Snapshot A 17-year-old female presents complaining of an irresistible urge to sleep at sudden times throughout the day. This has disturbed her school functioning. She sometimes feels like she "is paralyzed" for several minutes when she wakes up. She "passed out" one day at school when she was startled by her boyfriend. Introduction Pathophysiology hypocretin deficiency in lateral hypothalamus (per DSM-V) Clinical definition disordered regulation of sleep cycles nocturnal and narcoleptic sleep episodes start off with REM sleep patients cannot avoid falling asleep Epidemiology strong genetic component typically onsets in young adulthood Presentation Symptoms excessive daytime sleepiness naps can be refreshing may include hallucinations hypnagogic just before sleep hypnopompic just before awakening cataplexy loss of all muscle tone following a strong emotional stimulus only some patients sleep paralysis short paralysis with awakening Evaluation Polysomnography Treatment Pharmacologic stimulants e.g., methyphenidate (Ritalin), amphetamines, or modafinil SSRI's if cataplexy present Sleep regulation scheduled daily naps