Narcolepsy
What is it?
Narcolepsy is a sleep disorder characterized by excessive and
overwhelming daytime sleepiness. Sudden,uncontrollable and
inconvenient attacks of sleep occur, such as while working, eating
or driving. Paradoxically, nighttime sleep may be interrupted with
frequent awakenings.
What are the causes?
There is strong evidence that narcolepsy may run in families. While
it occurs once in every 2000 births, it is 40 times more likely in
immediate families after one member is diagnosed. Narcolepsy is a
disorder of the central nervous system in which a stage of the sleep
state, rapid eye movement (REM) sleep, occurs at unusual times,
including in the wakeful state(called cataplexy). Also in
narcolepsy, REM sleep occurs soon after a person falls asleep
instead of an hour or more after NonREM sleep. As a result, sleep
paralysis and hallucinations (as out of dreams) may occur while
falling asleep or waking up.
What are the signs and symptoms?
Symptoms usually appear during or immediately after adolescence, but
may take longer to diagnose since people with this disorder often
suffer for years before seeing a doctor about their problem.
An individual with narcolepsy may have one or more of these
symptoms:
Excessive daytime sleepiness - when a person cannot force
himself to stay awake at times of the day when he wants to be awake.
The clock time of sleepiness may be predictable.
Cataplexy - a sudden loss of muscle control in the body,
brought on by an emotionally loaded situation (evoking heavy
laughter, or extreme excitement). This loss can be slight, such as
slackening the jaw, or slurred speech, or knee buckling; or severe,
such as a complete collapse of the body. Cataplexy is a symptom
unique to narcolepsy .
Sleep paralysis - when an awake person cannot move or talk
for a short period of time, either right before falling asleep or
directly after waking up. This can last a few seconds to minutes.
Hallucinations - memorable, scary dreams involving sights or
sounds that occur right before falling asleep or directly after
waking up.
Automatic behavior - when a person performs a routine task
but is not aware of doing it, or later has no recollection of
performing the activity.
Patients with narcolepsy always have excessive daytime sleepiness,
but the presence of cataplexy, sleep paralysis or hallucinations is
less common.
How is it diagnosed?
Some other sleep disorders can have some of the same signs and
symptoms. We perform a special nap test at Sleepcare Diagnostics to
determine if a patient has narcolepsy called a multiple sleep
latency test (MSLT--- see below)). Test results of a person with
narcolepsy will show that he falls asleep rapidly and enters REM
sleep early.
How is it treated?
Medication is the most common method of treatment. A combination of
stimulants and antidepressants may be used. Stimulants often improve
a person's ability to stay alert and awake during the day, while the
antidepressants tend to control the symptoms of cataplexy. A newer
nighttime agent better controls cataplexy. As long as the side
effects of the medications can be controlled and the patient
diagnosed early enough, the disease can be managed.
There are some things an individual with narcolepsy can do to help
cope with the disease:
- Get enough exercise
- Follow a proper diet
- Establish a regular sleep
routine (which may include regular naps)
- Use bed only for sleep
- Be aware of possible sleep
trap situations (as on long drives in a warm car) and possible
cataplexy danger (car horn honks suddenly) in those predisposed
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