Narcolepsy is a rare and long-term brain disorder that causes a person to suddenly fall asleep at inappropriate times. In this case, the brain cannot normally regulate sleep and wake patterns. You can find more information below.

What is narcolepsy?

Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with this neurological disorder may feel rested upon waking, but may feel very sleepy much of the day afterwards. Many people with narcolepsy experience irregular and interrupted sleep, including frequent awakenings during the night. Narcolepsy can greatly affect daily activities. People may fall asleep involuntarily even if they are in the middle of an activity such as driving, eating or talking.

Other symptoms may include sudden muscle weakness (cataplexy), vivid dream-like images or hallucinations that cause the person to relax or be unable to move while awake, and sleep paralysis just before falling asleep or just after waking up.

In a normal sleep cycle , a person enters rapid eye movement (REM) sleep after about 60 to 90 minutes. Dreams occur during REM sleep, and the brain relaxes the muscles during this sleep phase, which prevents people from achieving their dreams.

People with narcolepsy quickly enter REM sleep, usually within 15 minutes of falling asleep. Also, the muscle weakness or dream activity of REM sleep may occur during wakefulness or not during sleep. This helps explain some of the symptoms of narcolepsy.

If this problem is not diagnosed or treated, it can interfere with psychological, social, and cognitive functions and interfere with academic, work, and social activities.

Who gets narcolepsy?

Narcolepsy affects both men and women equally. Symptoms usually begin in childhood, adolescence or young adulthood, but can occur at any time in life. Because people with this problem are often misdiagnosed as psychiatric disorders or emotional problems, it can take years for someone to get the correct diagnosis.

What are the types of narcolepsy?

There are two main types of narcolepsy:

  • Type 1 narcolepsy: This diagnosis is based on an individual who either has low levels of the brain hormone (hypocretin) or reports cataplexy and experiences excessive daytime sleepiness on a special sleep test.
  • Type 2 narcolepsy: People with this condition experience excessive daytime sleepiness, but do not usually experience muscle weakness triggered by emotions. They usually have less severe symptoms and have normal levels of the brain hormone hypocretin.

A condition known as secondary narcolepsy can also result from injury to the hypothalamus, an area deep in the brain that helps regulate sleep. In addition to experiencing the typical symptoms of narcolepsy, individuals may also experience serious neurological problems and sleep for long periods of time (more than 10 hours) each night.

What causes narcolepsy?

Narcolepsy can have several causes . Nearly all people with narcolepsy who have cataplexy have extremely low levels of the naturally occurring chemical hypocretin, which promotes wakefulness and regulates REM sleep. People with narcolepsy without cataplexy usually have normal hypocretin levels.

Read More  What Causes Head and Eye Pain?

While the cause of narcolepsy is not fully understood, current research suggests that this problem may be the result of a combination of factors working together to cause hypocretin deficiency. These factors include:

  • Autoimmune disorders: When cataplexy is present, it is mostly due to the loss of brain cells that produce hypocretin. The cause of this cell loss is unknown, but appears to be linked to abnormalities in the immune system. Autoimmune disorders occur when the body’s immune system mistakenly attacks healthy cells or tissues. Researchers believe that in individuals with narcolepsy, the body’s immune system selectively attacks brain cells containing hypocretin due to a combination of genetic and environmental factors.
  • Family health history: Most cases of narcolepsy are sporadic, meaning they occur in people with no known family history of the disorder. However, it sometimes runs in families—up to 10 percent of individuals diagnosed with narcolepsy with cataplexy report having a close relative with similar symptoms.
  • Brain injuries: Rarely, narcolepsy results from traumatic damage to parts of the brain that regulate wakefulness and REM sleep, or from tumors and other diseases in the same areas.

What are the symptoms of narcolepsy?

Narcolepsy is a lifelong problem, but it usually doesn’t get worse as a person gets older. Symptoms may improve partially over time, but they never go away completely. Common symptoms are excessive daytime sleepiness, cataplexy , sleep paralysis, and hallucinations. While they all have excessive daytime sleepiness, only 10 to 25 percent of affected individuals will experience all other symptoms during the course of their illness.

excessive daytime sleepiness

All individuals with narcolepsy have excessive daytime sleepiness and this is usually the most prominent symptom. Excessive daytime sleepiness is characterized by persistent sleepiness regardless of how much sleep an individual gets at night.

However, sleepiness in narcolepsy is more like a sleep attack in which an overwhelming feeling of sleepiness quickly emerges . Between sleep episodes, individuals experience normal levels of wakefulness, especially if they are doing activities that grab their attention.

Cataplexy

While the person is awake, this sudden loss of muscle tone, called cataplexy, leads to weakness and loss of voluntary muscle control . It is often triggered by sudden, strong emotions such as laughter, fear, anger, stress or excitement.

Symptoms of cataplexy may appear weeks or even years after the onset of excessive daytime sleepiness. Some people may only have one or two attacks in a lifetime, while others may experience many attacks per day.

In about 10 percent of narcolepsy cases , cataplexy is the first symptom to appear and may be misdiagnosed as a seizure disorder. Attacks may be mild and include only a momentary feeling of weakness in a limited number of muscles, such as slight drooping of the eyelids.

The most severe attacks result in a complete body collapse, in which individuals are unable to move, speak, or keep their eyes open. But even during the most severe periods, people remain fully conscious, a feature that distinguishes cataplexy from fainting or seizure disorders.

The loss of muscle tone during cataplexy is similar to the paralysis of muscle activity that occurs naturally during REM sleep . Attacks last a few minutes at most and resolve on their own almost instantly. Although scary, attacks are not dangerous as long as the person finds a safe place to crash.

Read More  What is SMA Disease?

sleep paralysis

The temporary inability to move or speak while falling asleep or waking up usually lasts only a few seconds or minutes and is similar to REM-induced inhibition of voluntary muscle activity. Sleep paralysis is similar to cataplexy, except it occurs at the margins of sleep.

As with cataplexy, humans are fully conscious. Even when severe, cataplexy and sleep paralysis do not cause permanent dysfunction . After the attacks are over, people can act quickly and fully regain their capacity to speak.

hallucinations

Very vivid and sometimes frightening images can accompany sleep paralysis and usually occur as people fall asleep or wake up. Often the content is primarily visual, but any of the other senses can also come into play.

Divided sleep or insomnia

Although individuals with narcolepsy are very sleepy during the day, they often have trouble staying asleep at night . Sleep can be disrupted by insomnia, vivid dreaming, sleep apnea , outbursts while dreaming, and periodic leg movements.

automatic behaviors

Individuals with narcolepsy may experience transient sleep attacks of very short duration, lasting no more than a second at a time . A person falls asleep during an activity (e.g. eating, talking) and automatically resumes the activity for a few seconds or minutes without being aware of what he or she is doing.

This mostly happens when people are busy with usual activities such as typing or driving. They cannot remember their actions and their performance is almost always impaired.

For example , their handwriting may turn into illegible scribbles, or they may hide items in strange places and then forget where they put them. If an attack occurs while driving, persons may be lost or have an accident.

How is narcolepsy diagnosed?

Clinical examination and detailed medical history are necessary for the diagnosis and treatment of narcolepsy . Individuals may be asked by their doctor to keep a sleep diary that notes their sleep times and symptoms over a period of one to two weeks.

Although none of the main symptoms are specific to narcolepsy, cataplexy is the most specific symptom and is not seen in almost any disease.

A physical exam can rule out or identify other neurological conditions that may be causing the symptoms. Two specific tests that can be done at a sleep disorders clinic are necessary to diagnose narcolepsy:

Polysomnogram (PSG)

PSG is an overnight recording of brain and muscle activity, breathing and eye movements. A PSG can help reveal whether REM sleep is occurring early in the sleep cycle and whether a person’s symptoms are due to another condition, such as sleep apnea.

Multiple sleep latency test

The multiple sleep latency test assesses daytime sleepiness by measuring how quickly a person falls asleep and whether they enter REM sleep.

The day after PSG, a person is asked to take five short naps, two hours apart, over the course of a day. If a person falls asleep in less than 8 minutes on average over five naps, this indicates excessive daytime sleepiness.

However, REM sleep begins abnormally quickly in individuals with narcolepsy. If REM sleep occurs within 15 minutes on at least two out of five naps and a sleep study was performed the night before, this is likely an abnormality caused by narcolepsy.

Read More  What Causes Pain in the Back of the Head?

Sometimes it can be helpful to measure the level of hypocretin in the fluid surrounding the brain and spinal cord. To perform this test, a doctor will use a lumbar puncture (also called a spinal tap) to draw a sample of the cerebrospinal fluid and measure the level of hypocretin-1. In the absence of other serious medical conditions, low hypocretin-1 levels almost certainly indicate type 1 narcolepsy.

How is narcolepsy treated?

While there is no cure for narcolepsy , some symptoms can be treated with medications and lifestyle changes. When cataplexy is present, the loss of hypocretin is believed to be irreversible and lifelong. Excessive daytime sleepiness and cataplexy can be controlled in most people who take medication.

Medication

Drug treatment for narcolepsy includes:

  • Modafinil: Initial therapy is usually a central nervous system stimulant such as modafinil. Modafinil is often prescribed first because it is less addictive and has fewer side effects than older stimulants. For most people, these medications are generally effective at reducing daytime drowsiness and improving alertness.
  • Amphetamine-like stimulants: In cases where Modafinil is not effective, doctors may prescribe amphetamine-like stimulants such as methylphenidate to alleviate EDS. However, these drugs should be carefully monitored because they can have side effects such as nervousness, tremors, heart rhythm disturbances, and disturbed nighttime sleep.
  • Antidepressants : Two classes of antidepressant drugs have proven effective in controlling cataplexy in many individuals, these are tricyclics and selective serotonin and noradrenergic reuptake inhibitors. In general, antidepressants produce fewer side effects than amphetamines. However, some people still experience problematic side effects such as impotence , high blood pressure , and heart rhythm irregularities.
  • Sodium oxybate: Sodium oxybate is approved by the U.S. Food and Drug Administration to treat cataplexy and excessive daytime sleepiness in individuals with narcolepsy. It is a powerful sedative that should be taken twice a night. Due to safety concerns associated with the use of this drug, the distribution of sodium oxybate is strictly limited.

Remember, your doctor will decide which medicine to take and how.

lifestyle changes

Not everyone with narcolepsy can consistently maintain a completely normal state of alertness using currently available medications. Medication should be accompanied by various lifestyle changes. The following strategies can help:

  • Most people should take short, regular naps when they tend to feel most sleepy.
  • Going to bed and waking up at the same time every day, even on weekends, can help people sleep better.
  • Individuals should avoid alcohol and caffeine several hours before bedtime.
  • Smoking should be avoided, especially at night.
  • Exercising for at least 20 minutes a day, at least 4 or 5 hours before bedtime, improves sleep quality and can help people with narcolepsy avoid gaining excess weight.
  • Eating too close to bedtime can make it harder to sleep, so eating before bedtime should be avoided.
  • Relaxing activities such as a warm bath before bed can also help. It is also beneficial that the sleeping area is cool and comfortable.

Safety precautions are important for anyone with this problem, especially while driving . Although the risk is lower in people who take the appropriate medication, people with untreated symptoms are more likely to be involved in automobile accidents.

EDS and cataplexy can cause serious injury or death if left unchecked . Falling asleep suddenly or losing muscle control can turn normally safe actions like walking down long stairs into danger.

Related Posts

Leave a Reply

Your email address will not be published.