Narcolepsy is a rare lifelong neurological disorder, marked by chronic sleepiness, that affects men and women equally; about one in 2000 people overall. This condition of chronic sleepiness begins to develop during the teenage years between thirteen and twenty years of age. It can also develop in some people as old as forty to fifty years of age. The good news is that narcolepsy is a manageable condition which means that even if you are diagnosed with it, you can still go on to live a full and rewarding life.
Symptoms of Narcolepsy
There are various symptoms of Narcolepsy. The most prominent symptom is persistent sleepiness to the point where you cannot distinguish being asleep or awake much of the time. The condition can be marked by fragmented sleep during the night and brief episodes of muscle weakness that is known as cataplexy as well as a brief paralysis that the person who is suffering from this condition experiences when he or she falls asleep upon waking up.
Additional symptoms of narcolepsy entail neurological symptoms that are more severe, such as a rare condition that is known as secondary narcolepsy which is caused by an injury to the deep section of the brain known as the hypothalamus.
Types of Narcolepsy
The two types of narcolepsy are with cataplexy and without cataplexy. Those that are diagnosed with narcolepsy without cataplexy have symptoms that are less severe. This just means their condition consists of a general sleepiness that has no emotionally triggered muscle weakness.
There are also two types of sleep with one kind being REM (rapid eye movement) and the other being Non-REM. The former is characterized by quick eye movements, dreams, and paralysis of the sleeper’s limbs and trunk that can prevent them from injuring themselves if they should act out their dreams while they are sleeping. The latter, Non REM, doesn’t experience this paralysis and the dreams are not as common as those with REM sleep.
The Basics of Sleep
To understand sleep disorders such as narcolepsy, it helps to understand the nature of sleep in the first place. It is by understanding the purpose of sleep that empowers us to make healthier choices which will, in turn, lead us to strive for a better quality of sleep.
Up until fifty years ago, sleep was once thought of as the passive and inactive state that the body slips into when the brain and body turns itself off in order to recuperate from the day’s activities. On average, the sleep cycle lasts about eight hours in much of western culture. In the last few decades, scientists are discovering that the brain is perhaps more active while we are sleeping than we are awake. People who have narcolepsy may even be more active than most of the general population which would explain their sleep disruptions and excessive sleepiness.
In its simplest form, sleep is that magical world where we leave the conscious world and traverse through a world of deep sleep and dreams. Although we rarely remember any of this when we wake up and in many cases, the sleep cycle passes so quickly we aren’t even aware of the time lapsing while we are asleep. The basic definition of sleep is period of reduced activity that is mostly associated with posture that involves lying down and closing our eyes; in doing so we also experience a decreased response to any outside, external stimuli that we normally experience during the day when we are conscious.
Also, we want to mention that the basic sleep cycle is easier to traverse than other forms of reduced consciousness such as hibernation and being in a coma where we have less control over the awaking process; if we actually do awaken in these other stages of reduced consciousness since these could lead to a more lasting period of reduced consciousness known simply as death.
People with Narcolepsy
- Usually feel inattentive and drowsy for a good part of the day, if not all.
- Fall asleep more easily and enter REM (rapid eye movement) sleep within fifteen minutes.
- Are more likely to have dreams during naps and experience hallucinations upon awakening, along with sleep paralysis and possible cataplexy.
- Could possibly wake up spontaneously in the middle of the night.
People without Narcolepsy
- Those that don’t have narcolepsy don’t readily fall asleep and typically feel more awake and alert.
- These people rarely enter REM sleep or have dreams during their midday naps and are not as likely to have a hallucination as soon as they wake up.
- Sleep paralysis and cataplexy are not common in those without the disorder so they have a better chance of sleeping well at night.
To sum it all up, narcolepsy makes it more of a challenge to distinguish being asleep with being awake. To those that do not have this neurological condition, being awake and being asleep are actually two different states that do not mix together.
There are a few methods for diagnosing an individual for narcolepsy, the disease which affects one in 2000 people annually. While a self-evaluation using Epworth Sleepiness Scale can give a person some general idea, one still needs to consult a medical professional for formal diagnosis in order to receive a treatment for narcolepsy disorder. The diagnostic process usually begins with a sleep study where a person has to stay overnight in a sleep lab.
Typically, the first overnight test for narcolepsy is a polysomnogram. The purpose of the polysomnogram is to record the individual’s brain waves, breathing, and muscle tone which helps to evaluate the quality of sleep the person is receiving as well as the amount of sleep that serves to detect possible evidence of another sleep disorder such as sleep apnea or periodic limb movement; an example of the latter being a condition known as restless leg syndrome where an individual’s leg jerks during the night uncontrollably while they are sleeping.
After the polysomnogram is taken, the individual will arrive next day for continued observation. The next step in the process is Multiple Sleep Lating Test, or MSLT. You will want to make sure that you get sufficient sleep prior to taking this test. Also, your doctor will want you to temporarily discontinue any medications, otherwise they could affect your sleep and the results of the test.
The MSLT consists of the five twenty minute naps every two hours throughout the following day after the overnight stay. This test is performed after the polysomnogram so that the doctor can better make a determination as to whether or not the previous nights sleep is affecting the patient’s naps during the day.
There are a few ways to diagnose the chronic sleepiness that is prevalent in the neurological disorder known as Narcolepsy. This article will cover the self-diagnose that is perhaps the most accurate since we know our own bodies better than anybody. Still self-diagnosis doesn’t replace a doctor’s report and we should still seek a medical opinion if we have symptoms or narcolepsy or any other illness. It should be noted that the more proactive we are in our own wellness, the easier the medical professional’s job.
A self-diagnosis of narcolepsy would begin by noticing a persistent of sleepiness that occurs throughout the day even despite getting a good nights sleep the previous night. This is usually the first clue and one can find self-assessment tools online to help support their conclusions. That’s the benefit of living in the information age; there is not much of an excuse to not know much of anything.
There are also three questions that you will need to ask yourself once you suspect that you may have narcolepsy:
1) How likely are you to fall asleep during periods of inactivity even after you had a vacation or a weekend or any other multiple days off to catch up on your sleep?
2) Do you often feel very tired despite during the day despite the fact that you begin the day feeling rested?
3) Is dozing off at highly inappropriate times the norm for you?
*Note: Any yes to one or more of these questions needs to be discussed with your primary care physician (PCP) or a sleep specialist.
While sleepiness can occur for a variety of reasons, persistent sleepiness is usually the first clue that someone may have narcolepsy. To help identify problematic sleepiness, ask yourself these questions:
- “Once you have caught up on your sleep during weekends or vacation, are you still likely to fall asleep when inactive?”
- “Do you feel rested in the morning but then tired throughout much of the day?”
- “Do you doze off at inappropriate times?”
If you answered “yes” to any of these questions, you should discuss your sleepiness with your primary care physician or sleep specialist.
Dream-like hallucinations just prior to sleep, and sleep paralysis at times when you are awake, are suggestive of narcolepsy. However, these symptoms are not considered very specific for the disorder, as they can occur in people who simply need more sleep. In contrast, true cataplexy is very distinct and occurs almost exclusively in narcolepsy.
The main purpose of the narcolepsy medication is to keep the patient away from an irregular schedule, to reduce the cataplexy episodes to minimum and to form a normal nyctemeral rythm.
Narcolepsy medications include:
- sodium oxybate
The stimulants of the central nervous system represent the first intention of treatment for people who suffer from narcolepsy. Modafinil is a new non-addictive stimulant and produces no significant changes in patient mood. Some people need treatment with methylphenidate or even with amphetamines, but although these latter drugs are effective, their pharmacological action is accompanied by side effects, such as irritability and palpitations; the risk of addiction is also very high if it is used for a long time.
Hypersomnia is an excess of sleep, which differs from the normal one in duration, depth and quickness of appearance. Hypersomnia should be distinguished from the comatose state of sleep by its reversible character. The two forms of sleep correspond to two kinds of hypersomnia, some corresponding to the slow sleep phase and other to the quickly sleep one.
As a definition, hypersomnia is characterized by excessive sleepiness that occurs almost every day in a person who sleeps normal at night(8-12 hours duration). The person with the disorder just wants to sleep during the day, but there are situations when sleep is installed unwittingly.
While narcolepsy is not a mental health condition, modern neuroscience shows that nearly every illness can be traced to the human mind. It is now clear that just about every illness, mental and physical, is related to emotional problems such as stress, anxiety, and trauma. While narcolepsy symptoms are often mistaken for depression, narcolepsy disorder often goes hand in hand with depression, especially in adolescents and young adults. Research studies on correlation between narcolepsy and depression are inconsistent regarding the rate of co-occurrence for depression and narcolepsy. Researchers claim that the rates of depression symptoms in narcolepsy patients are anywhere between 17% (Roth et al., 1975) and 50% (Daniels et al., 2001). The studies also differ in the conclusion on whether the depression is a cause or a consequence. When depression is suspected, mental health practitioners need to use social-emotional psychological assessments to identify whether observed symptoms have physical or mental health roots or both.
Word “Narcolepsy” gets its meaning from the Greek words “seized by numbness”. Two of the leading symptoms actually serve to reflect this phrase; they are the excessive sleepiness that is marked by “sleeping attacks” during the day that could be a physical version of a panic attack. Another leading symptom that validates the Greek phrase is the severe muscle weakness known as cataplexy which is actually brought about by very strong emotional stimuli. Continue reading →