Excessive Daytime Sleepiness (EDS) and Cataplexy

EDS

EDS definition per ICSD-3-TR diagnostic criteria: Daily episodes of an irrepressible need to sleep or unintended lapses into drowsiness or sleep1

The American Academy of Sleep Medicine (AASM) recommends assessing EDS with a validated scale, such as the Epworth Sleepiness Scale (ESS), at every visit2,3

  • The ESS is an 8-item questionnaire by which patients rate their perceived likelihood of falling asleep during usual daily activities, including sitting and reading, sitting inactive in a public place (eg, a theater), and in a car while stopped for a few minutes in traffic4
  • Each of the 8 items on the ESS is rated from 0 (would never doze) to 3 (high chance of dozing), with a maximum potential score of 244

It is important to assess EDS regularly, as severity may change over time1

EDS may present differently among patients with narcolepsy1,5

Ask your patients:Do you…

  • Stay awake iconFight to stay awake and alert throughout the day?1
  • Constant need to sleep iconFeel a constant need to sleep that you can't shake?1
  • Doze off iconFeel like you’ll doze off in everyday situations, like when you’re at work, or riding in a car?1,6
  • Wake up iconWake up feeling refreshed, but it doesn't last?1
Cataplexy

Cataplexy definition per ICSD-3-TR diagnostic criteria: Generally brief, usually bilaterally symmetrical, sudden loss of muscle tone with retained consciousness1

Cataplexy may manifest as complete collapse; however, it more commonly presents as partial cataplexy1,7,8

Patients may experience complete or partial cataplexy1,8:

  • Complete collapse iconComplete cataplexy attacks gradually progress over several seconds, potentially causing complete collapse1
  • Partial cataplexy is more common and can involve subtle facial, head, or limb weakness1,7,8

Mild or partial cataplexy can be very subtle and can go unnoticed9

In a study including 63 patients with narcolepsy with cataplexy, about 54% reported complete cataplexy (falling to the ground and unable to move)9,*

*Based on self-administered narcolepsy questionnaire. Participants were patients referred to the Stanford Sleep Disorders Clinic. Out of 983 patients who completed the study, 63 had clear-cut cataplexy.9

Regular assessment for cataplexy is important, as it may develop and evolve over time10-12

Cataplexy can be difficult to recognize1,13

Ask your patients:Do you…

  • Experience sudden periods of muscle weakness with strong emotions or certain situations?1,14
  • Notice weakness in your face or neck, like mouth opening or droopy eyelids?1,15
  • Ever feel your knees buckle or give out?9
  • Sometimes drop things or feel clumsy?9,16