Narcolepsy

Overview

Narcolepsy is a sleep cycle disorder that negatively impacts an individual's daily routine, causing them to dose off at any time during the day. It makes one feel drowsy and tired at random moments, hampering their productivity in the process. Narcolepsy can also sometimes trigger cataplexy, which is the sudden loss of muscle tone, caused by intense emotional reactions like laughter. It is a chronic disease that has no specific cure.

However, proper medication shall help manage the symptoms in the long run. Plus, support from friends and family can emotionally aid the affected person and help them deal with their condition more steadily.

What is Narcolepsy?

Narcolepsy is essentially a sleeping disorder which prevents the suffering individual from staying awake for hours at a stretch. The brain of the affected person is usually unable to control whether or not they stay awake. This urge to fall asleep is almost irresistible. Considered to be quite a disruptive condition, narcolepsy has a huge impact on a person’s social and professional life.

However, the symptoms can be managed as their response to medicine has mainly been positive, as per records to date. Yet, one cannot expect to be rid of the effects of narcolepsy because, after all, it is a chronic condition.

Types of Narcolepsy

Two recognised types of narcolepsy affect individuals, namely:

Type 1 Narcolepsy

The type 1 narcolepsy used to be known as narcolepsy with cataplexy. In this category, the concerned individual shall showcase low levels of hypocretin, which is a brain hormone. The individual may have developed cataplexy and portrayed extreme degrees of sleepiness on nap tests that are specially conducted for accurate diagnosis.

Type 2 Narcolepsy

Type 2 narcolepsy was initially known as narcolepsy without cataplexy. Under this category, the suffering individual does not showcase compromised levels of hypocretin i.e. the brain hormone. Their symptoms are much less intense and more manageable compared to type 1 narcolepsy. Individuals do experience high degrees of sleepiness in the daytime, but the urge is not accompanied by muscle weakness or other symptoms.

Secondary Narcolepsy

Secondary narcolepsy can result when there is an injury caused to the area located deep within the brain, which controls sleep. This region is known as the hypothalamus. The condition may trigger unusual neurological issues and cause the affected individuals to sleep for long hours at a stretch.

Symptoms of Narcolepsy

The primarily recognised symptom of narcolepsy is daytime sleepiness. One can fall asleep any time during the day, without prior warning. Naps can last for half an hour, a few minutes or more. Once they wake up, they are likely to feel fresh but eventually feel groggy again. This symptom is usually not one to be controlled, causing sleepiness at times. Whether one is out and about engaged in any work or simply unoccupied, the urge to sleep may arise.

Other symptoms associated with narcolepsy include cataplexy which can trigger complete or partial weakness of muscle tone and slurred speech; and sleep paralysis which may last a couple of frightening minutes or more.

Hallucinations may occur even when the affected individual is not in bed or sleeping. Hallucinations which occur when one is about to fall asleep are called hypnagogic hallucinations; ones that occur as they are waking up are termed hypnopompic hallucinations. Such episodes can cause great distress in individuals.

The average individual moves into the REM state around 60 - 90 minutes after they fall asleep, while one with narcolepsy shall enter the stage within 15 minutes of falling asleep. Individuals may even experience other sleeping disorders simultaneously, including obstructive sleep apnea or insomnia.

Causes of Narcolepsy

The exact cause of narcolepsy cannot be pinpointed. However, there has been research to provide some possible causative factors. While it is known type 1 narcolepsy is caused due to low levels of hypocretin in the brain, there is no explanation as to how the low levels are achieved. Researchers suggest that it could be an autoimmune response.

Genetics are also thought to play a role in triggering narcolepsy. However, note that there have been very few cases of the condition being passed down from parent to child. Finally, some cases of the condition have been linked to the H1N1 virus, which is the swine flu virus, and its vaccine.

Injury to the hypothalamus, a region within the brain that controls sleep, can trigger narcolepsy-like symptoms. Other causes may include immense psychological pressure and hormonal changes (typically experienced during menopause or puberty).

Narcolepsy Diagnosis and Tests

The complete analysis of an affected individual's medical records is crucial. Said person is also put through a thorough clinical examination before a diagnosis is made. The healthcare professional may recommend keeping a sleep journal so they can keep note of the concerned person's sleeping pattern and other symptoms. This knowledge shall help doctors establish a proper treatment plan.

The two specialised tests conducted to diagnose narcolepsy include a polysomnogram which is a sleep study recording muscle and brain activity, eye movements and breathing; and a multiple sleep latency test that studies daytime urges to nap. The latter analyses how long it takes for one to enter the REM state and how fast one falls asleep.

Genetic tests and a spinal tap may be performed at specialised centres, to check if an individual is at risk of developing type 1 narcolepsy.

Narcolepsy Management and Treatment

Narcolepsy cannot be treated as it is a chronic condition. However, its symptoms can be managed with a few lifestyle tweaks and appropriate medication. Some commonly prescribed medicines include stimulants like modafinil and armodafinil, which stimulate the central nervous system. SNRIs and SSRIs can suppress REM sleep, thus, cancelling out cataplexy, sleep paralysis and hallucinations. Tricyclic antidepressants, xyrem and xywav can also cure cataplexy or relieve its symptoms.

Preventive Measures for Narcolepsy

As there is no cure for narcolepsy, preventive measures may not apply. However, there are certain lifestyle changes one can adapt to and reduce the effects of the condition in their daily life. For example, having a proper sleeping pattern can help avoid extreme drowsiness at unexpected times. Brief naps can be squeezed into the suffering person's daily routine so they do not take anybody by surprise. Apart from that, avoiding smoking, alcohol and caffeine shall help.

Large meals before sleep and exercising right before bedtime should be avoided. Other measures to fix the sleep cycle like setting proper hours of sleep, waking up and going to bed at the same time every day, taking soothing showers before bedtime and maintaining a comfortable temperature in the bedroom shall all help get a fulfilling sleep.

Myths and Facts Related to Narcolepsy

Here are some misunderstandings related to narcolepsy and the truths of the matter:

Myth 1: Narcolepsy Isn’t a Serious Disease
Fact: Narcolepsy is, in fact, a serious disease that can hamper the daily life of affected individuals. It can cause them to fall asleep without notice, and obstruct the usual span of activities an average person would otherwise be able to participate in. Other associated complications like sleep paralysis, hallucinations and memory lapses shall also affect the diagnosed person.

Myth 2: Children Cannot Have Narcolepsy
Fact: Children, as young as 5 to 6 years old, can have narcolepsy. The symptoms of the condition can often start to show up at a tender age. However, the symptoms may differ in children when compared to the ones in adults. Thus, it can often be tricky to detect the condition in kids.

Myth 3: People with Narcolepsy are Just Lazy
Fact: Narcolepsy is a serious condition that causes the affected individual to feel drowsy and fall asleep at random times of the day, often due to low levels of hypocretin in the brain. It is not just a person being lazy or unmotivated. If symptoms are noticed, it’s recommended that the individual gets checked out by healthcare professionals immediately.