Is this cause for concern?

Cataplexy happens when your muscles suddenly go limp or significantly weaken without warning. You may experience cataplexy when you feel a strong emotion or emotional sensation. This can include crying, laughing, or feeling angry. You may find yourself falling over or losing control over your facial expressions.

Cataplexy is associated with narcolepsy. Narcolepsy is a neurological condition that causes extreme sleepiness during the day. You can also have unexpected episodes of falling asleep, even in the middle of a conversation or in the middle of an activity.

Other common symptoms of narcolepsy include:

  • feeling paralyzed while you’re falling asleep (sleep paralysis)
  • hallucinations before you fall asleep (hypnogogic hallucinations)
  • hallucinations when waking up in the middle of the night (hypnopompic hallucinations)

However, only about 1 in 2000 people have narcolepsy in the world, and those with cataplexy are even less common. But this condition can be disruptive to your life and cause complications if you suddenly lose muscle control at the wrong time, such as during an important meeting, while spending time with loved ones, or when you’re driving.

Keep reading to learn more about the symptoms of cataplexy, what causes it, and more.

What are the symptoms?

Symptoms of cataplexy can be different for each person. Most people start to notice their symptoms as teenagers or as young adults. This is usually when you enter college, the workforce, or other new, potentially stressful environments.

Some possible symptoms of cataplexy episodes include:

  • drooping eyelids
  • jaw dropping
  • head falling to the side due to neck muscle weakness
  • whole body falling to the ground
  • various muscles around your body twitching without an obvious cause

Cataplexy is often mistaken for a seizure when it’s more severe. But unlike a seizure, you will likely remain conscious and remember everything that happens during an episode. Cataplectic episodes also vary in length. They may last only a few seconds or go on for up to a few minutes.

Cataplexy usually happens after you feel a strong emotion. Emotional triggers can include:

  • excitement
  • happiness
  • stress
  • fear
  • anger
  • laughter

Not everyone with cataplexy has the same triggers. They may also not be consistent. Laughing may cause cataplexy in certain situations, but not others. Anger may trigger an episode in one case, but not another.

Cataplexy can be one of the first noticeable symptoms in people who have narcolepsy. It often shows up as a minor muscle abnormality, such as your eyelid drooping or your head falling over briefly because your neck muscles weaken. As a result, you may not even realize you have cataplexy or narcolepsy.

What causes cataplexy?

If you have narcolepsy with cataplexy, your brain doesn’t have enough hypocretin (orexin). This brain chemical helps keep you awake and controls your rapid eye movement (REM) sleep cycle. Other parts of your brain that control your sleep cycle are also thought to play a role in causing narcolepsy with cataplexy.

Who’s at risk for cataplexy?

Most narcolepsy isn’t inherited. However, as many as 10 percent of those with narcolepsy and cataplexy have close relatives who show symptoms of these conditions.

Other risk factors and causes of narcolepsy with cataplexy include:

  • traumatic head or brain injuries
  • tumors or growths near areas of your brain that control sleep
  • autoimmune conditions, which may cause your immune system to attack the brain cells that contain hypocretin
  • infections, such as swine flu (H1N1 virus), as well as getting injected with the vaccine for H1N1 virus

If you have narcolepsy, it’s likely that you’ll experience an episode of cataplexy at some point in your life. But not everyone with narcolepsy experiences cataplexy as a symptom.

How is cataplexy diagnosed?

If your doctor thinks you have narcolepsy with cataplexy, they may recommend one or more of the following tests in order to diagnose you:

  • getting a full physical examination to assess your overall health and make sure that your symptoms aren’t caused by another, possibly more serious condition
  • filling out a written evaluation, such as the Stanford Narcolepsy Questionnaire or the Epworth Sleepiness Scale, to learn more about your sleep habits and see how severe your narcoleptic symptoms are
  • taking part in a sleep study (polysomnogram), which records what happens to your muscles and brain while you’re sleeping
  • doing a multiple sleep latency test, in which you take short naps throughout the day spaced out by a couple of hours to see how quickly you fall asleep over the course of those naps

Your doctor may also draw fluid from around your spinal cord and brain (cerebrospinal fluid). Your doctor can test this fluid for abnormal levels of hypocretin.

How is cataplexy treated?

Both cataplexy and narcolepsy with cataplexy can be treated with medication and lifestyle changes. Medications won’t cure narcolepsy or cataplexy, but they can help you manage your symptoms.

Medications

Common medications for cataplexy (with or without narcolepsy) include:

  • tricyclic antidepressants, such as clomipramine (Anafranil)
  • selective serotonin uptake reinhibitors (SSRIs), another type of antidepressant, such as fluoxetine (Prozac) or venlafaxine (Effexor XR)
  • sodium oxybate (Xyrem), which can help with both cataplexy and sleepiness during the day

Medications used to treat narcolepsy with cataplexy include:

  • modafinil (Provigil), which reduces drowsiness and can help you feel more alert
  • stimulants that resemble amphetamines, which keep you alert

Some of these medications can have disruptive side effects. These can include nervousness, abnormal heart rhythms, and changes in mood. They also have a risk of becoming addictive. Talk to your doctor about these medications before taking them if you’re concerned about these effects.

Lifestyle changes

Certain lifestyle changes can make the symptoms of cataplexy and narcolepsy more bearable.

Are there possible complications?

Symptoms of cataplexy and narcolepsy can happen without warning. An episode can be dangerous and even deadly if you’re driving a car or operating machinery. An episode can also cause harm if it happens while you’re doing an activity that involves heat or dangerous objects. This can include cooking on the stove or using knives.

Knowing that emotions cause trigger cataplectic episodes may make you avoid situations where you know you’ll laugh, cry, or otherwise feel strong emotion.

Your friends, family, and romantic partners may not understand your condition. This can take a toll on your friendships and relationships.

It may also be hard to perform professionally if you have cataplectic episodes or feel sleepy at work.

Having lower levels of hypocretin, as well as certain lifestyle choices, can cause weight gain and obesity. Obesity has its own complications, such as high blood pressure, strokes, and heart disease.

What is the outlook?

Cataplexy and narcolepsy can both interfere with your daily life. It can strain your close relationships as well as your professional life. But cataplexy can be managed with treatment and lifestyle changes. Once you get it under control, you can lower your risk of having an episode while doing something potentially dangerous, such as driving.

If you start to notice any symptoms of cataplexy, see your doctor for a diagnosis so that you can get an early start treating and managing your condition.

Living with cataplexy

A few tips to remember for making your life a little easier with cataplexy:

  • Tell all of your close friends and relatives that you have cataplexy and how to identify the symptoms so that they can better understand your condition and help you cope with it.
  • Try to drive with someone else in the car or let someone else drive you as often as possible.
  • Be aware of objects or terrain around you that can harm you if you fall, such as heights or sharp edges.
  • Be prepared for situations that you know will cause strong emotions. Keep a chair close in case you need to sit down, or go with a friend who can keep an eye on you.
  • Try to get as much consistent sleep as possible — for example, a short nap in the afternoon and eight hours of sleep during the same time each night.