Narcolepsy

What is Narcolepsy?

Narcolepsy is a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. At various times throughout the day, people with narcolepsy experience fleeting urges to sleep. If the urge becomes overwhelming, individuals will fall asleep for periods lasting from a few seconds to several minutes. In rare cases, some people may remain asleep for an hour or longer. In addition to excessive daytime sleepiness, three other major symptoms frequently characterize narcolepsy: cataplexy, or the sudden loss of voluntary muscle tone; vivid hallucinations during sleep onset or upon awakening; and brief episodes of total paralysis at the beginning or end of sleep. Narcolepsy is not definitively diagnosed in most patients until 10 to 15 years after the first symptoms appear.

What are the symptoms?

• Excessive Daytime Sleepiness - Overwhelming and uncontrollable urge to fall asleep during the day.
• Cataplexy - A sudden loss of muscle control ranging from slight weakness (head droop, facial sagging, jaw drop, slurred speech, buckling of the knees) to total collapse. Cataplexy is commonly triggered by intense emotion (laughter, anger, surprise, fear) or strenuous athletic activity. Most persons with narcolepsy have some degree of cataplexy. Often the person experiencing cataplexy appears unconscious but is awake and alert.
• Sleep Paralysis - Being unable to talk or move for a brief period when falling asleep or waking up. Many persons with narcolepsy suffer short-lasting partial or complete sleep paralysis.
• Hypnagogic Hallucinations - Vivid and often scary dreams and sounds reported when falling asleep. People without narcolepsy may experience hypnagogic hallucinations and sleep paralysis as well.
• Automatic Behavior - Familiar, routine or boring tasks performed without full awareness or later memory of them.

What Causes Narcolepsy?

The cause of narcolepsy remains unknown. It is likely that narcolepsy involves multiple factors interacting to cause neurological dysfunction and sleep disturbances.

How is it treated?

There is no cure for narcolepsy. In 1999, after successful clinical trial results, the FDA approved a drug called modafinil for the treatment. Two classes of antidepressant drugs have proved effective in controlling cataplexy in many patients: tricyclics (including imipramine, desipramine, clomipramine, and protriptyline) and selective serotonin reuptake inhibitors (including fluoxetine and sertraline).

Drug therapy should be supplemented by behavioral strategies. Here are several examples:

• Several short daily naps (10-15 minutes) to combat excessive sleepiness and sleep attacks.
• Routine sleep schedule - try to go to sleep and awaken at the same time every day.
• Alert employers, coworkers and friends in the hope that others will accommodate your condition and help when needed.
• Break up larger tasks into small pieces and focus on one small thing at a time.
• Stand whenever possible.
• Take several short walks during the day.
• Avoid caffeine and nicotine.
• Carry a tape recorder if possible to record important conversations and meetings.

 

Used with Permission from Nationwide Respiratory a division of VGM, Inc.