Narcolepsy

Narcolepsy is a neurological disorder that affects your ability to wake and sleep. People with narcolepsy have excessive, uncontrollable daytime sleepiness. They may also suddenly fall asleep at any time, during any type of activity.

In a typical sleep cycle, we enter the early stages of sleep, then the deeper stages, and finally (after about 90 minutes) rapid eye movement (REM) sleep. People with narcolepsy go into REM sleep almost immediately in the sleep cycle and sometimes while they’re awake.

Types –
There are two types of narcolepsy –
•  Type 1 is the most common. It includes a symptom called cataplexy, that causes unexpected and temporary loss of muscle control. This can be mistaken for seizure activity, especially in children. People with this type of narcolepsy have episodes of extreme sleepiness and cataplexy during the daytime due to low levels in the brain of a protein called hypocretin.
•  Type 2 is narcolepsy without cataplexy. Usually, people with type 2 narcolepsy have normal levels of hypocretin.

Symptoms –
How often and how intensely narcolepsy symptoms occur can vary.
•  Significant daytime sleepiness
Almost everyone with narcolepsy has excessive daytime sleepiness (EDS), in which you suddenly experience an overwhelming urge to sleep. EDS makes it difficult to function properly during the day.
•  Cataplexy
Cataplexy is a sudden, temporary loss of muscle tone. It can range from drooping eyelids (referred to as partial cataplexy) to total body collapse.
Laughing and intense emotions, such as excitement and fear, can trigger cataplexy. It can happen several times a day to once a year.
•  Poorly regulated rapid eye movement (REM) sleep
REM sleep is the sleep stage when you have vivid dreams with loss of muscle tone. It usually starts about 90 minutes after you fall asleep. REM sleep can happen at any time of day for people with narcolepsy, often within about 15 minutes after falling asleep.

•  Sleep paralysis
Sleep paralysis is an inability to move or speak while falling asleep, sleeping, or waking. Episodes last only a few seconds or minutes.
Sleep paralysis mimics the paralysis seen during REM sleep. It doesn’t affect eye movements or the ability to breathe, though.
•  Hallucinations when falling asleep
People with narcolepsy may frequently have vivid dreams that may occur when falling asleep or waking up.
•  Fragmented sleep
Although people with narcolepsy are excessively sleepy during the daytime, they may have difficulty falling asleep and/or staying asleep at night.
•  Automatic behaviors
After falling asleep during an activity like eating or driving, a person with narcolepsy may continue doing that activity for a few seconds or minutes without consciously realizing they’re doing it.

Causes –
Scientists have discovered that people with narcolepsy have a loss of a neurotransmitter (chemical signal) in the brain called hypocretin. Hypocretin is important for regulating the sleep/wake cycle including the rapid eye movement (REM) sleep state. A shortage of hypocretin causes excessive sleepiness, and features of REM sleep (also called “dreaming sleep”) become present during wakefulness.

Other possible factors scientists think play a role in narcolepsy include:
•   An autoimmune disorder.
A person’s immune system attacks the brain cells that produce hypocretin, resulting in a shortage of this chemical.
•  Family history.
Some persons with narcolepsy have close relatives with similar symptoms.
•  Brain injury or tumor.
In a small number of patients, the area of brain that controls REM sleep and wakefulness can be injured by trauma, tumor or disease.
•  Infections.
•  Environmental toxins, such as pesticides, heavy metals and secondhand smoke.

Risk Factors –
Risk factors for narcolepsy include your age. Narcolepsy usually begins between the ages of 15 and 25, but it can show up at any age. If you have a family history of narcolepsy, your risk of getting it is 20 to 40 times higher.

Complications –
The complications associated with narcolepsy include:
•  People with narcolepsy also often have depression and anxiety, but it’s not clear whether these are symptoms of narcolepsy or due to its symptoms affecting their quality of life.

•  Because of excessive sleepiness and cataplexy, your social life may be affected. For example, you may have difficulty staying awake during social gatherings, or you may lose muscle control when laughing.
•  Perhaps because of lower activity levels or a slower metabolism, many people with narcolepsy are overweight. Adults with narcolepsy weigh about 15 to 20 percent more on average than the general population.

•   People with narcolepsy may have an increased risk for suicidal behavior.

Just because you’re living with narcolepsy doesn’t necessarily mean you’ll have these complications.

Diagnosis
Diagnosis is relatively easy when all the symptoms of narcolepsy are present, but if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. It is also possible for cataplexy to occur isolated. Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test (MSLT). A sleep specialist usually performs these tests.

Treatment –
There is no cure for narcolepsy and any associated loss of hypocretin is believed to be irreversible. However, many symptoms of the condition can be managed with the use of medications and lifestyle changes. 

•  Medications
Some of the medications that may be used to manage the symptoms of narcolepsy include:
▪︎  Wakefulness-promoting drugs: Modafinil (Provigil) or armodafinil (Nuvigil) are central nervous stimulants that are usually prescribed as first-line treatments.7 These drugs are used to help improve alertness levels during the day.
▪︎  Sodium oxybate : It is FDA approved for the treatment of narcolepsy. It helps reduce symptoms of excessive daytime sleepiness and cataplexy. It is high in sodium, so people who are taking this medication are advised to limit their dietary salt intake.
▪︎   Antidepressants: Some symptoms of narcolepsy may also be relieved with the use of certain types of antidepressants. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may help with cataplexy, hallucinations, sleep paralysis, and disrupted nighttime sleep

• Lifestyle Changes
•  Follow a regular sleep/wake schedule. Go to bed and wake up at about the same time every day. Avoid intentional sleep loss, such as staying awake late on weekends.
•  Keep your bedroom quiet, dark, cool and comfortable. Do not watch TV or bring computers or phones into bed with you.
•  Avoid alcohol and caffeine (colas, coffee, teas, energy drinks and chocolate) for several hours before bedtime.
•  Avoid smoking, especially in the evening.
•  Exercise at least 20 minutes per day. Do not exercise within three hours of bedtime.
•  Don’t eat large, heavy meals or a lot of liquids close to bedtime.
•  Relax before bedtime. Take a warm bath, meditate, perform some gentle yoga moves, listen to soft music, expose yourself relaxing scents such as peppermint, eucalyptus or lavender.
•   Take short naps (20 to 30 minutes) at times when you are feeling most sleepy, if possible.

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