Medicine: The Sleepy People

“Why, that sounds just like Mother’s trouble!” exclaimed a former Mayo Clinic secretary as she read an article on sleep seizures. Her chance observation led the clinic’s doctors to a research gold mine. Her whole family, for four and possibly five generations, has been studded with men and women who kept falling asleep at meals, on the job, on Army guard duty, while playing cards—and, distressingly often, at the wheel.

The secretary’s mother, interviewed by Neurologists David D. Daly and Robert E. Yoss. said that she had been “fighting sleep all of my life.” She could stay awake only while active (“If I sit down, I’m lost”), so she had to walk around the room all the time when she had guests. She fell asleep while playing cards. The diagnosis was narcolepsy (from the Greek narke, stupor, and lepsis, seizure). Relatively rare, its cause unknown, narcolepsy was not even known to run in families until the Mayo Clinic compiled records on more than 200 cases.

At Movies & Church. Most of the secretary’s family were in Minnesota, close around Rochester and accessible for interviews. The trail led back to the first patient’s grandfather, a farmer. His daughters remembered him as a “very sleepy person who always fell asleep when he sat down.” His wife was normal. So were his son and younger daughter. But his elder daughter, 67, complained of severe drowsiness and episodes of sleep many times a day for at least 40 years. How she managed was a mystery because she had 16 children. She consistently fell asleep at movies, even those she particularly liked. Her eldest son, 47, at first denied the trait because he thought it was normal to fall asleep at family gatherings, in church or at meetings; eventually he admitted an occasion when he drove into a ditch three times on the way home because he got sleepy. Also he often stopped his car for a five-minute nap.

A second son seemed normal. Third of the 16 sibs was the secretary’s mother and patient No. 1. As they worked down the line, the neurologists found that at least five sons and two daughters in the third generation were narcoleptics. One first noted the trouble on guard duty in the Army, has since had many “near accidents” from dozing while driving. Another insisted that he was not really a dangerous driver because a “close shave” would wake him and he had not yet had a serious accident. One of the sons had been disciplined in the Army for sleeping on duty, became a truck driver (he kept the windows open even in winter to stay awake); he fell asleep twice during the Mayo interview. One of his sisters has the knack of napping while standing up.

On Job & Highway. In the abundant fourth generation (57 members), the doctors ignored all under 15 because narcolepsy is a tricky diagnosis in the young. Still, they found several cases. Their first patient’s 20-year-old son had the not surprising habit of falling asleep in church, but carried it to the extreme of doing so while serving as an altar boy. Recently he was fired for sleeping on his job. and he has already had two serious accidents, in one of which he demolished the car.

Drs. Daly and Yoss are satisfied that they have found twelve definite and three strongly suspected cases of narcolepsy in the family. Their explanation of its inheritance: it “appears to be transmitted as a simple dominant factor with a high degree of penetrance.” For the reassurance of road users in the Rochester area; the doctors record hopefully that in the severe cases, including most of the drivers, the tendency to fall asleep has been checked with daily doses of methylphenidate, a mild stimulant and antidepressant.