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Narcolepsy is a sleep disorder characterized by four symptoms: excessive daytime sleepiness (EDS), cataplexy (loss of muscle control), hypnogogic hallucinations (having vivid, sometimes frightening dreams as one falls asleep), and sleep paralysis (an inability to move or speak while remaining aware of one's surroundings, usually as one falls asleep). These four key symptoms are called the Narcolepsy Tetrad. The symptoms of Narcolepsy can appear all at once or can develop gradually over months or years. Few patients have all four symptoms; most have only one or two. Narcolepsy is a fairly uncommon condition, affecting approximately 1 in 2000 Americans.
EDS is usually the first sign of Narcolepsy. Patients often feel tired or sleepy all the time. They tend to fall asleep when most people would remain awake (while watching a movie, writing a letter, walking, or driving). Narcoleptics have four times the number of automobile accidents and 75% of Narcoleptic patients have had work related problems as a result of their sleepiness. Narcoleptics can fall asleep during most any activity.
Attacks of cataplexy - sudden, brief losses of muscle control - may develop right away or not for months or years. Cataplexy can be mild, such as a brief feeling of weakness in the neck or knees, or it may cause a complete physical collapse or fall. Despite being awake and alert, the patient is unable to prevent the attack. Cataplexy is usually triggered by strong emotion, such as laughter, anger, sadness, surprise, or anxiety.
Hypnogogic hallucinations are vivid dreamlike experiences that occur when a person is drowsy, just beginning to fall asleep. These images can be frightening because the patient is partly awake but has no control over the events.
Sleep paralysis is a brief loss of muscle control that occurs when an individual is falling asleep or waking up. The patient may be completely aware of the surroundings, but is unable to move or speak. Sleep paralysis, unlike cataplexy, usually disappears when the person is touched or spoken to. Sleep paralysis may last just a few seconds or several minutes.
Many patients with Narcolepsy also have an increased number of night time arousals or awakenings. This may be related to less slow wave, or deep (restorative) sleep and more light sleep (Stage 1 or REM). Narcoleptic patients also report automatic behaviors (performing complex activities but not being aware of or remembering it). They may suffer double vision, difficulty concentrating, and memory loss. Depression is often seen in Narcoleptic patients. During the uncontrollable sleep episodes, dreaming (REM sleep) is common.
The cause of Narcolepsy is traced to the Central Nervous System, or CNS, which regulates wake and sleep in humans. When we sleep, we lose muscle tone, particularly when we are dreaming (REM sleep). Narcoleptics, however, experience this loss of muscle tone at any given time, whether they are awake or asleep. They fall asleep uncontrollably at inappropriate times.
Narcolepsy is a physical, genetic and hereditary condition. Relatives of Narcoleptic patients are eight to twelve times more likely to be predisposed. While it affects men and women, all races and all age groups, the usual age of onset is in the mid to late teens. Most patients live with the disorder for many years before being diagnosed and treated.
The first step to diagnosis and treatment is an evaluation by your primary care physician (PCP), in order to rule out another medical illness as the cause of your problems. Once this is done, you may be referred to a sleep disorders medicine center.
At a sleep center, two tests are performed to confirm the diagnosis of Narcolepsy and its severity. The first test, a polysomnogram, is an all night study in the sleep laboratory to rule out any other sleep disorders. The following morning and day, a multiple sleep latency test (MSLT), will be performed.
In some cases, pupillometry may also be performed. A physician may study the reaction of your pupils to light. This helps determine the severity of sleepiness.
Narcolepsy is sometimes also identified or confirmed with a blood test, to determine the presence of genetic markers, indicating a predisposition to the development of the disease.
Once diagnosed, Narcolepsy is a disorder, not a disease. While there is no cure, its symptoms can usually be controlled, allowing the patient to lead a fairly normal life. A typical Narcoleptic patient will be treated with medication, behavior modification, and management of the patient's environment.
Prescription medications are effective in controlling the excessive daytime sleepiness, cataplexy, hallucinations, and sleep disruptions. Medications typically include stimulants to combat the sleepiness and antidepressants to combat the cataplexy and paralysis. Drugs to suppress REM sleep (dreaming) may also be prescribed.
Treatment for Narcolepsy also requires adjustments in lifestyle and environment, including proper sleep hygiene (practicing good sleep habits) and regular and scheduled exercise and naps.
Be cautious during activities that can be dangerous, such as driving or cooking. Try to plan your schedule so that you will be alert at these times. Some states have legislation which restricts Narcoleptics from driving. Proof of successful treatment may result in reinstatement of your driver's license. All drivers should consider taking a nap before getting behind the wheel, and stopping on the side of the road to nap periodically.
Schedule car trips as soon as possible after taking your medication.
If the symptoms are affecting the person's ability to drive, hold a job, stay in school, perform normal daily activities, or if the symptoms are interfering with social activities and personal relationships, a visit with a healthcare provider is in order.