Falling asleep

We have a 19 y o son who has diagnosed himself with cataplexy, but who also falls asleep while in the car ( driving or not... hence, he doesn't drive much and it handicaps him as far as work goes)  The nature path we have seen also has said his blood sugar levels are extremely low, which means he is eating every hour and it still doesn't help. ( in a 3 hour fasting test, his levels went from 71, to 94, to 56 in the first hour) We are at a loss as to what to do next.  Any suggestions of what type of Dr. to see?  What to ask for?  We would appreciate any help we can get! Thank you!

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your son and obtain a history, I can not tell you what the exact cause of his symptoms is. However I will try to provide you with some useful information.

It sounds like your has excessive daytime sleepiness, and falls asleep throughout the day even while driving. This is obviously very concerning and may put his safety at risk. Causes for excessive daytime sleepiness with sleep attacks can include narcolepsy which, as you mention above, can include cataplexy (or a loss of tone) as part of its clinical features. Narcolepsy is a sleep disorder that leads to cataplexy during emotion or stress and sudden sleep attacks. Other possible sleep disorders may also be present, and some other disorders need to be excluded as well. I am not clear on what the low blood sugar issue is with your son, but the cause of this low blood sugar requires further investigation; attacks of low blood sugar can certainly affect someone's consciousness, making them appear asleep.

Evaluation by a sleep disorders specialist is recommended. After evaluation, he/she me choose to conduct a sleep study (polysomnogram, MSLT) and other testing on your son to be able to better understand what the problem is. Evaluation by a general practioner, with referral to a endocrinologist, is recommended for the low blood sugars.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.