Narcolepsy

Narcolepsy is a sleep disorder characterized by extreme daytime sleepiness and sudden sleep attacks. Individuals with narcolepsy find it challenging to stay awake for long periods of time, no matter the circumstances. Narcolepsy can significantly interfere with your daily routine and quality of life. While there is no cure for narcolepsy, lifestyle changes and medication can help you manage its symptoms.

Symptoms

The symptoms of narcolepsy typically appear when a person is between the ages of 10 and 25. The symptoms may worsen for the first few years and remain for life.

Excessive Daytime Sleepiness: Individuals with narcolepsy fall asleep suddenly, without warning anytime, anywhere. You may fall asleep for just a few minutes or up to a half an hour. You awaken feeling refreshed, but you will eventually fall asleep again.

Additionally, you may not be as alert during the day as you once were. Excessive daytime sleepiness is often the first symptom of narcolepsy to appear. It’s often the most troublesome and may interfere with your daily activities.

Sleep Paralysis: You may experience an inability to move or speak while you’re going to sleep or upon waking up. These episodes tend to be brief, lasting a few seconds to a few minutes, but they can be scary.

Not everyone who experiences sleep paralysis has narcolepsy. Many people who do not have narcolepsy experience episodes of sleep paralysis, particularly in early adulthood.

Sudden Loss of Muscle Tone (Cataplexy): Cataplexy can lead to a number of physical changes in your body. For instance, you may have slurred speech or weakness in most of the muscles in your body. These episodes tend to last from a few seconds to a few minutes. You cannot control cataplexy. It’s typically triggered by strong emotions, especially positive ones, like excitement and laughter. However, anger, fear, and surprise may also trigger cataplexy.

Not everyone with narcolepsy experiences cataplexy. Some people who experience cataplexy have one or two episodes a year while others have multiple daily episodes.

Hallucinations: Individuals with narcolepsy may experience hypnagogic or hypnopompic hallucinations. Hypnagogic hallucinations are those that occur when you’re falling asleep while hypnopompic hallucinations are those that happen upon awakening. Both types of hallucinations can be very vivid and frightening.

Causes

The exact cause of narcolepsy isn’t known. Most individuals with narcolepsy possess low levels of hypocretin. Hypocretin is a neurochemical in your brain that aids in the regulation of REM sleep and wakefulness. Those who experience cataplexy episodes possess a particularly low level of hypocretin. It’s not known why some people lose hypocretin-producing cells in the brain, but scientists suspect that it’s caused by an autoimmune reaction.

Diagnosis

Based off of your symptoms, your primary care doctor may make a preliminary diagnosis of narcolepsy. He may send you to a sleep specialist for a formal diagnosis. A sleep specialist may try to gauge your daytime sleepiness with the Epworth Sleepiness Scale, a questionnaire that asks several questions about your sleepiness. Your sleep specialist may also want you to keep a detailed sleep diary for a couple of weeks as well.

Your sleep specialist may want you to undergo a polysomnography, a test that measures many signals in your body as you sleep. For the test, you will spend a night in a sleep laboratory. Electrodes are placed on your body so that they can measure your muscle movement, brain activity, heart rate, and breathing while you sleep.

You may also need to undergo a multiple sleep latency test. During this test, you will be asked to take four or five naps throughout the day with each nap being two hours apart. Individuals with narcolepsy tend to fall asleep easily and enter into REM (rapid eye movement) sleep quickly.

Treatment

There is no cure for narcolepsy; however, lifestyle changes and medication can help you manage your symptoms. For instance, sticking to a sleep schedule everyday and scheduling several 20-minute naps throughout the day can help reduce daytime sleepiness. Getting regular moderate exercise at least four to five hours before you sleep can also help you feel more alert during the day and sleep better at night.

Several medications are effective at helping control narcolepsy symptoms. Stimulants are often prescribed to help those with narcolepsy remain awake during the day. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) may be prescribed because they suppress REM sleep. This can help relieve sleep paralysis, cataplexy episodes, and hypnagogic hallucinations.

Your doctor may prescribe a tricyclic antidepressant for your narcolepsy because they are effective at relieving cataplexy. Sodium oxybate (Xyrem) is also very effective in managing cataplexy. It can also improve sleep at night. In high doses, Xyrem may help reduce daytime sleepiness.

If you experience the symptoms of narcolepsy, talk with your doctor about them. She will be able to help you determine the cause of your symptoms and come up with a treatment plan that’s right for you. While there is no cure for narcolepsy, medication and lifestyle changes can help you manage your symptoms and improve your quality of life.