Sleep Attacks: What You Should Know

Medically Reviewed by Minesh Khatri, MD on March 16, 2023
3 min read

It’s 11:30 a.m. and you’re sitting at your desk, thinking about lunch. Will you grab a burger with co-workers or eat the salad you packed this morning?

The next thing you know, your eyes open and you wake up. Your head is on the desk and 10 minutes have passed.

You’ve just had a sleep attack.

Narcolepsy is a chronic neurological disorder that stops your brain from regulating your sleep-wake cycles. One of the most noticeable symptoms is excessive daytime sleepiness. No matter how much sleep you get overnight, you fall asleep quickly and often during the day. You may get an uncontrollable feeling of sleepiness beforehand, or it may happen without any warning at all.

Sleep attacks are the most obvious symptom of narcolepsy. They can be frustrating, scary, and dangerous. They come on quickly and can make it difficult to perform routine tasks like working and driving. Sleep attacks are also a sign that narcolepsy is controlling you instead of the other way around.

Hypocretin, also called orexin, is a brain chemical that controls when you’re awake and when you’re in rapid eye movement (REM) sleep. People with narcolepsy often don’t have as many brain cells that produce hypocretin, but researchers don’t fully understand why. Possible causes include an autoimmune disorder, which means your own body kills the healthy cells that produce hypocretin. Genetics and brain injury may also play a role.

One of the most frustrating parts of a sleep attack is that it comes without warning. A sleep attack can happen anytime and anywhere, whether you’re talking, driving, or eating. You don’t always have intense sleepiness beforehand as a warning.

However, there are triggers for cataplexy, or the sudden loss of muscle tone or control, that’s part of type 1 narcolepsy (type 2 doesn’t include it). Cataplexy triggers include strong emotions like laughter, fear, anger, or stress.

When a sleep attack hits, you have an overwhelming feeling of sleepiness that comes on quickly. You may be asleep for a few minutes to a half hour. When you wake up, you may feel refreshed but have another attack again later. In between, you have normal levels of alertness, especially if you’re doing something that keeps your attention.

Some people can be in the middle of a conversation, walking across a room, or watching TV, and suddenly be deeply asleep. But this is less common.

Though there’s no cure for narcolepsy, you may be able to control sleep attacks with a combination of medication and lifestyle changes.

Medication for sleep attacks include:

  • Stimulants
  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants
  • Sodium oxybate

Lifestyle changes include:

  • Short naps during the day
  • A regular sleep schedule at night
  • No caffeine, alcohol, or large meals before bed
  • No over-the-counter medication that causes drowsiness
  • No smoking
  • Daily exercise
  • Wind down before bed

Narcolepsy is rare, and falling asleep in public places, like work or a grocery store, may be interpreted in negative ways by others and make you feel more isolated. As much as you feel comfortable, tell teachers, co-workers, managers, friends, and family about your condition, and what to expect when you have a sleep attack.