To the Editor: We read with interest the clinical case conference by Lois E. Krahn, M.D., and Heydy L. Gonzalez-Arriaza, M.D. (1). Excessive daytime sleepiness is a common symptom of many sleep disorders, including narcolepsy. It can be difficult to make a firm diagnosis of narcolepsy, especially when the pathognomonic symptom of cataplexy is absent. Even when present, cataplexy rarely occurs in a physician’s office. As mentioned by the authors, some drug abusers fabricate sleep symptoms to obtain psychostimulants.