Narcolepsy

What is Narcolepsy?

Narcolepsy is a neurological disorder caused by the brain’s inability to regulate sleep-wake cycles. The main features of narcolepsy are excessive daytime sleepiness and cataplexy, or loss of voluntary muscle control. The disease is often associated with sudden sleep attacks, cataplexy, insomnia, dream-like hallucinations, and a condition called sleep paralysis. Narcolepsy is a chronic sleep disorder.

Those with narcolepsy find it difficult to stay awake for long periods of time. Individuals diagnosed with narcolepsy may feel well rested after sleep, but feel excessive sleepiness throughout the day. Interrupted sleep and waking up frequently during the night are also symptoms of narcolepsy. If left untreated, narcolepsy can affect psychological, social, and cognitive functions. Narcolepsy can interfere with daily life, including work, school, and social activities.

How does narcolepsy occur?

In order to understand the basics of narcolepsy, it is important to review the features of “normal sleep.” Sleep occurs in cycles. During a normal sleep cycle, an individual will initially enter a light stage of sleep and progress into increasingly deeper stages. Both light and deep sleep stages are called non-REM (rapid eye movement) sleep. After about 90 minutes, we enter the first stage of REM sleep, which is the portion of sleep where dreams occur. During REM sleep, your muscles are limp. Throughout the night, we alternate between stages of REM and non-REM sleep.

For people with narcolepsy, the REM cycle typically begins within 15 minutes of falling asleep. Fragments of REM occur involuntarily throughout the waking hours. This can cause the muscle weakness while awake that is experienced during a typical REM sleep cycle.

Despite the perception that people with narcolepsy are perpetually sleepy, they do not typically sleep more than the average person. Narcolepsy is considered a “state boundary” control abnormality. That is, narcolepsy patients sleep a normal amount, but cannot control the timing of sleep.

Narcolepsy affects both males and females equally and develops with age. Symptoms typically develop in adolescence or young adulthood and may remain unrecognized as they gradually develop. The instance of a familial connection with narcolepsy is quite small, but a combination of genetic and environmental factors may be at the root of this sleep disorder.

Narcolepsy patients typically endure many years of daytime sleepiness before seeking treatment because to most people, sleepiness is not indicative of disease. Yet the devastating potential of this disorder is reflected in studies showing narcoleptic patients are more accident-prone and have difficulty forming or maintaining interpersonal relationships.

Causes of Narcolepsy

Researchers believe that narcolepsy may be caused by a deficiency in hypocretin production in the brain. The results of one recent study, where hypocretin was directly administered to the brain, suggest that hypocretin derivatives may be an effective way to prevent cataplexy and improve wakefulness.

Other factors that may cause deficiency in hypocretin include:

  • Stress such as a big deadline at work or financial problems
  • Being overweight
  • Depression, anxiety, or other mental health problems
  • Medical problems such as sleep apnea or hyperthyroidism
  • Restless leg syndrome
  • Autoimmune disorders
  • Use of caffeine or other stimulants
  • Use of alcohol, other depressants, or sedatives, which can relax you but lead to shallow sleep that starts and stops, especially if you use these drugs for a long time
  • Medicines, such as those used to treat asthma
  • Pain and other discomfort caused by an illness such as
  • Shortness of breath caused by chronic obstructive
  • Poor sleep habits, including going to bed at different times or in a noisy environment, or eating or working in
  • Changes in sleep patterns because of different work hours or travel (jet lag).

What are the symptoms?

The main symptoms associated with narcolepsy are:

  • Excessive daytime sleepiness

This is typically the first symptom to appear in people who suffer from narcolepsy. The need to sleep can be overwhelming for narcolepsy patients. Someone who has narcolepsy is prone to falling asleep while engaged in conversation, driving, eating dinner, or at other inappropriate times. Sleepiness occurs in spite of a full night’s sleep and may persist throughout the day. EDS can feel like a sleep attack, where sleepiness occurs suddenly. All those with narcolepsy have EDS.

  • Cataplexy 

Cataplexy is a symptom of narcolepsy in which a sudden loss of muscle tone, usually triggered by emotional stimuli such as laughter, surprise, or anger. It may involve all muscles and result in collapse. Cataplexy may only affect certain muscle groups and result in slurred speech, buckling of the knees, or weakness in the arms. Consciousness is maintained throughout the episode, but the patient is usually unable to speak.

  • Hypnagogic hallucinations 

During the transition from wakefulness to sleep, the patient has bizarre, often frightening, dream-like experiences that incorporate his or her real environment. Typically this experience is visual. The images can be extremely vivid and may be accompanied by sleep paralysis.

  • Sleep paralysis

Sleep paralysis is a temporary symptom classified by the inability to move during sleep-wake transitions. Sleep paralysis is similar to cataplexy, but it only occurs during the period of waking up. Sleep paralysis may last for a few seconds to several minutes and may accompany hypnagogic hallucinations.

  • Disturbed nocturnal sleep

Waking up repeatedly throughout the night.

  • Leg jerks, nightmares, and restlessness 

How do we diagnose narcolepsy?

A narcolepsy diagnosis requires an exam and detailed medical history. Your doctor may ask you a series of questions regarding your history with sleep. You may also be asked to keep a sleep journal over a period of time.

At Gwinnett Sleep, our sleep clinic is equipped for a specialized test that can help diagnose narcolepsy. A sleep study, or polysomnography, is a recording that identifies various sleep stages for the treatment of sleep disorders. The process typically takes 6-8 hours. While most sleep studies occur at night, they are available during the day for patients that routinely work a third shift. Gwinnett Sleep’s days services include the Multiple Sleep Latency Test and Maintenance of Wakefulness Test.

Narcolepsy Treatment

Although there is no current cure for narcolepsy, sleep medicine and treatment is available. Treatment of narcolepsy consists of stimulants, antidepressants, and other medications. Besides medication, lifestyle changes can help manage narcolepsy. These changes include taking short daytime naps, maintaining a regular sleep schedule, regular exercise, avoiding caffeine, and relaxing before bed.

If you struggle with sleep over a long period of time, it’s time to consult a sleep specialist. Seeking a specialist could also be beneficial if you believe you are experiencing a sleep disorder like narcolepsy. If you are looking to get quality sleep and improve your overall health, call Gwinnett Sleep at 678-582-1929 to schedule an appointment today.