking nuvigil I had multiple sleep attacks multiple times a day. Since I've been on the medicine it has been effective in reducing the number and duration of the sleep attacks. I still have "waking dreams" fairly often where I don't know that I'm asleep until I realize my thoughts aren't making sense or I make movements acting out my dreams and it wakes me up. I don't have cataplexy as I understand that. I've experienced knee buckling following a sleep attack. Currently I am having some kind of insomnia. I haven't slept more than 3 consecutive hours of sleep in the last 5 days. I take naps of short duration no more than an hour at a time followed by several hours of wakefulness. I haven't had any tea or coffee for two days but that's had no effect. I do not drink alcohol or take any stimulants except for the nuvigil. I feel tired and low energy but can't stay asleep long enough to feel refreshed.
doctor
Answered by Dr. Kaushal Bhavsar (2 hours later)
Brief Answer:
Get done repeat sleep study.

Detailed Answer:

Hello,

Since you do not have cataplexy, diagnosis of Narcolepsy is in danger. For current insomnia, in my opinion, you should get done repeat sleep study to know the sleep pattern during awakenings.

Please let me know:
1. When did you had your sleep study lastly?
2. Is this insomnia thing new one (since 5 days) or you had it in the past also?
3. Are you obese?

Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Regards,
Dr. Kaushal Bhavsar
Pulmonologist
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar (26 minutes later)
I had the sleep study in 2013. The insomnia comes and goes but this is the longest stretch of prolonged insomnia that I've had. Usually I may miss a couple of nights of sleep and then it resolves itself. I would say that I have a missed nights sleep at least once a week. I don't think I'm obese. I am 5ft 5inches tall and weigh 149 pounds. They ruled out sleep apnea in my last sleep study. Is the knee buckling a symptom of cataplexy?
doctor
Answered by Dr. Kaushal Bhavsar (22 minutes later)
Brief Answer:
I want more information about your knee buckling.

Detailed Answer:

Hello,

Most common cause for knee buckling is ligament injury of the knee joint especially anterior cruciate ligament (ACL).

Please let me know:
1. Do you have any knee injuries in the past?
2. Do you have knee buckling in both the knees or only in one knee?
3. Do you have knee buckling always prior to sleeping?

Please reply me answers of above asked questions, so that I can guide you better.

I will be happy to help you further. Wish you good health. Thanks.

Regards,
Dr. Kaushal Bhavsar
Pulmonologist
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar (2 hours later)
I have had no injuries of the knees that I'm aware of. It happens in both knees but usually just one at a time. It occurs when I'm overwhelmingly sleepy or gave had a sleep attack. It is very slight and probably unnoticeable to others. It just feels like the muscle gives out suddenly but recovers almost instantly.
doctor
Answered by Dr. Kaushal Bhavsar (32 minutes later)
Brief Answer:
Possibility of cataplexy is less likely.

Detailed Answer:

Hello,

I don't think it is cataplexy. So I don't think it is Narcolepsy.

Possibility of idiopathic hypersomnolence is more likely.

You should also discuss this insomnia thing with your psychiatrist.

Hope I have solved your query. Wish you good health. Thanks.

Regards,
Dr. Kaushal Bhavsar
Pulmonologist
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Kaushal Bhavsar

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Can you have narcolepsy and periods of insomnia too at the same time?

Brief Answer: Do you have a stressful life? Detailed Answer: Hello, Narcolepsy itself is less likely to be the cause of insomnia. But if it is associated with excessive stress and anxiety then this can cause insomnia. You are also suffering from bipolar mood disorder. So please let me know- 1. Are you dealing with a lot of stress? 2. Is your bipolar disorder under control? Please let me know the details of the above-asked questions so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks. Regards, Dr. Kaushal Bhavsar Pulmonologist