Narcolepsy is a neurological condition characterized by excessive daytime sleepiness (EDS). This condition is the result of the body’s inability to regulate its natural sleep cycle. This can result in sudden ‘sleep attacks’ that can occur unexpectedly and without warning during routine activities, such as eating, working or even driving. The sufferer is also more likely to seek naps during the day. In contrast to popular perception, narcoleptics do not sleep more than the average person. They have simply have highly disturbed sleep patterns resulting in restless and inadequate sleep during the evenings, and napping or uncontrollable sleep during the day.
Additional symptoms that be present in some narcoleptics include sleep paralysis, cataplexy, hypnogogic hallucinations and automatic behaviour.
Sleep paralysis is the temporary inability to act upon waking up, and can last from a few seconds to several minutes. It can be also be accompanied by hypnogogic hallucinations. Sleep paralysis is perceived by many sufferers as a dream, and upon coming out of the state they will think nothing of it, or have limited recollection of it. Those who are consciously aware of their sleep paralysis often find the experience scary and disturbing, though it is not dangerous.
Hypnogogic hallucinations occur just before sleep, or just prior to waking up, and can include visual, tactile and auditory sensations. The most common of these, and one that many people experience is the sensation of falling just before waking, resulting in a startled awakening that may include lingering elements of fear and muscle tension. Visual hallucinations often include apparitions of some sort, and are believed to explain some of the reported cases of ghost sightings and alien abductions. Auditory hallucinations often feature undefined sound, such as deep ringing, buzzing or static-like noise.
Cataplexy is a form of muscle weakness triggered by strong emotions, and can result in drooping eyes or head, weakness in the knees, or a complete collapse. It is usually accompanied with blurred vision and occasionally ringing noises in the ear, though the person’s senses remain aware during the entire process, often making it a harrowing experience.
Automatic behaviour is a form of sleep walking, in which the person continues to perform activities despite being in a sleeping state. The person will have no recollection of their automatic behaviour state, and upon waking will often find themselves surprised by where they are, or the changes in their environment. Automatic behaviour affects over 40% of narcoleptics.
Narcolepsy is an uncommon condition, affecting approximately 1 in every 2000 people. It is strongly linked with certain genetic conditions, and is more likely to occur in people with a family history of the disease.
The onset of narcolepsy usually occurs in adolescence and develops over the next 15 years. Narcolepsy is difficult to detect early, and is often misdiagnosed as other conditions. Many fully developed cases of narcolepsy also go undiagnosed or undetected, especially in the case of patients living alone.
In fully developed forms of narcolepsy that exhibit all the aforementioned symptoms, diagnosis is relatively easy, and treatment plans can begin. In cases where cataplexy is mild or non existent and sleep attacks are uncommon, it can be more difficult to diagnose. The overnight polysomnogram test is the leading method for detecting narcolepsy. Narcoleptics have the tendency to fall asleep rapidly, and enter and exit deep sleeping states quickly. This is easily discernable by the polysomnogram test, which monitors brain wave activity and can detect the state of sleep the patient is in. Narcoleptics will also wake up frequently during the night, which is also recorded by the test.
The second routine detection test is the multiple sleep latency test. A patient will be given the chance to attempt to go to sleep every couple of hours during the daytime. The ease with which they fall asleep, and the speed at which they enter deep sleep are strong indicators of EDS and narcolepsy. Those without narcolepsy given this test will often have trouble sleeping, or will be unable to fall asleep at all.
Treatments for narcolepsy can alleviate the symptoms of the disease, but there is no known method of removing the underlying cause. Stimulants are used to offset the effects of daytime sleepiness such as amphetamines, methamphetamines and codeine. Treatment for cataplexy often comes in the form of antidepressants, with the leading cataplexy medication being gamma-hydroxybutyrate. It is only drug on the market specifically for use with cataplexy, and also alleviates the symptoms of EDS in patients. A recommended treatment for sleep attacks is to take numerous scheduled naps during the day to decrease the likelihood of an attack.
The connection between narcolepsy and hypocretin production in the brain has recently been targeted, and studies have shown that hypocretin derivatives decrease the onset of cataplexy and EDS.
Non-pharmacological treatments in conjunction with prescribed drugs, or as a stand alone treatment in less severe cases of narcolepsy, include taking regular daytime naps to improve EDS and reduce the possibility of sleep attacks, reduction of alcohol consumption and large servings of food which can increase drowsiness, regular exercise, consistent exposure to sunlight, and avoidance of any routines that require a drastic shift in schedule such as shift work.
The severity of symptoms can change rapidly, making it important to stay in contact with a sleep specialist and have your case monitored constantly. Narcoleptics are at a higher risk of accidents or mishaps as a result of sleep attacks, especially while driving, and being on top of your situation and understanding your limitations at all times is vital.
Reviewed September, 2007