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Tests and diagnosis
By Mayo Clinic staffYour doctor may make a preliminary diagnosis of narcolepsy based on your excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). After an initial diagnosis, your doctor may refer you to a sleep specialist for more evaluation.
Formal diagnosis may require staying overnight at a sleep center, where you undergo an in-depth analysis of your sleep by a team of specialists. Methods of diagnosing narcolepsy and determining its severity include:
- Sleep history. Your doctor will ask you for a detailed sleep history. A part of the history involves filling out the Epworth Sleepiness Scale, which uses a series of short questions to gauge your degree of sleepiness. For instance, you indicate on a numbered scale how likely it is that you would doze off in certain situations, such as sitting down after lunch.
- Sleep records. You may be asked to keep a detailed diary of your sleep pattern for a week or two, so your doctor can compare how your sleep pattern and alertness are related. Often, in addition to this sleep log, the doctor will ask you to wear an actigraph. This device has the look and feel of a wristwatch. It measures periods of activity and rest and provides an indirect measure of how and when you sleep.
- Polysomnogram. This test measures a variety of signals during sleep using electrodes placed on your scalp. For this test, you must spend a night at a medical facility. The test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram) and the movement of your muscles (electromyogram) and eyes (electro-oculogram). It also monitors your breathing.
- Multiple sleep latency test. This examination measures how long it takes you to fall asleep during the day. You'll be asked to take four or five naps, each nap two hours apart. Specialists will observe your sleep patterns. People who have narcolepsy fall asleep easily and enter into rapid eye movement (REM) sleep quickly.
- Hypocretin test. Most people with narcolepsy have low levels of this brain chemical that regulates REM sleep. This test measures the levels of hypocretin in the fluid that surrounds your spinal cord. A sample of your spinal fluid is obtained with a lumbar puncture (spinal tap), during which a needle is inserted into your lower spine to withdraw spinal fluid.
These tests can also help doctors rule out other possible causes of your signs and symptoms. Other sleep disorders, such as sleep apnea, can cause excessive daytime sleepiness.
References
- Ahmed I, et al. Clinical features, diagnosis and treatment of narcolepsy. Clinics in Chest Medicine. 2010;31:371.
- Narcolepsy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/narcolepsy/detail_narcolepsy.htm. Accessed Sept. 9, 2012.
- What is narcolepsy? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/nar/. Accessed Sept. 9, 2012.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Sept. 1, 2012.
- Cao M. Advances in narcolepsy. Medicine Clinics of North America. 2010;94:541.
- Overeem S, et al. Narcolepsy. Sleep Medicine Clinics. 2012;7:263.
- Silber MH (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 10, 2012.
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