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Narcolepsy
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Narcolepsy is a sleep disorder that involves wanting to sleep excessively during the day and having sudden episodes of sleep attacks during the day. It is hard to stay awake for a long period of time, even if you are completely rested and have recently slept. Narcolepsy is debilitating because it disrupts the sleep wake cycle and you cannot get anything done because of sleep attacks. Narcolepsy is unrelated to seizures, to depression, to fainting spells or to a lack of sleep.
There isn't any cure for narcolepsy but there are things you can do to prevent sleep attacks from occurring. Medications can help as well. Coping with narcolepsy doesn't have to be that difficult.
Symptoms of narcolepsy include excessive sleepiness during the day and the feeling of sleepiness that lasts all day long. You can fall asleep without any notice and may sleep just a few minutes of for a half hour or more. You generally feel refreshed after your "nap" but you soon feel tired once again. Your concentration and functionality seem to diminish over time and then you must fall asleep to restore yourself. There is also a sudden loss of muscle tone that can cause you to fall to the floor in your sleep attack. The loss of muscle tone is called cataplexy and can affect just a few or all muscles. You can have disturbances of your speech or a few muscles or problems with all the muscles.
It is possible to have sleep paralysis. This is when you can't move or speak upon the act of falling asleep or upon wakening. The episodes last just a few minutes and, during that time, you have complete awareness of what's going on but you cannot move. You can also have hypnagogic hallucinations which are like "waking dreams". The dream appears to be real when in fact, you are still dreaming.
Those with narcolepsy often have other sleep problems, such as sleep apnea, which interferes with a good night's sleep. Restless legs syndrome is another type of problem found in those with narcolepsy. You can also have problems with "acting out" your dreams or moving the extremities in sleep during a dreaming episode.
Sleep attacks can be very short-just a few seconds long or can last many minutes or an hour or so. You can fall asleep at any point, including activities that can be dangerous. When you awaken, you may have done things in your sleep for which you have no memory. You can write or perform tasks in your sleep and can engage in complex "sleep walking".
Narcolepsy can begin at any time in childhood or adulthood, up to the age of 50 or so. The most common age at onset is between age 10 and age 25 years. If you get narcolepsy early in life, the disease tends to be more severe than if you get it later in life. The exact cause of the disease is not known but it may be hereditary.
Narcolepsy is related to the level of hypocretin, a neurotransmitter in the brain. Those with narcolepsy do not have enough hypocretin in their spinal fluid or in their brain. This is especially true with those who have drop attacks or cataplexy. The lack of hypocretin in the system appears to have some autoimmune basis.
Complications of narcolepsy include interference with relationships due to sleep attacks and "strange" behavior on the part of the person with narcolepsy. There can even be sexual dysfunction because of the sleep attacks. Intense feelings can trigger sleep attacks and can interfere with intimacy. If you have narcolepsy, you can sustain physical harm due to falls or accidents that happen when you suddenly fall asleep. It is almost impossible to drive if you have narcolepsy.
Doctors can diagnose sleep disorders like narcolepsy by getting a sleep history and noting the presence of cataplexy or drop attacks. You may need to sleep overnight at a sleep center in order to have a sense of the sleep patterns. A sleep history and a sleep record is important to know the times and frequency of episodes of sleeping. An EEG during sleep, called a polysomnogram can check to see what's happening with brain frequency during sleep and waking episodes. There is a test known as a multiple sleep latency test that measures the time you stay awake before you must sleep. It determines how fast it takes you to get to sleep.
A hypocretin test determines the amount of hypocretin in the spinal fluid by doing a spinal tap and determining the amount of hypocretin in the spinal fluid.
Medications that help narcolepsy include stimulant medication, such as modafinil, which isn't as addictive as some stimulant medications. Methylphenidate (Concerta or Ritalin) can also be used to keep the individual with narcolepsy awake. Certain antidepressants that block serotonin and norepinephrine breakdown in the nerve spaces can be used. They include Prozac, Effexor and Strattera. Tricyclic antidepressants seem to help cataplexy and Xyrem or sodium oxybate are used for severe cataplexy. Nighttime sleep is improved with this medication and you tend to function better during the day.