Narcolepsy: Symptoms, Causes, Diagnosis & Treatment

Narcolepsy: Symptoms, Causes, Diagnosis & Treatment

Narcolepsy which is a neurological disorder, involves a decreased ability to regulate sleep-wake cycles. It is a long-term disorder and cause excessive uncontrollable daytime sleepiness. About 70% of those affected also experience sudden loss of muscle strength, known as cataplexy. Cataplexy is often mistaken for seizures. People with this disorder tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be worse.

About 0.2 to 600 per 100,000 people are affected and the condition often begins in childhood.Fewer than 1 million cases per year are reported in India.

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How does Narcolepsy affect your body?

Narcolepsy can affect the quality of sleep and can make a person exhausted all day.Lack of quality sleep can affect concentration or the ability to remain alert. Cataplexy, or lack of muscle tone, can strike any time, though is often linked to feeling extreme happiness, sadness, or other emotion. Sleep paralysis can occur preventing a person to move or speak for a short time after awakening, which can be scary. Narcolepsy may also diminish quality of nighttime sleep and sex drive.

What are the causes of Narcolepsy?

The cause of narcolepsy may be associated with genes, which control the production of chemicals in the brain that may signal sleep and awake cycles.

While it is also believed that narcolepsy may be due to a deficiency in the production of a chemical called hypocretin by the brain.

Abnormalities in various parts of the brain involved in regulating REM sleep can also be the cause. These abnormalities contribute to symptom development. Narcolepsy is likely to involve multiple factors that interact to cause neurological dysfunction and REM sleep disturbances.

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What are the risk factors of Narcolepsy?

  • Age– Narcolepsy begins in people between 10 and 30 years of age.
  • Family history– The risk of narcolepsy is 20 to 40 times higher if a family member has narcolepsy.
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What are the symptoms of Narcolepsy?

  • Excessive daytime sleepiness– People with narcolepsy fall asleep anywhere and anytime, without warning.
  • Decreased alertness and focus throughout the day, usually is the first symptom to appear.
  • Sudden loss of muscle tone-Cataplexy can cause a number of physical changes, from slurred speech to complete weakness of most muscles, and may last up to a few minutes.Cataplexy is triggered by intense emotions, usually positive ones such as laughter or excitement, but sometimes fear, surprise or anger.
  • Sleep paralysis– People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking, called sleep paralysis. It mimics the type of temporary paralysis that normally occurs during a period of sleep called rapid eye movement (REM) sleep.
  • Changes in rapid eye movement (REM) sleep– REM sleep can occur at any time of the day in people with narcolepsy, usually within 15 minutes of falling asleep.
  • Hallucinations– These hallucinations are called hypnagogic hallucinations and may be particularly vivid and frightening because you may not be fully asleep when you begin dreaming and you experience your dreams as reality.
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How is Narcolepsy diagnosed?

Methods of diagnosing narcolepsy and determining its severity:

  • Sleep history– A detailed sleep history is askedwhich involves filling out the Epworth Sleepiness Scale, which uses a series of short questions to gauge your degree of sleepiness.
  • Sleep records-A detailed diary of your sleep pattern for a week or two is asked to record so as to compare how your sleep pattern and alertness are related.
  • Polysomnography– This measures a variety of signals during sleep using electrodes placed on the scalp. For this test, one need to spend a night at a medical facility. The test measures the electrical activity of the brain (electroencephalogram) and heart and the movement of muscles and eyes.
  • Multiple sleep latency test– This measures how long it takes you to fall asleep during the day. Withfour or five naps, each nap taken two hours apart, sleep patterns are observed.This test can also help rule out other possible causes of symptoms.

How to prevent & control Narcolepsy?

  • Try to avoid or minimize exposure to emotional triggers or stressful environments to lessen the symptoms of this condition.
  • Excessive daytime sleepiness should be minimized to get adequate sleep at night.
  • Avoid sleeping in a supine position as it may cause sleep paralysis, one of the symptoms that cause fear in patients.

Treatment of Narcolepsy- Allopathic Treatment

Medications for narcolepsy:

  • Stimulants-Modafinil (Provigil) or armodafinil (Nuvigil) are prescribed and stimulate the central nervous system. This help people with narcolepsy to stay awake during the day.
  • Methylphenidate– This medication includes Aptensio, Concerta, and Ritalin and are very effective but can be addictive.
  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) – These medications, suppress REM sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis. These include fluoxetine (Prozac, Sarafem, and Selfemra) and venlafaxine (Effexor XR).
  • Tricyclic antidepressants– These antidepressants include protriptyline (Vivactil), imipramine (Tofranil) and clomipramine (Anafranil) and are effective for cataplexy.
  • Sodium oxybate (Xyrem) – This medication helps to improve nighttime sleep, which is often poor in narcolepsy. It may help control daytime sleepiness in high doses.

Treatment of Narcolepsy- Homeopathic Treatment

Homeopathic medicines can eradicate the symptoms of narcolepsy but it is advised to consult a doctor before using any. It is because narcolepsy medicines are prescribed based on your condition and the time period of the disorder.

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Narcolepsy- Lifestyle Tips

  • Stick to a schedule of going to sleep and waking up at the same time every day, including weekends.
  • Take scheduled short naps at regular intervals during the day for 20 minutes. This may be refreshing and will reduce sleepiness for one to three hours.
  • Avoid nicotine and consumption of alcohol, especially at night as this can worsen the symptoms.
  • Get regular and moderate exercise at least four to five hours before bedtime. This may help feel more awake during the day and sleep better at night.

What are recommended exercise for person with Narcolepsy?

Aerobic exercise for an hour at least 3 times a week:

  • Walking
  • Running
  • Cycling
  • Swimming

Narcolepsy & pregnancy- Things to know

  • Narcolepsy during pregnancy will cause gaining more weight, which puts a higher risk for impaired glucose metabolism and anaemia.
  • The risk for the first-degree relative to develop narcolepsy type is 1-2%.
  • Most patients with narcolepsy have vaginal delivery without complications.
  • Though rare, patientshaving cataplexy can interfere with delivery.

Common complications related to Narcolepsy

  • Public misunderstanding of the condition- Narcolepsy may cause serious problems professionally and personally. It may make one to look lazy or lethargic.
  • Interference with intimate relationships-Anger or joy, can trigger signs of narcolepsy such as cataplexy, causing affected people to withdraw from emotional interactions.
  • Physical harm- Sleep attacks can result in physical harm such as, increased risk of a car accident if an attack occurs while driving or the risk of cuts and burns by falling asleep while preparing food.
  • Obesity- People with narcolepsy are more likely to be overweight which may be related to a low metabolism.

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