Narcolepsy

Narcolepsy

OVERVIEW:
Narcolepsy is a serious sleep disorder that overrides the brain’s natural ability to control a person’s sleep and wake cycle. People with this condition are subject to extreme sleepiness and experience periodic sudden and involuntary episodes of sleep throughout the day. These abrupt sleep attacks are unpredictable and can happen during any kind of activity. At school or work, while eating a meal or driving a car – narcolepsy’s effects know no boundaries. The ‘microsleep’ episodes generally last from a few seconds to several minutes.

A normal sleep cycle lasts about 90 to 110 minutes, starting with NREM sleep, then progressing to REM sleep after approximately 90 minutes. Narcolepsy sufferers usually begin REM sleep after just a few minutes of falling asleep. It is during REM sleep that dreaming and muscle paralysis takes place which might begin to partially explain the manifestation of this sleep disorder.

People of any age and gender can develop narcolepsy, but it usually appears in individuals between the ages of 8 and 25 and can last one’s entire lifetime. It is not a rare condition and many cases go undiagnosed and untreated. Approximately 10 percent of people suffering from narcolepsy have relatives with the same symptoms.

SYMPTOMS:
People with narcolepsy experience one or more of the following symptoms:

  • Excessive daytime sleepiness (EDS): EDS is the most common major symptom of narcolepsy and is characterized by foggy mental disposition, concentration difficulties, poor memory, depression, low energy or acute exhaustion resulting in unintentional sleep episodes. Usually, EDS affects daily activities, whether or not a sufferer has had a normal night’s sleep.
  • Cataplexy: About 70 percent of narcolepsy victims have cataplexy which consists of abrupt muscle control loss triggered by heightened emotions (i.e., anger, surprise, embarrassment, laughter). Symptoms of cataplexy range from speech impairment to total body collapse.
  • Sleep paralysis: A person experiencing sleep paralysis will be temporarily unable to speak or move their body during the process of going to sleep or waking up. These episodes usually last from a couple seconds to several minutes. People instantly recover their facilities when the episode passes.
  • Hallucinations: Hallucinations are less common but nevertheless, often intense and unnerving and can happen in conjunction with sleep paralysis. These hallucinations are generally visual in nature, but other senses can also be active. These are called hypnagogic hallucinations when they occur as a person is falling asleep and hypnopompic hallucinations when a person is waking up.
  • Disrupted nighttime sleep: While many narcolepsy sufferers are able to fall asleep at night with no difficulty, most experience problems remaining asleep. Sleep interruptions may be the result of other sleep disorders, such as insomnia, sleep talking, nightmares and periodic leg movements.
  • Obesity: Many people are aware of sudden gain weight. This side effect that can be counteracted by vigilant monitoring and treatment.

CAUSE:
At present, the cause of narcolepsy is unknown. However, research is making progress towards identifying a genetic connection with the ailment. Studies also point to damage or low production of a brain chemical called hypocretin. Hypocretin helps control sleep and awake cycles so that they take place at the correct times.  People suffering from narcolepsy have been found to be deficient in hypocretin. What may be causing damage to hypocretin cells is still a mystery, but speculation indicates possible infection or abnormal immune system activity. In other words, the body’s immune system targets and destroys healthy brain cells containing hypocretin. Experts think that many factors involving neurological dysfunction and REM sleep disorders combine to cause narcolepsy.

DIAGNOSIS:
These are three essential tests used by sleep specialists to diagnose narcolepsy:

  • Nocturnal polysomnogram: An overnight test used to measure electrical activity of the brain, heart, muscles and eyes during sleep.
  • Multiple sleep latency test (MSLT): This test records the length of time it takes to fall asleep during the day.
  • Spinal fluid analysis: Extremely low levels or damaged hypocretin cells in the cerebrospinal fluid may indicate narcolepsy. The examination of spinal fluid is a relatively new test for narcolepsy diagnosis.

NarcolepsyTREATMENT:
Despite the fact that there is presently not a cure for narcolepsy, the most debilitating symptoms of the condition (EDS and cataplexy) can often be kept under control with drug therapy. Amphetamine-like stimulants are used to treat sleepiness, while antidepressant drugs are prescribed for symptoms of abnormal REM sleep.

Stimulants:

Xyrem is new drug that has recently been approved for sufferers of narcolepsy with cataplexy. It helps people with narcolepsy sleep better through the night, making them more alert and less sleepy during the day.

Antidepressants:

Most narcolepsy sufferers find that these drugs usually reduce daytime sleepiness and heighten levels of alertness. However, one needs to always be aware of potential common side effects, such as:

  • Nervousness
  • Irritability
  • Shakiness,
  • Irregular heart beat
  • Upset stomach,
  • Nighttime sleep disturbance
  • Anorexia

With any amphetamine, there is also the high potential of developing a tolerance which leads to increased dosages and abuse.

Generally, antidepressants have less negative side effects than amphetamines. But antidepressants can still adversely affect some people with reactions such as impotence, high blood pressure, and heart beat irregularities.

Behavioral Strategies
Since narcolepsy can be substantially helped, but not cured by medicine, it is imperative to also add behavioral strategies to one’s general therapy.

The following lifestyle adjustments should help to reduce narcolepsy symptoms:

  • Avoid caffeine
  • Avoid alcohol
  • Avoid smoking
  • Avoid eating heavy meals
  • Incorporate an exercise regimen
  • Maintain a strict sleep schedule
  • Schedule 10-15 minute daytime naps
  • Take safety precautions when driving or performing hazardous activities
  • Seek out a support group

RESOURCES:
More information can be found at the following organizations:

Narcolepsy Network, Inc.
110 Ripple Lane
North Kingstown, RI   02852
narnet@narcolepsynetwork.org
http://www.narcolepsynetwork.org
Tel: 888-292-6522 401-667-2523
Fax: 401-633-6567

National Sleep Foundation
1522 K Street NW
Suite 500
Washington, DC   20005
nsf@sleepfoundation.org
http://www.sleepfoundation.org
Tel: 202-347-3471
Fax: 202-347-3472

National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health, DHHS
31 Center Drive, Rm. 4A21 MSC 2480
Bethesda, MD   20892-2480
http://www.nhlbi.nih.gov
Tel: 301-592-8573/240-629-3255 (TTY) Recorded Info: 800-575-WELL (-9355)


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