Narcolepsy

1 What is Narcolepsy?

Narcolepsy is a chronic sleep disorder marked by lethargy and sudden attacks of sleep. This condition tends to interrupt  daily routine and activities, by preventing people from staying for long periods. Occasionally, narcolepsy can cause sudden weakness and loss of muscle tone, which is known as cataplexy. In most cases cataplexy is triggered by a strong emotion (laughter). 

So far, no medication  has been found to cure narcolepsy. However, a combination of symptom-treating medications and lifestyle changes has been proved to help. Also, the support of family, friends and community  is essential  for coping with this disorder.

2 Symptoms

Symptoms of narcolepsy tend to worsen in the first few years, and continue to persist for life. Narcolepsy occurs most commonly in young age,  between the ages of 10 and 25. You should see your doctor if you experience any of the following symptoms: 

  • Excessive daytime sleepiness-This is the first and most common symptom, which impairs your daily functioning and concentration. People with narcolepsy fall asleep suddenly, without any warning. This may happen at all places and at all times, regardless of the situation. These sleep attacks can take from few minutes up to half-hour period, before one becomes awake and eventually falls asleep again. 
  • Sudden loss of muscle tone-This condition, called cataplexy, is characterized by various sudden changes that may last for a few seconds up to a few minutes. These are caused by muscle weakness and can appear as mild as speech changes to generalized weakness of all the muscles. It is triggered by powerful emotions such as laughter, fear, surprise, anger etc. The frequency of these attacks is individual and can range from a few times on daily basis, to a few times per year. It is important to note, that not all the patients suffering from narcolepsy experience cataplexy.
  • Sleep paralysis-Many people with narcolepsy experience this condition, but not all of them are associated with it. It is marked by temporary inability to move or speak, mostly during the processes of falling asleep and waking up. Even though these episodes tend to be rather short, they can be extremely frightening. This paralysis is similar to the one that occurs during REM (rapid eye movement) sleep phase. Generally, people are aware of what had happened and can recall it afterwords.
  • Hallucinations-This condition has a tendency to be frightening as well, because it often happens while you are semi-awake, and consequently  you experience your dreams as reality.

Other aspects

Narcolepsy may be followed by other sleep disorders, such as: obstructive sleep apnea, insomnia, restless legs syndrome etc.

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3 Causes

The exact cause of narcolepsy is yet to be found. On the other hand, some other diseases and conditions, that may be linked with the condition, have been found. These include:

  • Hypocretin hormone deficiency - aneuropeptide that regulates arousal, wakefulness, and appetite.
  • Exposure to H1N1 virus – swine fly.

4 Making a Diagnosis

Making a diagnosis of narcolepsy is done by performing several tests.

Please note that there are some important pieces of information that you need to say to your doctor. These include:

  • all the symptoms you are experiencing,
  • all the changes in life habits and all the medications that you are using.

After the given set of questions, the doctor will determine your preliminary diagnosis. After that, he might refer you to the sleep specialist for further evaluation. 

You should be prepared to undergo a number  of tests for analysis, including:

  • Your sleep history – determined by Epworth Sleepiness Scale.
  • Sleep diary -  this should help the doctor get an insight on your sleep and wake time patterns. He may also ask you to wear a special wrist-watch-like device called actigraph, whose aim is to determine your sleep pattern.
  • Polysomnography – this method measures different sleep functions: electrical activity of your brain (electroencephalogram), heart (electrocardiogram), muscle movement (electromyogram) and eyes (electro-oculogram) and breathing. 
  • Multiple sleep latency test – this test determines the time period you need to fall asleep during the day. People who have narcolepsy quickly enter into rapid eye movement (REM) phase and fall asleep easily.

5 Treatment

Although there is no specific cure for narcolepsy, medications and lifestyle modifications can help you treat the symptoms. Medications for narcolepsy include:

  • Stimulants –these drugs are considered as a first-line treatment. They stimulate the central nervous system. The most commonly-used are modafinil and armodafinil, because they are less addictive then other stimulants. If required, some doctors may administer methylphenidate or amphetamines, although they are known to be addictive and have various side effects.
  • Selective serotonin re-uptake inhibitors (SSRIs) or serotonin and norepinephrine re-uptake inhibitors (SNRIs) – mostly paroxetine, fluoxetine and venlafaxine.
  • Tricyclic antidepressants –older older antidepressants, such as protriptyline, imipramine (Tofranil) and clomipramine (Anafranil), are used for treating cataplexy.
  • Sodium oxybate - effective for improvement of nighttime sleep and cataplexy .
  • Avoid drugs, such as allergy and cold medications because they can cause drowsiness.

6 Lifestyle and Coping

Modifications in your lifestyle can prove beneficial in coping with narcolepsy.Lifestyle modifications are important in managing the symptoms of narcolepsy.You shuold take these steps:

  • Make a timetable - regulate your sleep and wake up times every day. Take a few short naps during the day. These should ideally take around 20 minutes.
  • Try to avoid nicotine and alcohol - These substances tend to worsen the symptoms.
  • Do more exercise in a tolerable manner- four to five hours can help regulate your circadian rhythm. 
  • Talk about it – work the way for your friends, teacher or employer to understand your condition and help you deal with it. You should not be discriminated in any way, because of narcolepsy.
  • Be safe – especially whet it comes to driving. Ask your doctor to modify your therapy in a way that ensures the greatest level of alertness while you drive. Make pauses for naps and some exercise. If you have any doubt that you will not be able to handle the road, then don’t drive! 
  • Support group s and counseling – try to locate any such groups, because these can help you and your loved ones to cope with this condition.

7 Risks and Complications

There are several risks associated with narcolepsy, which include:

  • Professional and personal life - Narcolepsy  may have serious consequences on your personal and professional life. It can affect the way other people perceive you and decrease your work performance.
  • Relationships and sex - Narcolepsy is know to affect sexual life in many ways, but mostly through impotence and low libido. This can lead to depression episodes and witdhrawal from emotional bonds..
  • Risk of injury - people with narcolepsy are at risk of experiencing traffic accidents, praticularly as drivers. While at home or outside, they are also prone to physical injuries such as cuts, bruises, burns etc. 
  • Obesity – they tend to be overweight due to the combination of various factors, which include: hormonal imbalance, eating disorders, depression, medications.
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