Narcolepsy

An Overview

Narcolepsy is a neurological disorder that affects your ability to wake and sleep. People with narcolepsy have excessive, uncontrollable daytime sleepiness. They may also suddenly fall asleep at any time, during any type of activity. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your daily routine.

In a typical sleep cycle, we enter the early stages of sleep, then the deeper stages, and finally (after about 90 minutes) rapid eye movement (REM) sleep. Sometimes, narcolepsy can be accompanied by a sudden loss of muscle tone (cataplexy), which can be triggered by strong emotion. Narcolepsy that occurs with cataplexy is called type 1 narcolepsy. Narcolepsy that occurs without cataplexy is known as type 2 narcolepsy.
Type 1 narcolepsy comes with a sudden loss of muscle tone that causes weakness and makes you unable to control your muscles (cataplexy). Type 2 is narcolepsy without catalepsy

Symptoms for Narcolepsy

In REM sleep, we can dream and have muscle paralysis, which explains some of the symptoms of narcolepsy. Those symptoms may include:

  • Excessive daytime sleepiness (EDS): In general, EDS makes it harder to do everyday activities, even if you got enough sleep at night. The lack of energy can make it hard to concentrate. You have memory lapses and feel depressed or exhausted. People with narcolepsy fall asleep without warning, anywhere, anytime. For example, you may be working or talking with friends and suddenly you nod off, sleeping for a few minutes up to a half-hour. When you awaken, you feel refreshed, but eventually you get sleepy again.
  •  Cataplexy: This can cause problems ranging from slurred speech to total body collapse, depending on the muscles involved. It’s often triggered by intense emotions such as surprise, laughter or anger. Cataplexy is a sudden, temporary loss of muscle tone. It can range from drooping eyelids (referred to as partial cataplexy) to total body collapse. Laughing and intense emotions, such as excitement and fear, can trigger cataplexy. How often it occurs varies from person to person. It can happen several times per day to once a year.
  •  Hallucinations: These delusions can happen at any time and are often vivid and frightening. They’re mostly visual, but any of the other senses can be involved. If they happen as you’re falling asleep, they’re called hypnagogic hallucinations. If they happen when you’re waking up, they’re called hypnopompic hallucinations. These hallucinations may be particularly vivid and frightening because you may not be fully asleep when you begin dreaming and you experience your dreams as reality.
  •  Fragmented sleep: Although people with narcolepsy are excessively sleepy during the daytime, they may have difficulty falling asleep at night.
  •  Sleep paralysis: You may be unable move or speak while falling asleep or waking up. These episodes usually last a few seconds to several minutes. People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief lasting a few seconds or minutes but can be frightening. This temporary immobility during REM sleep may prevent your body from acting out dream activity. Not everyone with sleep paralysis has narcolepsy, however. Many people without narcolepsy experience some episodes of sleep paralysis.
  •  Disrupted sleep: You might have a hard time staying asleep at night because of things like vivid dreams, breathing problems or body movements. Narcolepsy can also be associated with other sleep conditions, such as:
    o obstructive sleep apnea
    o restless legs syndrome
    o insomnia

Causes of Narcolepsy

  • The exact cause of narcolepsy is unknown. People with type 1 narcolepsy have low levels of the chemical hypocretin (hi-poe-KREE-tin). Hypocretin is an important neurochemical in your brain that helps regulate wakefulness and REM sleep. Hypocretin levels are particularly low in those who experience cataplexy. Exactly what causes the loss of hypocretin-producing cells in the brain isn’t known, but experts suspect it’s due to an autoimmune reaction.
  • Scientists are getting closer to finding genes linked to the disorder. These genes control the production of chemicals in your brain that may signal sleep and awake cycles. Some experts think narcolepsy may happen because your brain has a hard time making a chemical called hypocretin. They’ve also found problems in parts of the brain involved in controlling REM sleep.
  •  Some evidence suggests that autoimmune disease may play a part in the development of narcolepsy.
  •  In a healthy immune system, immune cells attack invaders such as disease-causing bacteria and viruses. When the immune system mistakenly attacks the body’s own healthy cells and tissues, this is defined as autoimmune disease.
  • Narcolepsy has also been linked to certain genetic variants in a group of genes called the human leukocyte antigen complex. These genes affect how your immune system functions. More studies are needed to learn how they may contribute to narcolepsy.

Diagnosis

Symptoms of narcolepsy can look like those of other health problems. Your diagnosis might involve:

  • Physical exam and medical history.
  •  Your doctor will ask you for a detailed sleep history, which may include completing the Epworth Sleepiness Scale (ESS). The ESS is a simple questionnaire. It asks how likely you are to sleep in different circumstances.
  •  Sleep records: Your doctor might ask you to keep track of your symptoms and when you’re sleeping for a couple of weeks.
  •  Polysomnogram (PSG): This is done in a sleep disorder clinic or a sleep lab. It’s an overnight test that takes constant measurements while you’re asleep to record problems in your sleep cycle. A PSG can help reveal whether you go into REM sleep at unusual times in your sleep cycle. It can rule out other problems that might be causing your symptoms.
  •  An Autograph or other home monitoring system can keep track of how and when you fall asleep. This device is worn like a wristwatch and may be used together with a sleep diary.
  •  Multiple sleep latency test (MSLT): This is also done at a special clinic or lab. The test takes place during the day to measure your tendency to fall asleep and find out whether certain elements of REM sleep happen at unusual times during the day. You’ll take four or five short naps, usually 2 hours apart.

Treatment

Narcolepsy is a chronic condition. Although it doesn’t have a current cure, treatments can help you manage your symptoms.
Medications, lifestyle adjustments, and avoiding hazardous activities can all play a part in managing this condition.

  • Stimulants. These include armodafinil (Nuvigil), modafinil (Provigil) and methylphenidate (Ritalin). They may improve wakefulness. Although side effects are uncommon, they may include nausea, headache, or anxiety.
  •  Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs such as venlafaxine (Effexor) can help treat cataplexy, hallucinations, and sleep paralysis. Side effects may include digestion problems, insomnia, and weight gain.
  • Tricyclic antidepressants. These may include amitriptyline and nortriptyline. They may reduce cataplexy, sleep paralysis, and hallucinations. These older medications can have unpleasant side effects, such as constipation, dry mouth and urinary retention.

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