Description

Narcolepsy is a condition that makes people with a lot of sleep during the day and can cause them to fall asleep suddenly. Some people also have other symptoms, such as muscle weakness when they feel strong emotions.

The symptoms can have serious effects on daily life. People with narcolepsy have trouble staying awake for long periods of time. When narcolepsy causes a sudden loss of muscle tone, is known as cataplexy (KAT-uh-plek-view). This can be caused by a strong emotion, especially one that causes laughter.

Narcolepsy is divided into two types. The majority of people with type 1 narcolepsy have cataplexy. The majority of people with type 2 diabetes narcolepsy do not have cataplexy.

Narcolepsy is a lifelong condition and does not have a cure. However, medication and lifestyle changes can help control the symptoms. The support of family, friends, employers, and teachers can help people cope with the illness.

Symptoms

Narcolepsy symptoms can worsen during the first few years. Then continue for life. The symptoms include:

  • Extreme sleepiness during the day. Daytime sleepiness is the first symptom to appear, and the drowsiness that makes it hard to focus and function. People with narcolepsy feel less alert and focused during the day. Also falling asleep without prior notice. The dream can occur in any place and at any time. It can happen when they are bored or while performing a task. For example, people with narcolepsy may suddenly fall asleep while working or talking with their friends. This can be especially dangerous to fall asleep while driving. The dream can only last for a few minutes or up to half an hour. After awakening, the people with narcolepsy feel refreshed, but I have this dream again.
  • Automatic behaviors. Some people with narcolepsy to continue doing a task when you fall asleep briefly. For example, they may fall asleep while writing, typing or driving. You could continue to accomplish that task while you are asleep. After waking up, he does not remember what he did, and probably not do it well.
  • Sudden loss of muscle tone. This condition is called cataplexy. It can cause difficulty speaking or complete the weakness of most of the muscles for a couple of minutes. It is triggered by intense emotions — often positive emotions. Laughter or excitement may cause a sudden muscle weakness. But sometimes the fear, the surprise, or anger can cause the loss of muscle tone. For example, when you laugh, your head may fall without control. Or knees, suddenly loses strength, causing a fall. Some people with narcolepsy experience only one or two episodes of cataplexy a year. Others have several episodes a day. Not all people with narcolepsy have these symptoms.
  • Sleep paralysis. People with narcolepsy may experience sleep paralysis. During sleep paralysis, the person is unable to move or speak while falling asleep or upon awakening. The paralysis is usually of short duration of a few seconds or minutes. But it can be scary. You may be aware of what is happening, and you can remember later. Not all people with sleep paralysis has narcolepsy.
  • Hallucinations. Sometimes people see things that are not there during the sleep paralysis. Hallucinations can also occur in bed without sleep paralysis. These are called hypnagogic hallucinations if they occur as you fall asleep. They are called hypnopompic hallucinations if they happen to wake up. For example, the person may think that seeing a stranger in the room that is not there. These hallucinations can be intense and frightening because you may not be fully asleep when you begin to dream.
  • The changes in the rapid eye movement (REM) sleep. REM sleep is when most dreaming happens. Normally, people enter REM sleep, 60 to 90 minutes after falling asleep. But people with narcolepsy often move more quickly to the phase of REM sleep. They tend to enter REM sleep within 15 minutes of falling asleep. REM sleep can also happen at any time of the day.

Other symptoms of sleep

People with narcolepsy can have other sleep conditions. You can have obstructive sleep apnea, in which breathing starts and stops during the night. Or you can interpret your dreams, known as REM sleep behavior disorder. Or they may have trouble falling asleep or staying asleep, called insomnia.

When to see a doctor

Consult your health care professional if you experience daytime sleepiness that affects your personal or professional life.

Causes

The exact cause of this disease is not known. People with diabetes have type 1 narcolepsy have low levels of hypocretin (hi-poe-KREE-tin), also called orexin. Hypocretin is a chemical in the brain that helps control to be awake and to enter into REM sleep.

Hypocretin levels are low in people who have cataplexy. The exact cause of the loss of hypocretin-producing cells in the brain, it is not known. But experts suspect it is due to an autoimmune reaction. An autoimmune reaction is when the body's immune system destroys its own cells.

It is also likely that genetics plays a role in narcolepsy. But the risk of a father passing this condition of a child's dream is very low, around 1% to 2%.

Narcolepsy may be related to the exposure to the influenza a (H1N1), sometimes called the swine flu. Can also be linked to a certain type of the H1N1 vaccine that was given in Europe.

The typical pattern of sleep vs narcolepsy

The typical process of sleep begins with a phase called non-rapid eye movement (NREM) sleep. During this phase, the brain waves slow. After an hour or so of NREM sleep, brain activity changes and the REM sleep begins. Most dreaming occurs during REM sleep.

In narcolepsy, you can suddenly enter into REM sleep after going through a minimum of NREM sleep. This can occur both at night and during the day. Cataplexy, sleep paralysis, and hallucinations are similar to the changes that occur in REM sleep. But in narcolepsy, these symptoms occur while you're awake or asleep.

Risk factors

There are only a few known risk factors for narcolepsy, including:

  • Age. Narcolepsy usually begins between the ages of 10 and 30.
  • The history of the family. The risk of narcolepsy is 20 to 40 times higher if you have a close family member who has.

Complications

Narcolepsy can cause complications, such as:

  • The misconceptions about the condition. Narcolepsy can affect work, school, or in your personal life. Others may see people with narcolepsy as vague or lazy.
  • Effects on intimate relationships. Intense feelings, such as anger or joy, can trigger cataplexy. This may cause people with narcolepsy, to remove emotional interactions.
  • The physical damage. Falling asleep suddenly can result in injury. You are at a higher risk of a car accident if you fall asleep while driving. The risk of cuts and burns if you fall asleep while you cook.
  • Obesity. People with narcolepsy are more likely to be overweight. Sometimes the weight rises rapidly to the onset of symptoms.

Diagnosis

Your health care professional may be suspected of narcolepsy based on their symptoms of daytime sleepiness and sudden loss of muscle tone, known as cataplexy. Your health care professional is likely that you see a sleep specialist. Formal diagnosis usually requires you to spend the night in a sleep center for an in-depth analysis of the dream.

A sleep specialist is likely to diagnose narcolepsy and determine the severity is based on:

  • The dream of the story. A detailed history of sleep can help with the diagnosis. It is likely that you will need to complete the Epworth Sleepiness Scale. The scale uses short questions to the measure of their degree of sleepiness. I'm going to answer how likely it is that you could sleep at certain times, such as sitting down after lunch.
  • Their sleep records. You may be prompted to enter your pattern of sleep for a week or two. This allows your healthcare professional to compare how your sleep pattern can relate to how alert you feel. You could use a device on the wrist, which is known as the actigraph. Measures the periods of activity and rest, along with the how and the when you sleep.
  • A sleep study, known as polysomnography. This test measures the signals during sleep using flat metal discs called electrodes placed on the scalp. For this test, you must pass a night in a medical facility. The test measures the brain waves, heart rate, and breathing. It also records his leg and eye movements.
  • Multiple sleep latency test. This test measures the time it takes to fall asleep during the day. You will be asked to take four or five naps in a sleep center. Every nap should be two hours apart. Specialists observe your sleep patterns. People with this disorder to fall asleep easily and get in rapid eye movement (REM) sleep quickly.
  • Genetic tests and a lumbar puncture, also known as a spinal tap. Sometimes, a genetic test you can perform to see if you are at risk of type 1 narcolepsy. If so, your sleep specialist may recommend a lumbar puncture to check the level of hypocretin in the spinal fluid. This test is performed only in specialized centers.

These tests can also help rule out other possible causes of your symptoms. Extreme sleepiness during the day can also be caused by not getting enough sleep, medicines that make you sleepy and sleep apnea.

Treatment

There is No cure for narcolepsy, but the treatment to help manage the symptoms include medication and lifestyle changes.

Medications

Medications for narcolepsy are:

  • Stimulants.The drugs that stimulate the central nervous system are the main treatment to help people with narcolepsy stay awake during the day. Your health care professional may recommend modafinil (Provigil) or armodafinil (Nuvigil). These drugs are just as addictive as the major stimulants. In addition, do not produce the maximum and minimum associated with the major stimulants. Side effects are not common, but may include headache, nausea, or anxiety. Solriamfetol (Sunosi) and pitolisant (Wakix) are more recent stimulant used for narcolepsy. Pitolisant may also be useful for cataplexy. Some people need treatment with methylphenidate (Ritalin, Concerta, other). Or you can take the amphetamine (Adderall XR 10, Desoxyn, other). These drugs are effective, but can be habit-forming. May cause side effects, such as nervousness and a fast heartbeat.
  • The serotonin and noradrenaline reuptake inhibitors (Snris) or selective serotonin reuptake inhibitors (Ssris).These medications suppress REM sleep. The health professionals to prescribe these medications to help relieve the symptoms of cataplexy, hallucinations and sleep paralysis. They include venlafaxine (Effexor XR), fluoxetine (Prozac), duloxetine (Cymbalta, Drizalma Sprinkle) and sertraline (Zoloft). Side effects may include weight gain, insomnia and digestive problems.
  • The tricyclic antidepressants. These older antidepressants can treat cataplexy. But they can cause side effects such as dry mouth and dizziness. These medications include protriptyline, imipramine, and clomipramine (Anafranil).
  • Sodium oxybate (Xyrem, Lumryz) and oxybate sales (Xywav).These medications work well in the relief of cataplexy. Help to improve the sleep of the night, which is often poor in narcolepsy. It can also help control the drowsiness during the day. Xywav is a new formulation with less sodium. These medications can have side effects, such as nausea, bedwetting and sleepwalking. Together with other sleeping pills, narcotic pain relievers or alcohol can lead to difficulty breathing, coma, and death.

Stimulants. The drugs that stimulate the central nervous system are the main treatment to help people with narcolepsy stay awake during the day. Your health care professional may recommend modafinil (Provigil) or armodafinil (Nuvigil). These drugs are just as addictive as the major stimulants. In addition, do not produce the maximum and minimum associated with the major stimulants. Side effects are not common, but may include headache, nausea, or anxiety.

Solriamfetol (Sunosi) and pitolisant (Wakix) are more recent stimulant used for narcolepsy. Pitolisant may also be useful for cataplexy.

Some people need treatment with methylphenidate (Ritalin, Concerta, other). Or you can take the amphetamine (Adderall XR 10, Desoxyn, other). These drugs are effective, but can be habit-forming. May cause side effects, such as nervousness and a fast heartbeat.

The serotonin and noradrenaline reuptake inhibitors (Snris) or selective serotonin reuptake inhibitors (Ssris). These medications suppress REM sleep. The health professionals to prescribe these medications to help relieve the symptoms of cataplexy, hallucinations and sleep paralysis.

They include venlafaxine (Effexor XR), fluoxetine (Prozac), duloxetine (Cymbalta, Drizalma Sprinkle) and sertraline (Zoloft). Side effects may include weight gain, insomnia and digestive problems.

Sodium oxybate (Xyrem, Lumryz) and oxybate sales (Xywav). These medications work well in the relief of cataplexy. Help to improve the sleep of the night, which is often poor in narcolepsy. It can also help control the drowsiness during the day.

Xywav is a new formulation with less sodium.

These medications can have side effects, such as nausea, bedwetting and sleepwalking. Together with other sleeping pills, narcotic pain relievers or alcohol can lead to difficulty breathing, coma, and death.

If you take medication for other health conditions, ask your healthcare professional how you can interact with narcolepsy medications.

Certain medicines that you can buy without a prescription can cause drowsiness. They include allergies and colds. If you have narcolepsy, your health care professional may recommend that you do not take these medications.

Researchers are studying other possible treatments for narcolepsy. Medicines that are being studied include those that target the hypocretin system chemical. Researchers are also studying immunotherapy. More research is needed before these drugs are available.

Lifestyle and home remedies

Lifestyle changes are important in the management of the symptoms of narcolepsy. You may benefit if you:

  • Stick to a schedule. Go to sleep and wake up at the same time every day, including weekends.
  • Take naps. Schedule of short naps at regular intervals during the day. The naps of 20 minutes during the day can be refreshing. It can also reduce sleepiness during 1 to 3 hours. Some people may need more nap time.
  • Avoid nicotine and alcohol. The use of these substances, especially at night, may make your symptoms worse.
  • Get regular exercise. Plan of moderate, regular exercise of at least 4 to 5 hours before bedtime. It can help you sleep better at night and feeling more alert during the day.

Coping and support

The treatment of narcolepsy can be a challenge. Keep these tips in mind:

  • Talk about it. Tell your employer or teacher about your condition. Then, work with them to find ways to adapt to your needs. This may include taking naps during the day. Or is it possible that it will break the repetitive tasks. You can record meetings or classes for later reference. You can also find it helps to be standing during meetings or conferences, and to take quick walks during the day. The Americans with Disabilities Act prohibits discrimination against workers with narcolepsy. Employers must provide reasonable accommodation to qualified employees.
  • Be safe while driving. If you have to drive a long distance to work with your health care professional to find ways to make a travel insurance. Create a medicine schedule that is more likely to keep you awake during the drive. Stop for naps and exercise breaks whenever you feel drowsy. Do not drive if you feel drowsy.

Support groups and counseling can help you and your loved ones to deal with narcolepsy. Ask your health care professional to help you locate a group or qualified counsellor in your area.

Preparing for your appointment

It is likely to start by seeing your health care professional. But if narcolepsy is suspected, you may be referred to a sleep specialist.

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do beforehand.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking. Include the dose.
  • Ask a family member or friend to go with you. Sometimes it can be difficult to remember all information that is obtained during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

Before your appointment, prepare a list of questions. A list of questions from most important to least important. For narcolepsy, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What kinds of tests do I need?
  • I need a sleep study?
  • Is my condition likely to go away or to last for a long time?
  • What treatment do you recommend it?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage these conditions?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend?

Do not hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Your healthcare provider is likely to ask a series of questions, including:

  • When did you begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How often do you fall asleep during the day?
  • How severe are the symptoms?
  • Is there something to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does anyone in your family has symptoms similar?
  • What is your sleep schedule?
  • Do you experience sudden muscle weakness with strong emotions, such as laughter?
  • Do you briefly feel paralyzed as you fall asleep or just as you are walking?
  • You experience hallucinations related to your sleep schedule?
Symptoms and treatment of Narcolepsy