Sleep Disorders: Narcolepsy

Narcolepsy is sometimes misdiagnosed or mistaken for depression, a seizure disorder, fainting, or dismissed as simply the result of an extreme lack of sleep. It is actually a chronic neurological condition caused by the brain's inability to regulate sleep cycles normally. Sufferers experience an overwhelming and uncontrollable desire to fall asleep at various points during the day. When the urge becomes overwhelming, narcoleptics will fall asleep for periods lasting from a few seconds to several minutes- and in rare instances, several hours.

In addition to excessive daytime sleepiness which can also be attributed to conditions like hypersomnia, sleep apnea, and depression, narcoleptics frequently present the following symptoms:

Cataplexy - a sudden loss of voluntary muscle tone

Vivid hallucinations - during sleep onset or upon awakening

Paralysis - brief episodes of total paralysis at the beginning or end of sleep

Other characteristics include restless nighttime sleep, active behavior during sleep, such as sleepwalking, talking in one's sleep, and acting out during dreams by flailing, kicking, and shouting while asleep.

The sleep patterns of a narcoleptic differ from normal sleep cycles. Whereas regular sleep moves through four stages of deepening sleep into the REM (rapid eye movement) phase, narcoleptics move directly into REM sleep. Often the line between waking and sleep is blurred, and causes them to manifest REM-like characteristics such as loss of muscle tone, inability to speak while falling asleep or immediately after waking, and the vivid hallucinations and dreams mentioned above.

Narcolepsy can significantly disrupt someone's life. The sleep attacks of the narcoleptic aren't restricted to quiet times like reading. They can also occur while eating, driving, or during other active times which can lead to accidents, injuries, social problems, impaired memory or concentration, and depression.

The causes of narcolepsy are still largely unknown. Only 2% of people with narcolepsy have a close relative with the condition, which suggests that factors other than genetics are at play.

Signs of narcolepsy develop in the earlier part of life, usually between ages 10 and 25, but have been known to manifest before age ten and well into the thirties. The symptoms of narcolepsy are chronic- they vary in severity, but they never go away permanently. About one in every 2,000 people in the United States suffers from narcolepsy.

Screening and diagnosis of narcolepsy usually begins with a sleep questionnaire which charts an individual's sleep patterns against the Epworth Sleepiness Scale. Other tests are used to screen out various sleep disorders including a polysomnogram which measures electrical activity during sleep and a multiple sleep latency test or MSLT which measures how long it takes someone to fall asleep during the day.

There is no known cure for narcolepsy. The goal of treatment is to manage symptoms and includes drugs that stimulate the central nervous system and antidepressants, which suppress REM sleep and alleviate the symptoms of cataplexy, sleep paralysis, and sleeping/waking hallucinations.

In terms of self-care, lifestyle modification can play an important role in managing the symptoms of narcolepsy. These behavior changes include:

  • Establishing a regular sleep schedule by going to bed at the same time every day
  • Taking short naps at regular intervals during the day
  • Avoiding substances which inhibit restful sleep such a caffeine and alcohol
  • Regular exercise

If you find yourself excessively sleepy during the day regardless of how much sleep you get at night, speak to your physician. Even if it's not narcolepsy, it's important to get some help so you can get the sleep you need where and when you need it.

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