Sleep Disorders: Narcolepsy

Narcolepsy affects about 1 in 2,000 people. It is characterized by excessive sleepiness and abnormal intrusions of rapid eye movement (REM) sleep phenomena into awake time.

Symptoms

Typically, during REM sleep, our muscles are inactive (except for our breathing muscles and eye muscles) and unable to move. In individuals with narcolepsy, this “paralysis” of muscles may occur during wakefulness (known as cataplexy, usually brought on by strong emotions) or during transitions between sleep and wakefulness (known as sleep paralysis). In addition, dreams may intrude at these times (known as hypnagogic or hypnapompic hallucinations). Other symptoms of narcolepsy may include poor nighttime sleep and automatic behaviors (performing tasks without being aware of what you are doing or having recall of having done it).

While true cataplexy is considered very strong evidence of narcolepsy, the other symptoms listed may be seen in individuals who do not have narcolepsy. Furthermore, individuals diagnosed with narcolepsy may not have any or only some of these. Profound sleepiness, however, is always present in patients with narcolepsy. Some individuals may experience progressive sleepiness that eventually stabilizes, while others may notice a gradual improvement in their sleepiness over time. However, all individuals with narcolepsy will have some degree of sleepiness for the duration of their lifetime. The other associated symptoms mentioned above also may vary over time, but many notice a gradual improvement with the passing of years.

The diagnosis of narcolepsy is usually determined by a sleep physician following a thorough history, examination, and objective testing. The testing to make the diagnosis typically requires a sleep study and a daytime nap study (known as a Multiple Sleep Latency Study).

Causes

The cause of narcolepsy is not completely clear, but recent data suggests some individuals with narcolepsy, especially those with cataplexy, may be lacking in a specific type of brain chemicals (called hypocretinins or orexins). Why this happens and how this causes the symptoms of narcolepsy is not known at this time, but further research in this area may well provide some answers.

Treatment

At present, narcolepsy cannot be cured, though it can be controlled. The available treatments focus on symptom relief and improving one’s quality of life. Simple maneuvers, such as practicing good sleep hygiene and regularly scheduled naps may help tremendously. Along these lines, it is important for those with narcolepsy to avoid situations that may worsen their symptoms — such as performing shift work, having a job that requires night-time calls, or any job that requires continuous attention for long periods of time without breaks.

Specific treatment for narcolepsy is usually geared towards symptom relief. For the problem of excessive sleepiness, stimulant therapy is typically recommended. There are a variety of medications available for this and the appropriate medication is best determined after consultation with a sleep specialist. Treatment for cataplexy had been problematic in the past, with antidepressants being used with variable success. Gamma hydroxy butyrate (trade name Xyrem) has approved for the treatment of cataplexy and seems quite effective at relieving this symptom.

Christiaan Janssens

CRO Akwa Wellness

Originally published at brianluman.tumblr.com.