Narcolepsy has a known association with mood and anxiety. In fact, narcolepsy is often comorbid with mental health conditions including anxiety. Comorbidity refers to when two or more conditions occur in the same person at the same time, often impacting their quality of life.

Narcolepsy is a chronic sleep disorder that affects approximately 1 in every 2,000 people. Symptoms of narcolepsy include excessive daytime sleepiness, chronic fatigue, sleep paralysis, dream-like hallucinations, and (in the case of narcolepsy type 1) cataplexy, or a sudden loss of muscle tone.

Anxiety is an umbrella term that includes several anxiety disorders, with symptoms such as generalized anxiety or worry, specific phobias, and panic attacks. Whereas everyday stressors and genetic predispositions can lead to anxiety, anxiety disorders are also associated with chemical and electrical imbalances in the brain.

Narcolepsy and Increased Rates of Anxiety

Research has shown that people who have narcolepsy are at a significantly increased risk of having an anxiety disorder.

Consider the Burden of Narcolepsy Disease study, an analysis of five years of claims data from more than 9,000 people with narcolepsy and 46,000 controls (people without narcolepsy). This study found that about 12 percent of people without narcolepsy have an anxiety disorder. In people diagnosed with narcolepsy, the prevalence of anxiety disorders was about 25 percent — approximately double that of the general population.

This same study also demonstrated that people with narcolepsy were more likely to be on psychiatric medications, including drugs that treat anxiety disorders such as benzodiazepines and selective serotonin reuptake inhibitor (or SSRI) antidepressants.

Other research also supports the idea that people with narcolepsy experience anxiety disorders — most notably panic attacks and social phobia — more frequently than the general population. Another study found similar results, also noting that women with narcolepsy are more likely to experience a comorbid anxiety disorder.

The Influence of REM Sleep

Research suggests that narcolepsy and extreme emotional states, such as fear and anxiety, are both associated with rapid eye movement (REM) sleep. In narcolepsy, people transition in and out of REM sleep states abruptly, which is why they experience dream-like hallucinations. Disruptions in REM sleep patterns may increase emotional reactivity and lead to emotion-driven mental illness such as anxiety disorders. Some research suggests that anxiety results from a person with narcolepsy feeling as though they have no control over their body or its responses.

The Influence of Hypocretin

Hypocretin is a neurotransmitter (brain chemical) associated with REM sleep and wakefulness. Experts believe that the hypocretin system may provide a link between narcolepsy and anxiety.

Narcolepsy and Hypocretin

It is well established that the hypocretin system is dysfunctional in individuals with narcolepsy. Narcolepsy is believed to be an autoimmune disease in which the body attacks and kills its own hypocretin-producing cells in a brain region known as the hypothalamus. People with narcolepsy also have lower levels of hypocretin in their cerebrospinal fluid as measured during a spinal tap. Insufficient hypocretin is thought to be a major driver of narcolepsy symptoms.

Anxiety, Fear, and Hypocretin

Anxiety is also associated with the hypocretin system. Animal research shows that when mice are unable to produce hypocretin normally, they display increased anxiety. There is also research in humans that suggests there is dysfunctional activity within the amygdala (the brain region associated with the fear and stress response) in individuals with narcolepsy. Anatomy studies of the brain show that the hypocretin system is heavily connected to the stress system in addition to sleep centers.

Taken together, it is likely that the connection between anxiety and narcolepsy is driven by brain biology, in particular the hypocretin system.

Managing Anxiety From Narcolepsy

If you are experiencing anxiety or other emotional effects, such as depression, talk to your health care team or contact a mental health provider for help. In addition to the treatments that your physician recommends, you can also find other ways of treating depression and anxiety with lifestyle changes and therapies that go beyond medication.

Find Your Community

MyNarcolepsyTeam is the social network for people with narcolepsy and their loved ones. On MyNarcolepsyTeam, members come together to ask questions, give advice, and share their stories with others who understand life with narcolepsy.

Are you living with narcolepsy and anxiety? Share your experience in the comments below, or start a conversation by posting on MyNarcolepsyTeam.