NARCOLEPSY

Overview

Narcolepsy is a sleep disorder that makes you feel very sleepy and hard to stay awake for long periods. This can cause serious problems in their daily routine.

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Narcolepsy is divided into two types. Most people with type 1 narcolepsy have cataplexy, which is a loss or muscle tone usually triggered by strong emotions such as laughter. Most people who don't have cataplexy have type 2 narcolepsy.

Narcolepsy is a life-long condition for which there's no cure. Wake-promoting and stimulant medications can be very effective to manage symptoms. Support from others — family, friends, employers and teachers — can help people cope with the disorder.

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Causes

The exact cause of narcolepsy is unknown. Hypocretin, also called Orexin, is a chemical in the brain that helps control being awake and also controls the stability of sleep stages during sleep. People with type 1 narcolepsy have low levels of hypocretin.

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Exactly what causes the loss of hypocretin-producing cells in the brain isn't known. But experts suspect it's due to an autoimmune reaction. An autoimmune reaction is when the body's immune system destroys its own cells.

It's also likely that genetics plays a role in narcolepsy. But the risk of a parent passing this disorder to a child is very low — only about 1% to 2%.

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Symptoms

The symptoms of narcolepsy may get worse during the first few years of the disorder. Then they continue for life. They include:

• Excessive daytime sleepiness. People with narcolepsy fall asleep without warning. It can happen anywhere and at any time. It may happen when you're bored or during a task. For example, you may be working or talking with friends and suddenly fall asleep. It can be especially dangerous if you fall asleep while driving. You might fall asleep for only a few minutes or up to a half-hour. After waking, you'll often feel refreshed but you'll get sleepy again.
  
  You also may experience a decrease in how alert and focused you feel during the day. Daytime sleepiness often is the first symptom to appear. Feeling sleepy makes it hard to focus and function.
  
  Some people with narcolepsy continue doing a task when they fall asleep briefly. For example, you may fall asleep while writing, typing or driving. You might continue to perform that task while asleep. When you awaken, you can't remember what you did, and you probably didn't do it well.

• Sudden loss of muscle tone. This condition is called cataplexy. It can cause slurred speech or complete weakness of most muscles. Symptoms may last up to a few minutes. This is usually triggered by strong positive emotions such as laughter but can also be triggered by negative emotions such as fear, anger. Loss of muscle tone can result to suddenly dropping things, feeling weakness in knees which can result to a fall.

• Sleep paralysis. You might feel like you cannot move or speak while trying to fall asleep or wake up from sleep. It's usually brief — lasting a few seconds or minutes. You are usually aware of what is going on during these episodes. It is worth noting that not everyone with sleep paralysis has narcolepsy.

• Hallucinations. Sometimes people see things that aren't there during sleep paralysis. Hallucinations also may happen in bed without sleep paralysis. These are called hypnagogic hallucinations if they happen as you fall asleep. They're called hypnopompic hallucinations if they happen upon waking. For example, you might feel as if there is a stranger in your bedroom. These hallucinations may be vivid and frightening because you may not be fully asleep when you begin dreaming.

• Changes in rapid eye movement (REM) sleep. With narcolepsy, the timing of REM sleep is out of control and usually happens very quickly than normal soon after falling asleep. REM sleep can also happen during the day during wakefulness.

 

Other Features of Narcolepsy:

People with narcolepsy may have other sleep disorders including sleep apnea, REM sleep behavior disorder, restless leg syndrome and insomnia. They can also be art increased risk for obesity and cardiovascular diseases.

Call and talk to us if you experience excessive daytime sleepiness that affects your personal or professional life.

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Risk factors

There are only a few known risk factors for narcolepsy, including:

• Age. Narcolepsy typically begins between ages 10 and 30.

• Family history. Your risk of narcolepsy is 20 to 40 times higher if you have a close family member who has it.

 

Complications

• Public misconception of the condition. Narcolepsy can cause problems at work or in your personal life. Your performance may suffer at school or work. Others might see people with narcolepsy as lazy or lethargic.

• Effects on intimate relationships. Intense feelings, such as anger or joy, can trigger cataplexy. This can cause people with narcolepsy to withdraw from emotional interactions.

• Physical harm. Falling asleep suddenly may result in injury. You're at increased risk of a car accident if you fall asleep while driving. Your risk of cuts and burns is greater if you fall asleep while cooking.

• Obesity. People with narcolepsy are more likely to be overweight. Sometimes weight rapidly increases when sleepiness symptoms start.

 

Diagnosis

Your health care provider may suspect narcolepsy based on your symptoms of excessive daytime sleepiness and sudden loss of muscle tone, known as cataplexy. Your provider will likely refer you to a sleep specialist. Formal diagnosis requires staying overnight at a sleep center for an in-depth sleep analysis.

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A sleep specialist will likely diagnose narcolepsy and determine how severe it is based on:

• Your sleep history. A detailed sleep history can help with a diagnosis. You'll likely fill out the Epworth Sleepiness Scale. The scale uses short questions to measure your degree of sleepiness. You'll answer how likely it is that you would fall asleep in certain times, such as sitting down after lunch.

• Your sleep diary. You may be asked to write down your sleep pattern for a week or two. This allows your provider to compare how your sleep pattern may relate to how alert you feel.

• Your health care provider also may ask you to wear an actigraph. This device is worn like a watch. It measures periods of activity and rest. It provides an indirect measure of how and when you sleep.

• A sleep study, known as polysomnography. This test measures signals during sleep using flat metal discs called electrodes placed on your scalp. For this test, you must spend a night at a medical facility. The test measures your brain waves, heart rate and breathing. It also records your leg and eye movements.

• Multiple sleep latency test. This test measures how long it takes you to fall asleep during the day. You'll be asked to take four or five naps at a sleep center. Each nap needs to be two hours apart. Specialists will observe your sleep patterns. People who have narcolepsy fall asleep easily and enter into rapid eye movement (REM) sleep quickly.

• Genetic tests and a lumbar puncture, known as a spinal tap. Occasionally, a genetic test may be performed to see if you're at risk of type 1 narcolepsy. If so, your sleep specialist may recommend a lumbar puncture to check the level of hypocretin in your spinal fluid. This test is only done in specialized centers.

Treatment

There is no cure for narcolepsy, but wake-promoting and stimulant medications, and lifestyle changes can help you manage the symptoms.

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