Narcolepsy is a chronic neurological sleeping disorder that affects the brain's ability to regulate sleep-wake cycles. Patients who suffer from narcolepsy feel rested after waking up but may experience excessive daytime sleepiness. Typically individuals enter rapid eye movement (REM) sleep within ninety minutes, but patients who suffer from narcolepsy fall into REM sleep almost immediately into their sleep cycle, as well as periodically throughout the day.
Narcolepsy is usually diagnosed between the ages of fifteen and twenty-five but can be developed at any age. Narcolepsy affects approximately one in every two-thousand Americans and about three million worldwide. However, the condition is frequently misdiagnosed or undiagnosed, often going untreated. In a recent study, sixty percent of patients were misdiagnosed, with the most common misdiagnoses being depression, insomnia, and obstructive sleep apnea. It is estimated that only twenty-five percent of patients who have narcolepsy have been diagnosed and are receiving treatment. The average time from the onset of the symptoms to the diagnosis of narcolepsy is seven years.
What Are The Types Of Narcolepsy?
There are two types of narcolepsy: type one and type two. Type one narcolepsy, previously termed narcolepsy with cataplexy, was diagnosed based on the patient either having low levels of the brain hormone, orexin, or dealing with cataplexy and excessive daytime sleepiness.
Type two narcolepsy was previously termed narcolepsy without cataplexy. Patients with type two narcolepsy experience excessive daytime sleepiness but usually do not have triggered muscle weakness. Their symptoms tend to be less severe, and have normal levels of orexin. There is also a condition known as secondary narcolepsy that can result from a head injury. Patients with secondary narcolepsy experience typical symptoms of narcolepsy, but may even have neurological problems and sleep for more than ten hours every night.
Excessive Daytime Sleepiness (EDS)
Excessive daytime sleepiness is one of the most common symptoms of sleep disorders, including narcolepsy, with approximately twenty percent of the population being affected by it. Those who deal with excessive daytime sleepiness feel sluggish and drowsy most days, which can impact their productiveness at work, school, activities, hobbies, or relationships.
Another symptom of excessive daytime sleepiness is an increased pressure to fall asleep throughout the day, which can be life-threatening when operating a vehicle or heavy machinery. Most patients are treated with positive pressure devices, though some other treatments such as medications, dental appliances, and surgery work on a case-to-case basis. It is best to consult a psychiatrist before attempting to treat excessive daytime sleepiness or narcolepsy.
Cataplexy is a sudden and uncontrollable muscle weakness or paralysis that occurs during the waking hours. It is triggered without warning of intense emotion, usually laughter, though other triggers can be feelings of annoyance, happiness, excitement, surprise, or stress. A patient affected by cataplexy remains awake and is aware of what is happening but experiences loss of muscle control and can have a slack jaw, broken speech, and weakness in their face and limbs, or can even become temporarily paralyzed.
The duration is brief, tending to last anywhere from a few seconds to minutes. Although cataplexy is most commonly associated with narcolepsy, it has been seen in other conditions such as stroke, multiple sclerosis, head injuries, and encephalitis.
Sleep paralysis is the temporary inability to move or speak when falling asleep or waking up. It tends to occur while falling asleep or waking up. If sleep paralysis happens while falling asleep, it is called hypnagogic or predormital sleep paralysis. If it happens while waking up, it is called hypnopompic or postdormital sleep paralysis. Factors that may contribute to sleep paralysis include a lack of sleep, a change in the sleeping schedule, medications, substance abuse, mental illness, and, of course, narcolepsy. Sleep paralysis can be treated by improving sleeping habits, using antidepressants if they were prescribed, and working with a psychologist and doctor to address any other sleep disorders or mental health issues.
Over ten percent of the population experience hallucinations at some point during their life. Vivid hallucinations are commonplace in patients with narcolepsy and they can target any sensory perception, whether it is visual, auditory, smell, or tactile. These hallucinations can occur when individuals are falling asleep, called hypnagogic hallucinations, or they may occur when waking up, called hypnopompic hallucinations.
These sleep-related hallucinations may be accompanied by sleep paralysis, and are often the result of sleep disorders and mental illnesses such as narcolepsy, insomnia, anxiety, stress, or alcohol and drug use. The best ways to treat hallucinations are by getting adequate sleep, reducing stress, and avoiding alcohol, drugs, and medications that may contribute to the hallucinations.
Additional Symptoms Of Narcolepsy
Other symptoms factor into the lives of some patients who suffer from narcolepsy. Fragmented sleep and insomnia may occur, causing the patient to feel very sleepy and drowsy throughout the day and experiencing difficulties falling and staying asleep at night. Sleep can be disrupted by insomnia, vivid dreams, sleep apnea, obstruction, and acting out while dreaming.
Patients may also experience automatic behaviors, where they fall asleep during activity and automatically continue the activity upon waking up without being aware of what they were doing or being able to recall their actions. Automatic behaviors usually occur while patients are engaged in regular activities such as driving.
Causes And Risk Factors
Most diagnosed cases of narcolepsy are caused by a lack of the hormone orexin, which regulates an individual's sleep-wake cycle, though not all cases are caused by a lack of orexin. Many factors can increase the risk of narcolepsy including genetics, hormonal changes, stress, a change in sleeping patterns, an infection, or having the Pandemrix vaccination. The Pandemrix vaccine was used to treat swine flu in children during the epidemic between 2009 and 2010.
However, research has shown one out of fifty-two-thousand developed narcolepsy after receiving the vaccination. As a result, Pandemrix is no longer given to those under twenty years old. Other factors that may play a role in developing narcolepsy include head injuries, brain tumors, multiple sclerosis, and encephalitis. It has been reported damage to the areas of the brain that produce the hormone orexin can result in the development of the disorder.
How Does Diagnosing Narcolepsy Work?
A physical examination and detailed medical history are essential for the proper diagnosis of narcolepsy, as they can identify possible neurological conditions that may cause the symptoms. Although none of the significant signs remain exclusive to narcolepsy, type one narcolepsy is the easiest to diagnose due to having cataplexy as a symptom, which occurs in almost no other diseases.
Two tests can be performed at a sleep disorder clinic, and are usually required before a diagnosis can be determined. A polysomnogram (PSG) is an overnight test that monitors abnormalities in the REM cycle while the patient is asleep. The second test is the multiple sleep latency test (MSLT), which is performed during the day to measure the patient's tendency to fall asleep. This test determines whether or not REM sleep intrudes at inappropriate times of the day.
What Treatments Are Available For Narcolepsy?
There is no known cure for narcolepsy, though many of the symptoms can be controlled with medications and changes in lifestyle. Sleepiness and REM regulation can be treated with a combination of stimulants and antidepressants. Another form of treatment for narcolepsy is by changing lifestyle and habits. Some lifestyle changes include reducing stress; avoiding alcohol, caffeine, nicotine, and heavy meals; regulating sleep schedules; scheduling naps; and getting daily exercise. It is essential to keep in mind not every case of narcolepsy is alike, and neither are the treatments. If there is any worry about possibly being diagnosed with narcolepsy, it is essential to get tested and work out treatment with a neurologist or psychiatrist.