Daytime drowsiness or recurrent, involuntary bouts of sleep during normal waking hours, sometimes accompanied by brief, intermittent periods of muscular weakness (cataplexy). Sleep paralysis, vivid nightmares, and hallucinations during sleep and awakening are other symptoms.
• Polysomnography and repeated sleep latency tests performed in a sleep laboratory are required for diagnosis.
Table of Contents
Medicines may be used to treat sleeplessness and manage other symptoms.
• About 1 in 2,000 persons in the United States, Europe, and Japan suffer with narcolepsy. Neither sexes are at a higher risk than the other.
•The root of narcolepsy’s mysterious symptoms remains a mystery. Although some cases of narcolepsy have a genetic signature, this is not believed to be the root cause. The condition may be triggered by environmental causes. The destruction of nerve cells in a specific region of the brain by an autoimmune response has been proposed as a potential cause of narcolepsy. (When the immune system mistakenly assaults healthy tissue, this is called an autoimmune response.)
Those who suffer from narcolepsy are more likely to nap often during the day. Because of this, narcolepsy may be very debilitating and significantly increases the probability of being involved in a car crash or other mishap. Life expectancy is unaffected by narcolepsy, which lasts a lifetime.
• Impairments in the regulation of REM sleep, namely rapid eye movement (REM) sleep, are thought to contribute to narcolepsy. Some of the symptoms are similar to those seen during REM sleep. Narcolepsy symptoms such as muscular weakness, sleep paralysis, and hallucinations are similar to REM sleep symptoms such as loss of muscle tone, paralysis, and vivid dreaming.
Characteristics of Narcolepsy
Typically manifesting in late teens or early adulthood, narcolepsy is a lifelong disorder.
The most prominent signs are:
• Extreme drowsiness throughout the day;
• Cataplexy (sudden, temporary episodes of muscle weakness)
Sleep paralysis; sleep hallucinations; nocturnal sleep disturbances; hallucinations when falling asleep or waking up (such as waking up frequently and having vivid, frightening dreams)
Ten percent or less of those who have narcolepsy have every symptom. For the most part, folks just have a few. All of them suffer from chronic afternoon drowsiness.
An excessive inability to stay awake throughout the day
Nap difficulty is a common symptom of narcolepsy, and those who suffer from it often oversleep. Sleep paralysis is a condition in which a person has abrupt, involuntary bouts of sleep at any moment, usually without notice (called sleep attacks). There is only so long that one can fight off sleep.
A person may have many episodes in a single day, or they may experience none at all. Typically, each lasts little more than a few minutes, although they might go on for quite some time. Awakening someone is as simple as waking them from a regular sleep state. Even if they just sleep for a minute or two, they usually feel revitalised when they wake up. Nonetheless, they could nod off again in a few of minutes.
Naps often happen during uninteresting activities like lengthy highway drives or meetings, but they may also happen when you’re eating, talking, or writing.
Cataplexy is an event of transient muscular weakness without loss of consciousness that may occur during the daytime and be caused by strong emotions including anger, fear, joy, laughing, or surprise. Those affected may become slack, lose their balance, or even collapse on the floor. Some people may experience a sagging jaw, twitching of the facial muscles, a closing of the eyelids, and a nodding of the head. Vision impairment is possible. As a result, people could have trouble communicating clearly.
These spells are reminiscent of the paralysis of muscles experienced during REM sleep and, to a lesser extent, the feeling of “weak with laughing.”
About one-fifth of narcoleptics have considerable cataplexy.
Muscle paralysis during sleep
Sometimes, just before falling asleep or right after waking up, individuals attempt to move but are unable to. The paralysis that may occur during sleep is known as sleep paralysis, and it can be a terrible experience. The paralysis might be lifted by the contact of another person. If nothing is done, the paralysis will go away within a few minutes on its own.
About a quarter of those who have narcolepsy will also have sleep paralysis at some point. On occasion, healthy adults and children may experience this.
People often vividly see or hear things that aren’t there when they’re falling asleep or, less often, as they’re waking up. The hallucinations are comparable to those seen during regular sleep, but on a far more powerful level. Hypnagogic hallucinations occur just before sleep while hypnopompic hallucinations occur just after waking.
About a third of persons with narcolepsy report seeing hypnagogic hallucinations. They occur often in otherwise healthy youngsters and even in adults on rare occasions.
Sleep disturbances People with narcolepsy may have sleep disturbances, including awakenings and terrifying nightmares, throughout the night. People may wake up feeling much more exhausted than before, and their sleep won’t restore them.
Those who suffer from narcolepsy typically struggle with day-to-day tasks and maintaining focus. For instance, if they doze off behind the wheel, they are more likely to have an accident and hurt themselves. Trauma is a common side effect of narcolepsy. There’s a chance that output, inspiration, and focus might all drop. Isolation may be harmful to connections between people. A lot of people get into depression because of it.
Narcolepsy Testing and Diagnosis
Sleep studies and multiple sleep latency tests (polysomnography)
When patients with a history of daytime drowsiness also report bouts of muscular weakness, doctors may consider narcolepsy. Because many different diseases might produce similar symptoms, physicians can’t rely on them to make a diagnosis. Normal folks, those with sleep deprivation, sleep apnea, or depression may all experience sleep paralysis and related hallucinations on occasion. Taking certain medications might cause these same side effects. Therefore, sleep lab testing is required.
Overnight polysomnography is the gold standard for sleep assessment in a sleep lab.
Multiple overnight sleep-delay tests the next day
The term “sleep laboratory” refers to any place having a bed, a restroom, and monitoring equipment; this might be a hospital, clinic, hotel room, or other establishment. During electroencephalography (EEG), electrodes are adhered to the scalp and face to capture the brain’s electrical activity and the subject’s eye movements. These electrodes are completely painless to apply. Insight into a patient’s sleep pattern may be gained from the recordings and shared with medical professionals. Electrodes are also used to monitor the heart (electrocardiography, or ECG), muscles (electromyography), and the respiratory system (spirometry). If you want to monitor your blood oxygen levels, just clip a sensor onto your finger or earlobe. Sleep breathing problems (such as obstructive sleep apnea), seizures, narcolepsy, periodic limb movement disorder, and other abnormalities in movement and behaviour may all be diagnosed by polysomnography (parasomnias).
In order to diagnose narcolepsy
Rule out the possibility of misdiagnosis due to physical exhaustion, doctors use a multiple sleep latency test. A sleep laboratory is where people go to spend their days. Five 2-hour sleep times are allotted to them. They are instructed to slumber while lying in a pitch-black chamber. This evaluation of sleep latency makes use of polysomnography. It is used to track when individuals go to sleep, how long they stay asleep, and whether or not they enter REM (dreaming) sleep throughout their naps. People with narcolepsy often experience two or more REM sleep episodes during repeated sleep latency tests.
The functions of the brain, heart, lungs, muscles, and eyes are all tracked and recorded throughout these examinations. The activity of the limbs, among other things, is tracked and recorded.
Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the brain often show no underlying structural or functional abnormalities in people with narcolepsy (MRI). The use of brain imaging and blood and urine testing may help physicians rule out other conditions that might cause excessive daytime drowsiness.
Narcolepsy treatment includes
Both broad strategies and specific tools, like as medications that promote wakefulness.
Unfortunately, narcolepsy remains incurable. However, many individuals are able to lead regular lives after undergoing therapy.
As a corollary to this, it is recommended that people receive the recommended amount of sleep each night and take short naps (less than 30 minutes) at around the same time each day (typically afternoon). These steps may be sufficient if the symptoms are minor. Those who suffer from cataplexy should avoid situations where they may feel compelled to laugh, get angry, or feel fearful.
Drugs that promote wakefulness are used to treat the drowsiness in certain persons. These include modafinil, armodafinil, solriamfetol, pitolisant, sodium oxybate, and calcium, magnesium, potassium, and sodium oxybate. Those receiving medication from a doctor are subject to strict monitoring.
Different receptors in the brain are targeted by
The wakefulness-inducing medicine Modvigil and Modalert. The medications are given once daily, either first thing in the morning or, for shift workers, up to an hour before starting the shift. People with narcolepsy who do not have cataplexy often respond best to these four medications. All of these medications are considered to be safe, although they have the potential for side effects like those listed above. Modafinil shouldn’t be used by pregnant women since it has been linked to serious birth abnormalities, including heart problems.
Extreme drowsiness throughout the day and cataplexy may often be alleviated by sodium oxybate or the oxybate combo medication. These meds are often given twice overnight, one just before bed and once while you’re already in the sack. People who suffer from narcolepsy or cataplexy often find relief from these medications. Nausea, vomiting, dizziness, involuntary urination, drowsiness, and even sleepwalking may all be unwanted side effects.
Stimulants like dextroamphetamine and methylphenidate are reserved for cases when other narcolepsy medications have failed or caused severe side effects. Anxiety, hypertension, tachycardia, and irritability are among side effects of stimulants. They might also be addictive. People over the age of 40 should have an exercise stress test to rule out cardiac problems before being prescribed dextroamphetamine or methylphenidate.
Idiopathic hypersomnia is treated with medicines that promote wakefulness, much like narcolepsy.