Many people with narcolepsy also have insomnia for extended periods of time. The excessive daytime sleepiness and cataplexy often become severe enough to cause serious problems in a persons social, personal, and professional life. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular, which is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again, called REM sleep (rapid eye movement sleep), when most remembered dreaming occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present called REM atonia.In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Also, some aspects of REM sleep that normally occur only during sleep, like lack of muscular control, sleep paralysis, and vivid dreams, occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is an intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up.
The term leukemoid reaction describes an increased
white blood cell count (> 50,000 cells/μL), which is a physiological response to stress or infection (as opposed to a primary blood malignancy, such as leukemia). It often describes the presence of immature cells such as myeloblasts or red blood cells with nuclei in the peripheral blood. It may be lymphoid or myeloid. Causes
As noted above, a leukemoid reaction is typically a response to an underlying medical issue. Causes of leukemoid reactions include:
Severe hemorrhage (retroperitoneal hemorrhage)
Drugs
Use of sulfa drugs
Use of dapsone
Use of glucocorticoids
Use of G-CSF or related growth factors
All-trans retinoic acid (ATRA)
Ethylene glycol intoxication
Infections
Clostridium difficile
Tuberculosis
Pertussis
Infectious mononucleosis (lymphocyte predominant)
Visceral larva migrans (eosinophil predominant)
Asplenia
Diabetic ketoacidosis
Organ necrosis
Hepatic necrosis
Ischemic colitis
As a feature of trisomy 21 in infancy (incidence of ~10%)
As a paraneoplastic phenomenon (rare)

Diagnosis
Conventionally, a leukocytosis exceeding 50,000 WBC/mm3 with a significant increase in early neutrophil precursors is referred to as a leukemoid reaction. The peripheral blood smear may show myelocytes, metamyelocytes, promyelocytes, and rarely myeloblasts; however, there is a mixture of early mature neutrophil precursors, in contrast to the immature forms typically seen in acute leukemia. Serum leukocyte alkaline phosphatase is normal or elevated in leukemoid reaction, but is depressed in chronic myelogenous leukemia. The bone marrow in a leukemoid reaction, if examined, may be hypercellular but is otherwise typically unremarkable.Leukemoid reactions are generally benign and are not dangerous in and of themselves, although they are often a response to a significant disease state (see Causes above).