Narcolepsy and hallucinations in the spectrum of its manifestations. Clinical сase

Narcolepsy type 1, a chronic sleep-wake regulation disorder, often goes undiagnosed for years, worsening patients' quality of life. In a 22-year-old man, long-term sleep disturbances linked to computer game addiction and emotional stress preceded the onset of all classic narcolepsy symptoms, including visual, tactile, and auditory hallucinations upon awakening. Despite severe deterioration, he avoided medical help for over a year due to fear of being labeled mentally ill. After diagnosis, therapy rapidly and significantly improved his condition. The case highlights the importance of physician awareness for earlier diagnosis, distinguishes hypnagogic and hypnopompic hallucinations from daytime hallucinations to reduce stigma, and discusses updated diagnostic criteria and treatment.

Study at a glance

Abstract

Narcolepsy is a rare chronic disorder characterized by impaired regulation of the sleep-wake cycle, which significantly worsens the quality of life of patients but is often diagnosed with considerable delay. Increasing physician awareness of this pathology can contribute to its earlier diagnosis and therapy optimization. A description and discussion of a clinical case of narcolepsy type 1 in a 22-year-old man. The development of narcolepsy type 1 in the patient was preceded by long-term sleep-wake disorders associated with addiction to computer games, and that the clinical manifestations of narcolepsy type 1 was provoked by emotional stress. The patient eventually developed all the classic signs of narcolepsy type 1, including visual, tactile, and auditory hallucinations upon awakening. Although the patient's quality of life had deteriorated dramatically, he did not seek medical attention for over a year, fearing that he would be considered mentally ill because of hallucinations. After the diagnosis, therapy led to rapid and significant improvement in the patient's condition. In the context of the clinical case, current pathogenic concepts of narcolepsy and its clinical manifestations are discussed. Particular attention is paid to hypnagogic and hypnopompic hallucinations and their differences from 'daytime hallucinations,' which is important for preventing the stigmatization of patients as 'mentally ill' individuals. The diagnostic criteria update for narcolepsy type 1, that was made in the International Classification of Sleep Disorders, Third Edition, Text Revision of 2023, is provided and the treatment of this disease is discussed.