Narcolepsy: When You Have Excessive Daytime Sleepiness
Narcolepsy is a rare neurological disorder that causes excessive, uncontrollable daytime sleepiness. Find out more about its causes, symptoms, treatment, etc.
What Is Narcolepsy?
Narcolepsy is a rare condition that affects your neurological system. Your brain becomes incapable of regulating your sleep patterns leading to a disturbed sleep-wake cycle. A Person with narcolepsy could sleep as much as a person without it, but they may feel fatigued continuously due to inadequate restorative sleep. They can also fall asleep at inappropriate times and suffer from several other symptoms correlated to this disease.
Narcolepsy affects men and women equally and is believed to affect just one in every 2000 people. The symptoms can start in childhood or adolescence, but many people have narcolepsy symptoms for years before they get a diagnosis.
People with narcolepsy feel very sleepy during the daytime and could involuntarily fall asleep during regular activities. As the sleep-wake cycle of people with narcolepsy is blurred, sleep characteristics may occur while a person is actually awake. For instance, cataplexy refers to the muscle paralysis of REM sleep, which happens during waking hours. It leads to a sudden loss of muscle tone that causes a slack jaw or weakness of the legs, arms, or trunk. People with narcolepsy may also have dream-like hallucinations and paralysis as they are waking up or falling asleep, as well as interrupted nighttime sleep and vivid nightmares.
What Are The Types Of Narcolepsy?
The symptoms of narcolepsy may vary from person to person, with some being more severe than others. There are two types of narcolepsy:
- Narcolepsy With Cataplexy: In addition to other narcolepsy symptoms, people having narcolepsy with cataplexy suffer sudden muscle weakness and lose control over muscles in their arms, legs, face, or torso. This makes the person speak slurred words, have a sagging jaw, slump over, and be unable to move. The person remains awake during cataplexy. An episode may persist for seconds or up to 1 - 2 minutes and is usually triggered by intense emotion, including excitement or laughter.
- Narcolepsy Without Cataplexy: A person having narcolepsy without cataplexy experience all the symptoms of narcolepsy such as extreme sleepiness, dream-like hallucinations, sleep attacks, and paralysis while waking up or falling asleep, and interrupted nighttime sleep), but without occurrences of sudden muscle weakness led by strong emotions. Narcolepsy without cataplexy can be less severe than narcolepsy with cataplexy.
What Are The Symptoms Of Narcolepsy?
Following are some of the most common symptoms of narcolepsy:
- Excessive daytime sleepiness: People with narcolepsy experience excessive daytime sleepiness (EDS). In this, you may feel a sudden overwhelming urge to sleep, making it challenging to function correctly throughout the day.
- Cataplexy: Cataplexy refers to a sudden loss of muscle tone. It may vary from a drooping eyelid (partial cataplexy)to a total body collapse. Intense emotions, such as laughing, fear, excitement, etc., may trigger cataplexy. The frequency by which it occurs differs from person to person. It could happen multiple times a day or even once a year. In some cases, cataplexy occurs later in the course, or you may be unable to recognize it if you take certain medications that suppress it—for example, antidepressants.
- Poorly regulated REM sleep: REM (Rapid Eye Movement) is a sleep stage in which you see vivid dreams with a loss of muscle tone. It generally happens after about 90 minutes of falling asleep. REM sleep could occur any time of day for people with narcolepsy, within nearly 15 minutes of falling asleep.
- Sleep paralysis: Sleep paralysis refers to the inability to speak or move while falling asleep, sleeping, or walking. The episodes generally last for only a couple of seconds or minutes. Sleep paralysis is just like the paralysis observed during REM sleep. It doesn’t impact eye movements or the ability to breathe.
- Hallucinations while falling asleep: People with narcolepsy can also experience vivid hallucinations simultaneously with sleep paralysis. The hallucinations generally occur during waking up or falling asleep.
- Fragmented sleep: As we have discussed, people with narcolepsy experience excessive daytime sleepiness. However, they feel difficulty falling asleep at night.
- Automatic Behaviours: People with narcolepsy can sleep during any activity such as driving or eating. They can continue doing the activity for a couple of minutes without consciously knowing that they are doing it. Narcolepsy can also be linked with other sleep conditions such as insomnia, restless leg syndrome, or obstructive sleep apnea.
What Causes Narcolepsy?
The cause of narcolepsy is usually unknown, and it’s believed that several factors may work together. The brain chemical hypocretin (also called orexin) has been found to be low in people with narcolepsy, specifically those who have narcolepsy with cataplexy. This brain chemical helps to regulate sleep and makes you feel awake.
There are numerous things that can trigger low hypocretin levels and, therefore, may cause you to develop narcolepsy, including:
- Inherited conditions: Narcolepsy seems to have run between families, suggesting a genetic cause. It could be that the trait inherited is the incapability to create or maintain sufficient amounts of hypocrisy.
- Autoimmune disorders: There are several autoimmune disorders where the body starts recognizing normal tissues as abnormal and starts killing them. In the case of narcolepsy, it strikes the area in the brain that creates hypocretin.
- Brain injuries: Sometimes, brain injuries or tumors that impact the portions of the brain that manages sleep and wakefulness may also cause narcolepsy.
However, some people with narcolepsy have standard levels of hypocretin, the cause of which is still not clear. Other possible triggers that can cause narcolepsy include hormonal changes such as those observed during puberty or menopause. Exposure to toxins, stress, and infections may also lead to narcolepsy in some cases.
How Is Narcolepsy Diagnosed?
The most significant factor in making a diagnosis of narcolepsy is the description of the symptoms a person is experiencing. Inform your doctor everything you see or feel and also the time of day when it occurs. The doctor may also want you to share if you have a family history of narcolepsy or any other sleep disorders. Then to make the final diagnosis, the doctor will order one or more of the following tests:
- Sleep study (polysomnogram)
- Multiple sleep latency test
- Lumbar puncture
- Blood tests
How Is Narcolepsy Treated?
Narcolepsy is a lifelong condition, which means it couldn’t be cured. However, you can consider some lifestyle changes along with medications to manage your symptoms.
Lifestyle changes are made with an aim to improve sleep pattern as much as possible and includes the following:
- Take short naps throughout the day to minimize daytime sleepiness.
- Maintain a sleep routine. Go to sleep and wake up at the same time each day.
- Avoid caffeine, fatty meals, and alcohol for several hours before bedtime.
- Relax and unwind before sleep. Also, have a calm and cool bedroom.
- Get plenty of exercise before two hours of sleep. It will help improve the quality of your sleep.
Medications for narcolepsy are aimed at decreasing sleepiness during the daytime and controlling cataplexy. The doctors generally prescribe one of the following drugs:
- Sodium oxybate