Understanding Narcolepsy

A Sleep Disorder with Adverse Everyday Effects

Narcolepsy is a chronic sleep disorder that is characterized by daytime drowsiness and sudden onsets of sleep. Individuals who have narcolepsy often find that it is difficult to stay awake for any lengthy amount of time, regardless of how rested they might feel. Compared to other sleep disorders, narcolepsy can cause serious disruptions in a person’s daytime routine and potentially be harmful.

 

Like many other sleep disorders, narcolepsy can be broken down into two different types: type 1 and type 2. Type 1 narcolepsy stems from low levels of a brain hormone known as hypocretin. Type 2 on the other hand, can be caused by issues such as an injury to the hypothalamus, which is a region in the brain that regulates sleep functions. This type of narcolepsy can also co-exist with other neurological problems.

Symptoms and Causes

The signs and symptoms of narcolepsy typically continue for life but can also gradually become worse over time. The general symptoms include:

  • Excessive and sudden daytime sleepiness
  • Sudden loss of muscle tone (the sudden loss of voluntary muscle control also known as cataplexy)
  • Sleep paralysis
  • Hallucinations
  • Changes in rapid eye movement (REM) sleep.

There are several known causes of narcolepsy, but almost all people with type 1 narcolepsy and cataplexy have extremely low levels of the chemical hypocretin. This chemical normally promotes wakefulness and regulates REM sleep. This lack of hypocretin can be due to autoimmune disorders that cause deficiency in hypocretin production. However, those with type 2 narcolepsy show normal levels of this hormone and typically don’t experience cataplexy. For these individuals, the disorder can be caused by brain injury or other conditions such as tumors or stroke.

Narcoleptic Brain

There are 2 types of Narcolepsy, Type 1 and Type 2. Type 1 stems from low production of the brain chemical Hypocretin, and Type 2 typically stems from injury to the brain. 

Risk Factors

While narcolepsy is less common than other sleep disorders, some factors can put individuals at higher risk for the condition. Age plays a somewhat important role, as people between 10 and 30 are more likely to have it. Family history is also important, as you are up to 20 to 40 times more likely to have narcolepsy if a family member has had it. Other potential risk factors can include genetic background, environmental or occupations factors that make an individual more prone to head injury, as well as health factors such as stroke or tumors.

    Daytime Sleeper

    If a relative has Narcolepsy, you are 20-40 times more likely to have narcolepsy.

    Complications

    Narcolepsy, like many other sleep disorders, can cause dangerous complications in day to day activities. Due to the sudden nature of the condition, normal activities like operating machinery or driving should only be done if proper medications and lifestyle changes have resulted in an adequate reduction of symptoms. Failing to do so can result in fatal automobile accidents, or injury to self or others. Other activities that require alertness and control should also be carefully considered in regard to the impact an episode of narcolepsy.

    Dealing with narcolepsy may prove difficult with employers. Even though the Americans with Disabilities Act requires employers to accommodate the condition, it may be challenging to maintain a good career. This can also apply to children in school who deal with the condition. Both groups of people will have to find ways to balance their schedules and obligations with the effects narcolepsy has on their daily routines.

    Prevention and Treatment

    There is unfortunately no true cure for narcolepsy, but some of the symptoms can be treated with prescribed medications or lifestyle changes. For those that experience cataplexy, the lack of hypocretin is thought to be irreversible and lifelong, but this and daytime sleepiness can be controlled with the use of medications. The following medications are regularly used to help with lack of hypocretin and cataplexy:

    • Modafinil. The initial method of treatment is usually a central nervous system stimulant such as modafinil.  For most people, this medication is generally effective at reducing daytime drowsiness and improving alertness.
    • Amphetamine-like stimulants. In cases where modafinil is not effective, doctors may prescribe amphetamine-like stimulants such as methylphenidate to alleviate daytime sleepiness. 
    • Antidepressants. Two classes of antidepressant drugs have often proven effective in controlling cataplexy in many individuals: tricyclics (including imipramine, desipramine, clomipramine, and protriptyline) and selective serotonin and noradrenergic reuptake inhibitors (including venlafaxine, fluoxetine, and atomoxetine).  In general, antidepressants produce fewer adverse effects than amphetamines.
    • Sodium oxybate. Sodium oxybate (also known as gamma hydroxybutyrate or GHB) is a strong sedative that must be taken twice a night to maintain normal sleep times and thus help control or alleviate daytime sleepiness.

    In case where medications prove ineffective, or simply do not alleviate symptoms on their own, various lifestyle changes can be made to reduce the severity or frequency of narcolepsy symptoms, especially with type 2 narcolepsy. These lifestyle changes include:

    • Take short naps. Many individuals take short, regularly scheduled naps at times when they tend to feel sleepiest.
    • Maintain a regular sleep schedule. Going to bed and waking up at the same time every day, even on the weekends, can help people sleep better.
    • Avoid caffeine or alcohol before bed. Individuals should avoid alcohol and caffeine for several hours before bedtime to avoid disruptions to what should be normal sleeping time.
    • Avoid smoking, especially at night.
    • Exercise daily. Exercising for at least 20 minutes per day at least 4 or 5 hours before bedtime also improves sleep quality and can help people with narcolepsy avoid gaining excess weight.
    • Avoid large, heavy meals right before bedtime. Eating very close to bedtime can make it harder to sleep.
    • Relax before bed. Relaxing activities such as a warm bath before bedtime can help promote sleepiness.  Also make sure the sleep space is cool and comfortable.

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