AIIMS November 2011 – MCQ 187

35 year old gentleman has exessive sleep at work attributed to sleep discomfort at night. He also has recent history of falling while partying with friends. What are the other features that can be seen associated with his condition?
A. Paralysis with sleep awake junction hallucinations.
B. Snoring with witnessed sleep apneoa
C. Pain in the legs before going to bed.
D. ?

I agree with naushad that this look like a case of narco lepsy. Main clinical features of narcolepsy involves mainly following clinical features:

  1. Day-time sleepiness: not more than normal sleep hours but abnormal timing characterized by “Sleep attacks” (as desribed in the above patient). This can also result in diplopia, blurred vision or automatic behaviors like writing off the page. Epworth sleepiness scale scores of more then 15 are characterstically seen in untreated narcolepsy.
    2)Hypnogogic Hallucinations-Frightening and vivid visual, tatcile or auditory hallucinations while falling asleep. May also occur upon waking up (hypnopompic). A mixture of waking and REM sleep dreaming.
    3)Sleep Paralysis- 1-2 minutes after waking up. Associated with hypnopompic hallucinations or suffocated feeling (decreased Tidal volume).
    4)Cataplexy-muscle weakness brought on by very strong positive emotions like laughter, joking or excitement. Partial weakness affects face, neck and knee. severe may cause collapse. Lasts <2 minutes with no LOC.Highly specific to narcolepsy.