Narcolepsy – What it is, Causes, Symptoms and Drug Treatments. Furthermore, Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime sleepiness and sudden sleep attacks. 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. Narcolepsy can sometimes be accompanied by a sudden loss of muscle tone (cataplexy) that leads to weakness and loss of muscle control . Cataplexy is often triggered by a strong emotion, most of it laughter.
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Narcolepsy is a chronic condition for which there is no cure. However, medications and lifestyle changes can help you manage your symptoms. Support from others – family, friends, employer, teachers – can help you cope with Narcolepsy .
Causes of Narcolepsy: The exact cause of Narcolepsy is unknown. There can be many causes. Most people with 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. Hypocrepine levels are particularly low in those who experience cataplexy.
Exactly what causes the loss of hypocretin-producing cells in the brain is not known, but experts suspect it is due to an autoimmune reaction. Research indicates a possible association with exposure to the H1N1 virus (swine flu) and a certain form of H1N1 vaccine currently administered in Europe.
It is not yet known whether the virus directly triggers Narcolepsy or whether exposure to the virus increases the likelihood that someone will have Narcolepsy . In some cases, genetics can play a role.
REM sleep, or Rapid Eye Movement, is the phase of sleep in which the most vivid dreams occur. During this phase, the eyes move quickly and brain activity is similar to what happens during waking hours. People awake during REM sleep typically feel alert, more alert, or more alert and ready for normal activity.
Eye movements associated with REM are generated by the lateral geniculate nucleus of the thalamus and associated with occipital waves. During REM sleep , a person’s muscle tone decreases considerably. Also called paradoxical sleep, a term that has fallen into disuse. In REM, the brain blocks motor neurons, so the body doesn’t obey dreamed orders or act them out. The result is known as sleep paralysis.
Normal Sleep Pattern Versus Narcolepsy: The normal process of falling asleep begins with a phase called non-rapid eye movement (NREM) sleep. During this phase, your brain waves slow down considerably. After an hour or so of NREM, your brain activity changes, and REM sleep begins. Most dreams occur during REM sleep.
In Narcolepsy , however, you may suddenly enter REM sleep without experiencing NREM sleep, either at night or during the day. Some of the features of REM sleep, such as cataplexy, sleep paralysis, and hallucinations, occur during wakefulness or sleepiness in people with Narcolepsy .
Symptoms of Narcolepsy: Symptoms of Narcolepsy usually start between the ages of 10 and 25. They can get worse in the first few years and then continue to live. They include:
- Excessive Daytime Sleepiness. People with Narcolepsy fall asleep without warning, anywhere and anytime. For example, you may suddenly nod while working or talking to friends. You may sleep for a few minutes or even a half hour before waking up and feel refreshed, but eventually you fall asleep again. You may also experience a decrease in alertness throughout the day. Excessive daytime sleepiness is usually the first symptom to appear and is often the most bothersome, making it difficult to concentrate and function fully.
- Sudden loss of muscle tone. This condition, called cataplexy (KAT-uh-plek-see), can cause a range of physical changes, from slurred speech to complete weakness of most muscles and can last a few seconds to a few minutes. Cataplexy is uncontrollable and is triggered by intense emotions, usually positive, such as laughter or excitement, but sometimes fear, surprise, or anger. For example, your head may drop uncontrollably or your knees may suddenly buckle when you laugh. Some people with Narcolepsy experience only one or two episodes of cataplexy a year, while others have numerous episodes daily. Not everyone with Narcolepsy experiences cataplexy.
- Sleep paralysis. People with Narcolepsy often experience a temporary inability to move or speak when falling asleep or waking up. These episodes are usually brief – lasting a few seconds or minutes – but they can be frightening. You may be aware of the condition and have no trouble remembering it later, even if you had no control over what was happening to you. This sleep paralysis mimics the type of temporary paralysis that normally occurs during rapid eye movement (REM) sleep, the period of sleep during which most dreams occur. This temporary immobility during REM sleep can prevent your body from engaging in dream activity. However, not everyone with sleep paralysis has narcolepsy .. Many people without Narcolepsy experience some episodes of sleep paralysis, especially in young adulthood.
- hallucinations. These hallucinations are called hypnagogic hallucinations if they happen as you fall asleep and hypnopomic hallucinations if they happen when you wake up. They can be particularly vivid and frightening because you can be half awake when you start dreaming and experience your dreams as reality.
Other Features: People with narcolepsy may have other sleep disorders such as obstructive sleep apnea, a condition where breathing starts and stops during the night, restless legs syndrome, and even insomnia. People with Narcolepsy may also represent their dreams at night by flapping their arms or kicking and screaming.
Some episodes of sleep attacks are brief and lasting. Some people with Narcolepsy experience automatic behavior during these brief episodes. For example, you may fall asleep while performing a task you normally do, such as writing, typing, or driving, and you continue to function while you are sleeping. When you wake up, you can’t remember what you did, and you probably didn’t do it well.
When to See a Doctor: See your doctor if you experience excessive daytime sleepiness that disrupts your personal or professional life.
Complications of Narcolepsy: The main complications of Narcolepsy are:
- Public misunderstanding about the condition: Narcolepsy can cause serious problems for you professionally and personally. Others may see you as lazy or lethargic. Your performance may suffer at school or at work.
- Interference with Intimate Relationships: Extreme sleepiness can cause poor sexual drive or impotence, and people with Narcolepsy may even fall asleep while having sex. Intense feelings such as anger or joy can trigger some signs of Narcolepsy , such as cataplexy, causing affected people to withdraw from emotional interactions.
- Physical damage: Sleep attacks can result in physical damage to people with Narcolepsy . You run the risk of a car accident if you have a fit while driving. Your risk of cuts and burns is higher if you fall asleep while preparing food.
- Obesity: People with Narcolepsy are more likely to be overweight. Weight gain can be related to medications, inactivity, binge eating, hypocretin deficiency, or a combination of factors.
Narcolepsy Tests and Diagnosis: Your doctor may make a preliminary diagnosis of Narcolepsy based on your excessive daytime sleepiness and sudden loss of muscle (cataplexy). After an initial diagnosis, your doctor may refer you to a sleep specialist for further evaluation.
Formal diagnosis may require spending the night at the sleep center, where you undergo an in-depth sleep analysis by sleep experts. Diagnostic methods of Narcolepsy and determination of severity include:
- Sleep history. Your doctor will ask you for a detailed sleep history. Part of the story involves filling out the Epworth Sleepiness Scale, which uses a series of short questions to assess how sleepy you are. For example, you indicate on a numbered scale how likely you are to fall asleep in certain situations, such as sitting down after lunch.
- Sleep logs. You may be asked to keep a detailed diary of your sleep pattern for a week or two so your doctor can compare how your sleep pattern and alertness are related. Often the doctor will ask you to use an actigraph. This device has the appearance of a wristwatch. It measures periods of activity and rest and provides an indirect measure of how and when you sleep.
- Poly sonography. This test measures a variety of signals during sleep using electrodes placed on the scalp. For this test, you must spend one night in a medical facility. The test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram) and the movement of your muscles (electromyogram) and eyes (electrooculogram). It also monitors your breathing.
- Multiple sleep latency test. This test measures the time it takes you to fall asleep during the day. You will be asked to take four or five naps, each two-hour sleep apart. Specialists will observe your sleep patterns. People who have Narcolepsy fall asleep easily and go into rapid eye movement (REM) which flares up quickly. These tests can also help doctors rule out other possible causes of your signs and symptoms. Other sleep disorders, such as sleep apnea, can cause excessive daytime sleepiness. There is no cure for Narcolepsy , but medications and lifestyle modifications can help you manage symptoms.
Narcolepsy Medications: Medications for Narcolepsy include:
- Stimulants. Drugs that stimulate the central nervous system are the main treatment to help people with Narcolepsy stay awake during the day. Doctors usually try modafinil (Provigil) or armodafinil (Nuvigil) first for narcolepsybecause it is not as addictive as older stimulants and does not produce the highs and lows often associated with older stimulants. Modafinil side effects are uncommon but can include headache, nausea, or dry mouth. Some people need treatment with methylphenidate (Aptensio XR, Concerta, Ritalin) or various amphetamines. These medications are very effective but can sometimes cause side effects such as nervousness and heart palpitations and can be addictive.
- Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Doctors often prescribe these medications, which suppress REM sleep, to help relieve symptoms of cataplexy, hypnagogic hallucinations, and sleep paralysis. They include fluoxetine (Prozac, Sarafem, Selfemra) and venlafaxine (Effexor XR). Side effects can include weight gain, sexual dysfunction and digestive problems.
- Tricyclic antidepressants. These older antidepressants, such as protriptyline (Vivactil), imipramine (Tofranil), and clomipramine (Anafranil), are effective for cataplexy, but many people complain of side effects such as dry mouth and dizziness.
- Sodium oxybate (Xyrem). This medication is highly effective for cataplexy. Sodium oxybate helps improve nighttime sleep, which is often poor in Narcolepsy . In high doses it can also help control daytime sleepiness . It should be taken in two doses, one at bedtime and one up to four hours later. But you will hardly find Xyrem in Brazil. Xyrem can have side effects such as nausea, wetting and worsening sleep. Taking sodium oxybate along with other sleep medications, narcotic pain relievers, or alcohol can lead to difficulty breathing, coma, and death.
If you have other health problems, such as high blood pressure or diabetes, ask your doctor how the medications you take for your other conditions may interact with those that are treated with Narcolepsy . Certain over-the-counter drugs, such as allergy and cold medications, can cause drowsiness. If you have Narcolepsy , your doctor will likely recommend that you avoid taking these medications.
Emerging treatments being investigated for Narcolepsy include hypocretin replacement, hypocretin gene therapy, and immunotherapy, but additional research is needed before any cases are available in clinical practice. The most commonly used drugs for the treatment of Narcolepsy are:
NOTE: Only a doctor can tell you which drug is most suitable for you, as well as the correct dosage and duration of treatment. Always follow your doctor’s instructions to the letter and NEVER self-medicate. Do not stop using the drug without consulting a doctor first, and if you take it more than once or in much larger amounts than prescribed, follow the instructions on the package insert.
Prevention of Narcolepsy: There are no known ways to prevent Narcolepsy . But lifestyle modifications are important in managing the symptoms of Narcolepsy . You can benefit from these steps:
- Meet a Schedule. Go to sleep and wake up at the same time every day, including weekends.
- Take Naps. Schedule short naps at regular intervals throughout the day. 20 minutes at strategic times during the day can be refreshing and reduce drowsiness for one to three hours. Some people may need longer naps.
- Avoid Nicotine and Alcohol. Using these substances, especially at night, can make your signs and symptoms worse.
- Do Regular Exercises. Moderate, regular exercise at least four to five hours before bedtime can help you feel more awake during the day and sleep better at night.