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| NARCOLEPSY |
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| Narcolepsy (NAR-ko-lep-see) is a disorder that causes a person to have difficulty staying awake. Narcolepsy can cause a person to suddenly fall asleep during the day. These “sleep attacks” occur even after getting enough sleep at night. The unusual sleep pattern that people with narcolepsy have can affect their schooling, work and social life. |
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| The two main types of sleep are rapid eye movement (REM) sleep and non rapid eye movement (NREM) sleep. During REM sleep, your eyes move rapidly even though your eyelids stay shut. Dreaming mainly happens during REM sleep, when your body becomes limp and you are unable to move your muscles. This temporary inability to move prevents you from acting out any dreams that you may be having. |
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| Normally, when people fall asleep they first have NREM sleep. Then they go through a period of REM sleep. People with narcolepsy have a different sleep pattern. They often fall into REM sleep before NREM sleep. Also, in people with narcolepsy, the fine line between being asleep and being awake can be blurred. They often find that certain aspects of REM sleep can happen while they are awake. This causes them to: |
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- Suddenly lose muscle tone and control when awake (cataplexy). This can appear to be muscle weakness and sometimes can trigger the body to collapse.
- Not be able to move or speak while falling asleep or waking up (sleep paralysis).
- Have vivid dreams while falling asleep or waking up (hallucinations).
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| Effects of Narcolepsy |
| People with narcolepsy often fall asleep without warning at inappropriate times. Sleep attacks don’t just happen during quiet times, such as when reading or watching TV. These attacks can occur during driving, eating or other activities and can cause: |
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- Accidents and injuries
- Problems at work or at school
- Social problems
- Impaired memory, thinking or ability to concentrate
- Depression
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| Outlook |
| There is no cure yet for narcolepsy. This lifelong condition can be disabling if left untreated. But medicines and lifestyle changes can improve the symptoms of narcolepsy so that it is easier to live with |
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| What Causes Narcolepsy? |
| Research suggests that the cause of narcolepsy is a lack of the chemical in the brain called hypocretin. This chemical stimulates brain cells and helps promote wakefulness. It is not known why hypocretin is missing in people who have narcolepsy. Some factors that may work together to cause a lack of hypocretin include: |
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- Infection
- Loss of certain brain cells due to brain injury, toxins and/or the body’s destruction of its own tissues (autoimmune reaction)
- Changes in hormones
- Stress
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| One out of 10 people with narcolepsy and cataplexy has a close relative with the same symptoms. This suggests that some people may inherit the tendency to develop narcolepsy. |
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| Who Is At Risk for Narcolepsy? |
| Narcolepsy may affect 150,000 (1 in 2,000) people or more in the United States. It usually first occurs between the ages of 15 and 30 and affects both men and women. The symptoms can start suddenly or appear gradually. The condition is difficult to diagnose without medical tests. Often people live with mild symptoms, such as daytime sleepiness and muscle weakness, for several years before narcolepsy is diagnosed. Narcolepsy can also develop later in life or in children, but it is rare before age 5. Factors that may increase the risk of developing narcolepsy include having: |
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- A brother, sister or parent with narcolepsy
- Certain thyroid disorders
- Diabetes
- A disease in which the body’s infection fighting system mistakenly attacks the body’s own organs and tissues (an autoimmune disorder)
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| What Are the Signs and Symptoms of Narcolepsy? |
| The major symptom of narcolepsy is excessive daytime sleepiness with sleep attacks. People with narcolepsy may also have one or more of the following signs and symptoms: |
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- Sudden loss of muscle tone and control (muscle weakness) over parts or all of the body while awake (cataplexy)
- Sudden inability to move or speak while falling asleep or waking up (sleep paralysis)
- Vivid dreams while falling asleep or waking up (hallucinations)
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| Daytime Sleepiness |
| All people with narcolepsy have excessive daytime sleepiness. This is usually the first symptom of the condition. They also may have sudden, irresistible urges to sleep during the day (sleep attacks). They usually fall asleep for just a few seconds or minutes. Rarely, they may fall asleep for as long as an hour or more. Daytime sleepiness can cause: |
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- Mental cloudiness or “fog”
- Memory problems
- Problems focusing
- Lack of energy
- Depression
- Extreme exhaustion
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| Cataplexy |
| Nearly 3 out of 4 people with narcolepsy (75 percent) experience sudden muscle weakness while they are awake. This is called cataplexy and it is similar to the paralysis that occurs during dream sleep. Mild attacks of muscle weakness can cause: |
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- Head nodding
- Drooping eyelids
- Difficulty speaking
- Difficulty moving arms or hands or a weakened grip
- Buckling of the knees
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| Severe attacks of narcolepsy may cause complete paralysis and falls. Attacks often last less than 2 minutes and they may only last a few seconds. During both mild and severe attacks, the person stays fully conscious. |
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| The sudden attacks of muscle weakness in narcolepsy can happen at any time. But these attacks are often triggered by strong emotions, including: |
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| Attacks of muscle weakness and tone are sometimes the first symptom of narcolepsy that is noticed. But usually this symptom occurs weeks or months after people who have narcolepsy first start to experience excessive sleepiness during the day. |
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| Sleep Paralysis |
| People with narcolepsy may suddenly not be able to move or speak while falling asleep or waking up. They are fully conscious during these periods of sleep paralysis. The paralysis usually lasts just a few seconds or minutes, but it can be scary. Sleep paralysis is similar to the paralysis that happens in rapid eye movement (REM) sleep. Not all people with narcolepsy have sleep paralysis. |
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| Hallucinations |
| Some people with narcolepsy have vivid dreams while they are falling asleep, waking up or dozing. These hallucinations differ from normal dreams because they seem very real and include sights, sounds, smells, tastes and touch. People with narcolepsy may say these hallucinations are scary like a nightmare. The hallucinations can occur with sleep paralysis. |
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| Other Symptoms |
| Some people with narcolepsy have difficulty staying asleep through the night. These frequent awakenings may start years after experiencing the first symptoms of narcolepsy. Another symptom of narcolepsy is to carry out certain actions without awareness. This is called automatic behavior. For example, if people with this symptom are writing, they may scribble rather than form words. When driving, people with automatic behavior may get lost or have an accident because of periods when they aren’t aware of what they are doing. People usually do not remember such automatic behavior. |
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| How Is Narcolepsy Diagnosed? |
| Sleep Tests |
| Sleep tests are usually done at a sleep disorders center. For some sleep tests, you may need to sleep overnight at the center. Other sleep tests can be done during the day. The three tests most often used to diagnose narcolepsy are: |
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- Polysomnogram (PSG)
- Multiple sleep latency test (MSLT)
- Hypocretin test (low levels may indicate narcolepsy)
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| How Is Narcolepsy Treated? |
| There is no cure for narcolepsy, but many of the symptoms of this disorder can be relieved with medicines and lifestyle changes. Treatment for narcolepsy is based on the type and severity of symptoms. Some medicines help relieve daytime sleepiness, while other medicines may help prevent the sudden loss of muscle tone and movement (cataplexy) or vivid dreams while falling asleep or waking up (hallucinations) that some people with narcolepsy have. Not all medicines work for everyone. It may take weeks to months for your doctor to find the best treatment for you. |
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| Medicines To Relieve Daytime Sleepiness |
Doctors may prescribe stimulants to increase daytime alertness in narcolepsy patients, including: |
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- Modafinil
- Pemoline
- Methylphenidate
- Amphetamines
- Xyrem
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| Lifestyle Changes |
| If you have narcolepsy, it is important to combine any drug treatments with lifestyle changes that help lessen symptoms. By taking regular naps at times during the day when you are feeling the sleepiest, you may need less medicine to treat daytime sleepiness. You should also try to go to sleep and wake up at the same time each day and give yourself at least 8 hours to sleep each night. To make it easier to fall asleep at night, you can: |
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- Do something relaxing before bedtime, such as taking a warm bath.
- Keep your bedroom or sleep area quiet, comfortable and free of light and distractions, such as a TV or computer.
- Exercise regularly, but not within 3 hours of bedtime.
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| A few hours before bedtime, you should also try to avoid substances that can make it hard to fall or stay asleep. These substances include: |
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- Caffeine in coffee, chocolate and certain soft drinks and teas
- Tobacco
- Alcohol
- Certain over-the-counter and prescription medicines
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