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Narcolepsy

Narcolepsy is a sleep disorder defined by constant sleepiness and a tendency to sleep at inappropriate times. Typically, a person with narcolepsy suffers sleep attacks as well as continual sleepiness and a feeling of tiredness that is not completely relieved by any amount of sleep. If not recognized and appropriately managed, narcolepsy can drastically and negatively affect the quality of a person's life.

The exact cause of narcolepsy is not known, but it appears to be a disorder of the part of the brain that controls sleep and wakefulness. As a result, sleep or parts of sleep intrude into the times they are awake. The symptom most easily understood is the sleepiness, which is just the brain being unable to control when the individual falls asleep. Other symptoms, such as cataplexy (sudden, brief losses of muscle strength), hypnagogic hallucinations (vivid dreams that occur when a person is drowsy), and sleep paralysis (brief loss of muscle strength when a person is falling asleep or waking up), are similar to the loss of muscle tone of dreaming that accompanies a normal part of sleep called REM. In people with narcolepsy, these events (the lack of muscle tone or the dream experiences) occur at inappropriate times while they are awake.

Symptoms of Narcolepsy

  • Excessive daytime sleepiness. People with narcolepsy report feeling continually tired or sleepy all the time.
  • Brief losses of muscle strength, also called cataplexy, are typically sudden. Cataplexy can be mild, such as a brief feeling of weakness in the knees, or it may cause a complete physical collapse, resulting in a fall. Cataplexy is usually triggered by strong emotion, such as laughter, anger, or surprise.
  • Sleep paralysis, which is also a brief loss of muscle strength, but it occurs when a person is falling asleep or waking up.
  • Hypnagogic hallucinations are vivid dreams that occur when a person is drowsy. These hallucinations may involve disturbing images or sounds, such as of strange animals or prowlers.
  • Other symptoms including disturbed nighttime sleep, performing routine tasks but not being aware of performing the activity, or double vision may also indicate narcolepsy.

What to Do

If you experience any of the symptoms of narcolepsy and especially if you find them affecting your ability to drive, hold a job, stay in school, and perform normal daily activities, or if the symptoms are interfering with your social activities and personal relationships, it is important for you to see your healthcare professional, or one of our board certified sleep specialists. If one of our sleep experts suspect that you have narcolepsy, you will usually be asked to undergo testing at one of Northside Hospital Sleep Disorders Center clinics. Two tests, a polysomnogram and a multiple sleep latency test (MSLT) are commonly performed to confirm the diagnosis of narcolepsy and determine its severity.

Although narcolepsy cannot yet be cured, its symptoms can usually be controlled or improved so that sufferers experience symptoms less frequently and lead fairly normal lives.

Treatment

There is no known cure for narcolepsy. The goal of treatment is to control symptoms.

Lifestyle changes and emotional counseling may help you do better in work and social activities. This involves:

  • Eating light or vegetarian meals during the day and avoiding heavy meals before important activities
  • Planning naps to control daytime sleep and reduce the number of unplanned, sudden sleep attacks
  • Scheduling a brief nap (10 to 15 minutes) after meals, if possible
  • Telling teachers and supervisors about the condition so you are not punished for being "lazy" at school or work

You may need to take prescription medications to help you stay awake. The stimulant drug armodafinil is usually tried first. It is much less likely to be abused than other stimulants. Other stimulants include dextroamphetamine (Dexedrine, DextroStat) and methylphenidate (Ritalin).

Antidepressant medications can help reduce episodes of cataplexy, sleep paralysis, and hallucinations. Antidepressants include:

  • Selective norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine
  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, or citalopram
  • Tricyclic antidepressants such as protriptyline or imipramine
  • Sodium oxybate (Xyrem) is prescribed to some patients for use at night.

If you have narcolepsy, you may have driving restrictions.

Outlook

Narcolepsy is lifelong (chronic) condition.

It is not deadly, but it may be dangerous if episodes occur during driving, operating machinery, or similar activities.

Narcolepsy can usually be controlled with treatment. Treating other underlying sleep disorders can improve symptoms of narcolepsy.

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