Narcolepsy
Narcolepsy is a serious sleep disorder that affects many people in many different ways. Those with this condition are frequently tired during the day, and they sometimes suddenly fall asleep right in the midst of performing everyday tasks. The previous section discussed the symptoms of narcolepsy and its suspected causes. This section continues with a discussion of how narcolepsy is diagnosed and treatment options.
Symptoms and Causes
If you or someone you know constantly feels tired during the day, and without notice, may even fall asleep right in the middle of doing everyday tasks such as cooking or typing, these symptoms could be an indication of narcolepsy. Narcolepsy is a frequently misdiagnosed sleep disorder. While others might attribute the symptoms as resulting from laziness or poor sleeping habits, to the affected individual, the symptoms are very real, they're uncontrollable, and they can be very frightening.
The symptoms of narcolepsy rarely begin after a person reaches age 40. Most often (but not always), they begin appearing between ages 10 and 25.
The primary symptom of narcolepsy is persistent daytime tiredness that does not subside no matter how much sleep the affected individual gets. The constant tired feeling makes concentration difficult and can keep an individual from functioning as needed. This in itself is a problem, however those who experience another symptom of narcolepsy – the propensity to suddenly fall asleep - compounds the situation.
What makes falling asleep so serious is that it happens without warning, which means the affected individual has no time in advance to prepare for sleep. In other words, getting to a safe place to lie down isn't an option. It's not bad if the sleep attack occurs while talking with friends. In fact, many people find this amusing. However, if the person is driving a car when this symptom strikes, the repercussions can be deadly.
The amount of time spent sleeping during these episodes can range from just a few minutes to 30 minutes or longer. Once awakened, the attacks can repeat several times throughout the day. Some experience automatic behavior during these episodes meaning that they continue doing the task they were performing (although poorly) just prior to falling asleep. Afterwards, however, there is no recollection of this behavior
Cataplexy is another symptom that is experienced by almost three-quarters of narcolepsy sufferers. Cataplexy is an inability to control muscles so someone with this symptom might have trouble speaking clearly or worse, he or she might barely be able to control muscle function at all. Some experience this symptom daily while others experience it very rarely. Its onset seems to be linked with a change in emotions such as when a person laughs excessively or when the person becomes scared or angry.
Paralysis similar to that which normally takes place during REM sleep is yet another symptom of narcolepsy. But rather than taking place during REM, this brief paralysis occurs either upon awakening or while falling asleep. Even though a person may be fully aware of this brief inability to move or speak, that person is totally unable to control it, which can be very scary.
Hypnagogic hallucinations – vivid, almost real images that appear while in a semi-awake state – are another symptom that approximately one-quarter to one-half of narcolepsy sufferers experience.
To date no one is certain what causes narcolepsy. It appears genetics plays some role as does an abnormally low amount (or total absence) of a brain chemical important for regulating sleep awakening called hypocretin.
Diagnosis and Treatment
When constant daytime sleepiness is the problem, and other conditions such as depression, insufficient sleep, fainting and a disorder that causes seizures have been ruled out, narcolepsy is generally suspected, especially if the sleepiness is accompanied by cataplexy (sudden loss of muscle tone).
Responses to specific sleep-related questions helps narrow down the diagnosis as can spending time at a sleep center where sleeping patterns can be monitored and evaluated. Sleep pattern evaluation is known as multiple sleep latency testing. While at the sleep center, the patient may also undergo a series of tests known as a Polysomnogram. With the help of strategically-paced electrodes, the patient's heartbeat, eye movements, brain activity and muscle movements can be measured.
Testing the patient's blood for antigens is sometimes performed, especially when there is a family history of narcolepsy.
Treatment of narcolepsy is generally a combination of behavioral changes, counseling and prescription medication. Behavioral changes are primarily geared towards encouraging better sleeping routines. Moderate exercise done daily will energize during the day and help bring on sleep at night. Getting into the habit of sleeping and waking at specific times every day can help bring routine to sleep. Taking several brief naps during the day can help eliminate fatigue and abrupt bouts of daytime sleeping. Eliminating caffeine, alcohol and nicotine are also advisable.
When it comes to prescription medications, stimulants are effective because they work on the nervous system which helps those with narcolepsy stay awake. Modafinil works in a similar manner, but with this drug, there is no risk of addiction. Antidepressants are an effective way to treat the cataplexy, sleep paralysis and hypnagogic hallucinations that some narcolepsy sufferers experience during REM sleep by inhibiting REM sleep. Sodium oxybate also treats these symptoms.
Counseling is also another important treatment component. Those suffering from narcolepsy have trouble themselves dealing with this sleep disorder, but they also can experience negativity from the others with whom they associate. The nature of this sleep disorder is such that it can put a person's life in danger. As a way of ensuring their own safety, some will cut themselves off from the outside world. They choose not to work, to drive, or to interact socially with others and instead become isolated. Living in this manner is unhealthy and can lead to depression.
Those who don't fully understand the sleep disorder aren't always supportive, either. Feelings of doubt, thinking the situation is humorous, mistrust and a lower libido resulting from extreme fatigue can ruin relationships at home and at work.
Counseling or joining a support group is highly recommended because doing so can help those suffering with narcolepsy better cope with their situation.