Narcolepsy: Narcoleptic Symptoms, Causes, Treatment, and Medication

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                   Narcoleptic Symptoms, Causes,
                      Treatment, and Medication

                                     Narcolepsy is a chronic neurological disorder,
                                     affecting the part of the brain that regulates when to
                                     be asleep and when to be awake. Narcoleptics can
                                     fall asleep while working, cooking, or even driving.

                                   Narcolepsy affects about 1 in 2,000 people, and is
                                   thought to be a genetic disorder. Most people
                                   experience their first symptoms between the ages of
                                   10 and 25. Narcolepsy is a lifelong condition, but
narcoleptics who make certain lifestyle changes and seek medical help can reduce
symptoms, improve alertness and enjoy a full and active life.

Signs and symptoms of narcolepsy
The main narcolepsy symptoms are excessive daytime sleepiness (with or without
sudden sleep episodes) and abnormal REM sleep, Several unusual symptoms of
narcolepsy are related to abnormal REM sleep, including hallucinations, sleep paralysis
and cataplexy (loss of muscle control). Cataplexy (sudden loss of muscle control) is the
sole unique symptom of narcolepsy.

Each person with narcolepsy may experience very different symptoms and sometimes the
only symptom they can report on is extreme daytime tiredness, which may make it hard
to                               diagnose                                narcolepsy.
Other narcolepsy symptoms include:

   •   Cataplexy (loss of muscle control): People with narcolepsy often have a sudden
       loss of muscle control while awake, usually triggered by strong emotions, such as
   •   Hallucinations: Some people with narcolepsy experience vivid, sometimes
       frightening, visual or auditory sensations while falling asleep or upon awakening.
   •   Sleep paralysis: Sleep paralysis is the inability to move or talk at the beginning or
       end of sleep.
   •   Microsleep: Microsleeps are very brief sleep episodes during which people with
       narcolepsy continue to function (talk, put things away, etc.), and then awaken
       with no memory of the activities.
   •   Nighttime wakefulness: People with narcolepsy may have periods of
       wakefulness at night, with hot flashes, elevated heart rate, and sometimes intense
   •   Rapid entry into REM sleep: Narcoleptics have unique sleep cycles. They enter
       the REM, or dream, phase of sleep right after falling asleep, whereas most people
       take about 90 minutes to enter the REM phase. Someone with narcolepsy will
       experience the characteristics of REM sleep (vivid dreams and muscle paralysis)
       at the beginning of sleep, even if that sleep is during the day.

Two of the most common narcolepsy symptoms (excessive daytime sleepiness and
cataplexy) seem to be connected to emotional state. People often have these symptoms
when they are experiencing intense emotions, such as laughter, sadness, surprise, or

The causes of narcolepsy
Researchers continue to seek out the root cause of narcolepsy. The general consensus is
that genetics, accompanied by an environmental trigger of some sort—a virus, for
example— may affect brain chemicals and cause narcolepsy.

Scientists have discovered that people with narcolepsy are lacking in hypocretin (also
called orexin), a chemical in the brain that activates arousal and regulates sleep.
Narcoleptics generally do not have as many the Hcrt cells (neurons that secrete
hypocretin), inhibiting their ability to fully control their alertness and tendencies to fall
asleep. Scientists are working on developing treatments to supplement hypocretin levels
and reduce narcolepsy symptoms.

Heredity appears to be a factor in narcolepsy, but environmental triggers also play a
strong role. Research is also investigating these triggers.

Diagnosing narcolepsy
Narcolepsy is often misdiagnosed or undiagnosed. People with narcolepsy often wait to
to consult a doctor because the most common (and sometimes the only) symptom is
excessive daytime sleepiness, a symptom which could be indicative of many conditions.
Additionally, narcolepsy symptoms are often falsely attributed to other sleep disorders or
medical conditions (such as depression or epilepsy). Cataplexy (sudden loss of muscle
control) is the sole unique symptom of narcolepsy.

Diagnosis of narcolepsy can take a very long time, sometimes more than one year, or
even up to several decades. If you suspect you have narcolepsy, be sure to speak with
your doctor about all symptoms you are experiencing.

Along with your list of symptoms, physicians and sleep specialists use the following
methods to diagnose narcolepsy:
   •   Epworth Sleepiness Scale – A general sleep questionnaire.
   •   Nocturnal polysomnogram- This overnight test measures the electrical activity
       of your brain and heart , and the movement of your muscles and eyes.
   •   Multiple sleep latency test (MSLT) – This test measures how long it takes for
       you to fall asleep during the day.
   •   Spinal fluid analysis – The lack of hypocretin in the cerebrospinal fluid may be a
       marker for narcolepsy. Examining spinal fluid is a new diagnostic test for

The effects of narcolepsy
Narcolepsy can have serious repercussions on many aspects of life. The following are just
a few of the effects narcolepsy can have on your life.

Effects of Narcolepsy
Physical well-being Many activities, including driving, working, cooking, or walking,
and safety            can be very dangerous if you fall asleep or lose muscle control
Mental health         Narcolepsy disrupts all aspects of life and can lead to depression
                      and anxiety.
Social            and Unfortunately, sudden sleep episodes are often found humorous to
professional          those not familiar with narcolepsy. People may assume that the
relationships         individual with narcolepsy is lazy, rude or faking the sudden sleep
Intimate              Personal relationships, especially spousal relationships, often
relationships         suffer. Extreme sleepiness may also cause low sex drive and
Memory            and People with narcolepsy may have problems remembering things
attention             and concentrating.

Treating narcolepsy
Although no cure yet exists for narcolepsy, a combination of treatments can control
narcolepsy symptoms. The recommended treatment for narcolepsy includes a
combination of counseling, medication, and behavioral changes.

Treating narcolepsy with counseling and support groups

The symptoms of narcolepsy—particularly sleep attacks and cataplexy—can wreak
havoc on your ability to live a normal life. The episodes can be frightening, and you may
become depressed because of the sudden lack of control. Fear of falling asleep or of
sudden collapse forces some people to become reclusive and withdrawn. Depression in
people with narcolepsy is understandably very common. Reaching out to a psychologist,
counselor, or support group can help you to cope with the effects of the disorder.
Medications for narcolepsy

Medication is very helpful for treating the symptoms of narcolepsy. Commonly
prescribed drugs for narcolepsy are stimulants, antidepressants and sodium oxybate. All
medications have side effects so talk with your doctor

Behavioral changes that help the effects of narcolepsy

Behavioral changes are usually recommended along with medications to help a person to
manage narcolepsy symptoms. Combining the various treatments can improve alertness
and help you control the effects of a narcoleptic episode.

Self-Help for Narcolepsy
Schedule      your     sleep Take a few brief, scheduled naps during the daytime (10-15
periods                      minutes each). Try to get a good night’s sleep during the
                             same hours each night. Planned naps can prevent unplanned
                             lapses into sleep.
Avoid caffeine, alcohol, These substances interfere with sleep when you need it.
and nicotine
Involve your employers, Alert others so that they can help when needed.
coworkers, and friends
Carry a tape recorder        Record important conversations and meetings, in case you
                             fall asleep.
Break up larger tasks into Focus on one small thing at a time.
small pieces
Exercise on a regular basis Exercise can make you feel more awake during the day and
                             stimulate sleep at night. For example, take several short
                             walks during the day.
Avoid activities that would If possible, don’t drive, climb ladders, or use dangerous
be dangerous if you had a machinery. Taking a nap before driving may help you to
sudden sleep attack          manage any possible sleepiness.
Wear a medical alert A bracelet or necklace will alert others if you suddenly fall
bracelet or necklace         asleep or become unable to move or speak.

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