Narcolepsy

Introduction

Narcolepsy is a neurological malady that afflicts approximately 4 in 10,000 Australians. Unfortunately, and currently, there are inadequate practical treatment opportunities available in our country.

What Is Narcolepsy?

Narcolepsy is classified as a neurological disorder that induces experiences of unpreventable sleep to occur rapidly. These episodes occur frequently and at the most inappropriate times, such as while eating, talking, having conversations, and even driving. While the incidents do occur at any time, they are more frequent during periods of inactivity or uniform, repetitious activity.

Narcolepsy happens when the specific portion of the brain that controls and coordinates sleep and wakefulness does not function properly. This results in sudden fits of Rapid Eye Movement (or REM) sleep, which is the deep dreaming state of one’s nightly sleep.

Image by Shaun F from Pixabay

These periods of “quick-acting sleep attacks” can last anywhere from seconds to approximately 30 to 40 minutes – despite the amount or quality of sleep a narcolepsy sufferer experiences. These sleep attacks can and do occur while at work, socialising, or during other similarly inappropriate occasions.

What are the Main Causes of Narcolepsy?

The cause of Narcolepsy can have several underlying reasons. Practically all narcolepsy sufferers have deficient and shallow hypocretin levels – which is the natural and commonly occurring chemical in our brain that increases wakefulness and regulates one’s REM sleep.

While not completely comprehensible, current studies and research suggest that narcolepsy may result from a mixture of multiple factors when combined, result in a lack of hypocretin being created within our bodies.

These factors include the following three items:

1. Auto-immune Disorders:

Abnormalities in our immune system occur when the body mistakenly attacks healthy human cells or tissue, as it regards them as foreign and dangerous entities. Studies have shown that narcolepsy sufferers have immune systems that will selectively attack the hypocretin-generating brain cells – due to a combination of environmental and genetic factors.

2. Family History and Genealogy

The majority of reported narcolepsy cases have been sporadic in nature, which means that patients do not have any known family history occurrences.

However, there are reported cases of narcolepsy where approximately 10 % of sufferers who were diagnosed reported a close family relative who was diagnosed with comparable symptoms.

3. Brain injuries

While it is exceedingly rare, narcolepsy can result from a traumatic brain injury, specifically to those parts of the brain that coordinate wakefulness and REM sleep.

What are some of the Symptoms of Narcolepsy?

The most characteristic symptoms of narcolepsy are excessive daytime sleepiness, sleep paralysis, cataplexy, and hallucinations.

Excessive daytime sleepiness (or EDS)

Sufferers of narcolepsy will certainly have EDS, and it is usually the most common and obvious symptom. EDS is defined by persistent sleepiness, despite how much sleep a sufferer experiences at night.

Cataplexy

Cataplexy is the sudden loss of muscle tone while awake, leading to debility and voluntary control muscle loss. This condition is frequently triggered by sudden, intense emotional responses such as anger, laughter, high stress, or even excitement. The cataplexy symptoms generally develop weeks and sometimes even years after the original EDS episode.

Sleep Paralysis

Sleep paralysis is the transient inability to either move or speak while attempting to fall asleep or awakening. It typically lasts for only a few seconds and is comparable to REM-induced restraints of any voluntary muscle activity.

Hallucinations

Vivid and frightening images and movements occasionally accompany sleep paralysis. Typically, these hallucinations are visual in nature, however, they can involve the other senses too.

How is Narcolepsy Diagnosed?

Sufferers of narcolepsy all have symptoms that can vary significantly from person to person. As a result of this assertion, a specific laboratory test was devised to diagnose narcolepsy patients, and it is called the Multiple Sleep Latency Test.

The test measures daytime sleepiness periods during a range of four to five rest periods of approximately 20 minutes in length. This test may also determine if there is an early interruption of REM sleep.

What is the best treatment for Narcolepsy?

Unfortunately, there is no direct cure for narcolepsy, and some of the symptoms can be managed only using medication and lifestyle changes. If the condition cataplexy is present, it is believed that the loss of hypocretin will be irreversible and lifelong. However, extreme daytime sleepiness and cataplexy can be regulated in most sufferers with medication.

Modafinil Medicine

Initial treatment of narcolepsy is usually Modafinil, which is a central nervous system stimulant. Modafinil is prescribed first for narcolepsy sufferers as it is less addictive, with fewer side effects than other medications. For the majority of sufferers, this drug is commonly effective in reducing daytime drowsiness and increasing alertness.

Amphetamine Medicine

In some cases, modafinil will not be effective, and doctors then prescribe amphetamine stimulants called methylphenidate to alleviate EDS symptoms.

However, using these medications requires careful and consistent monitoring as they have side effects such as irritability, nervousness, heart rhythm disturbances, and evening sleep disruption. Also, these medical drugs are highly addictive, so they require constant medical supervision.

Any medical treatment should supplement corresponding lifestyle changes, and the following lifestyle strategies have been proven to help narcolepsy sufferers:

Lifestyle Changes

Taking short, scheduled naps when sufferers feel the sleepiest. Also, maintaining a regular sleep schedule is highly recommended.

Sufferers should avoid caffeine and alcohol before bed. Also, individuals should resist alcohol and caffeine for many hours before bedtime. Avoiding smoking, particularly at night-time, is recommended.

Exercising for ~ 20 to 30 minutes per day, at least 6 or 7 hours before bedtime, also promotes quality sleep.

Avoid extensive, heavy meals directly before bedtime. Also, eating near bedtime will make it more difficult to sleep. Sound familiar? They certainly are all common, but tried and true sleep hygiene habits we can all brush up on.

Support groups have been described as remarkably helpful for sufferers. They can share and develop improved coping strategies, share feelings, and remove that sense of social isolation caused by feeling embarrassed about their condition. Narcolepsy support groups provide sufferers with a social network that can contribute practical assistance and important emotional support.

Conclusion

Sufferers of narcolepsy will experience extreme sleepiness most of the time and, in difficult cases, will fall asleep involuntarily, and several times during the day as well.

Narcolepsy is a result of a brain malfunction called the hypothalamus.

Even mild narcolepsy cases can be successfully managed with frequent nap periods, while critical cases will require medication.