Narcolepsy

Narcolepsy is characterised by excessive daytime sleepiness, with episodes sometimes building over a few minutes, whereas others may experience so-called ‘sleep attacks’ during which they transition from being awake to asleep with no warning.

Other symptoms of this relatively rare condition may include sudden loss of muscle tone triggered by intense emotions such as laughter (cataplexy), sleep paralysis, hallucinations, vivid dreams and poor memory. 

Narcolepsy is considered a spectrum neurological disorder and can be difficult to diagnose. There is no cure, but medication (most commonly stimulants such as methylphenidate, modafinil and pitolisant, all under specialist initiation) and lifestyle changes (including sleep hygiene measures and planned naps) can make the condition – and day-to-day living – feel more manageable. Resources are available from Narcolepsy UK.

Sleepwalking and night terrors

These occurrences are more common in children than adults. Sufferers will often have no recollection of the incident the next morning, despite appearing awake at the time. If sleepwalking occurs, the individual should be guided back to bed. Managing hazards such as locking doors and windows, and putting away knives and tools, is a sensible precaution.

Nightmares are relatively common but tend only to be an issue if they happen regularly. If they are a response to a distressing event, such as an accident, violent incident or death, counselling may be helpful. The NHS has guidance on what to do about sleepwalking, night terrors and nightmares, including when each warrants medical attention. 

Restless legs syndrome

Disturbed sleep is often a prominent feature of restless legs syndrome (RLS) – a neurological condition that features limb movements accompanied by paraesthesia. Although many sufferers do not experience the tiredness and daytime functional deterioration that afflicts those with other sleep disorders, quality of life is negatively impacted for many. 

Management involves correction of any underlying triggers – iron deficiency anaemia, for example – and reassurance of the time-limited nature of the condition if the patient is pregnant, plus self-help sleep hygiene measures. 

Episodes are often relieved by walking, stretching, applying heat pads, massage, relaxation exercises and mental distraction (e.g. reading). Anyone with frequent symptoms may be offered a non-ergot dopamine agonist such as pramipexole, ropinirole or rotigotine, although careful counselling is necessary due to the risk of treatment complications.