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Other REM related symptoms (sleep paralysis and hypnagogic hallucinations) are improved with TCA usage.
Narcolepsy is classically a tetrad of symptoms including EDS, cataplexy, sleep paralysis, and hypnagogic hallucinations. The exact pathophysiology is not yet known, but hypocretin deficiency appears to play a significant role, especially in cases with cataplexy.
'The devil lay upon her and held her down.'Hypnagogic hallucinations and sleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609-1674) in 1664.
Seventy-four percent of these narcoleptics reported hypnagogic hallucinations, 71% cataplexy, 53% sleep onset paralysis and 44% awakening paralysis.
Clinicians have also reported cases of narcolepsy with prominent hypnagogic hallucinations that were mistakenly diagnosed as schizophrenia.
Narcolepsy is a syndrome consisting of four symptoms: excessive sleepiness, hypnagogic hallucinations, sleep paralysis, and cataplexy.
Since Gelineau's initial description, the definition of narcolepsy has changed slightly to encompass these four symptoms: excessive sleepiness and/or uncontrolled episodes of overwhelming sleepiness (often called "sleep attacks"); hypnagogic hallucinations (realistic imagery occurring with the onset of sleep); sleep paralysis (inability to move just as one is awakening or going to sleep); and cataplexy (sudden, brief loss of muscle tone triggered by strong emotions).
(8,9) Its 4 classic symptoms are EDS, cataplexy (a sudden drop in muscle tone that is triggered by emotional factors), sleep paralysis (a generalized flaccid paralysis that happens slightly before or at the time of falling asleep or on awakening), and hypnagogic hallucinations (hallucinations that occur while falling asleep).
* Hypnagogic hallucinations - vivid, realistic imagery occurring just as a person is falling asleep
Additionally, a person with narcolepsy may have cataplexy, sleep paralysis, and/or hypnagogic hallucinations. Cataplexy is the sudden temporary loss of tone in all or a few skeletal muscles when a person experiences heightened emotion (e.g., mirth, anger, etc).
The recognition of two additional features, hypnagogic hallucinations (the onset of dreams while still awake) and sleep paralysis (a temporary loss of muscle tone or an inability to perform voluntary movements either at sleep onset or upon awakening), were added by Yoss and Daly in 1957.