Narcolepsy 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 laughing. • 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 alertness. • 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 frustration. 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 narcolepsy. 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 unexpectedly. 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 episodes. Intimate Personal relationships, especially spousal relationships, often relationships suffer. Extreme sleepiness may also cause low sex drive and impotence. 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.