What do you mean by narcolepsy？
The inability of your brain to regulate your sleep-wake cycle is known as narcolepsy. This can cause you to feel sleepy abruptly at any time of day. You may have narcolepsy if you’re frequently sleeping off during activities like conversing on the phone, operating a motor vehicle, eating, attending classes, or working. This can be dangerous sometimes, such as when driving.
Although narcolepsy can affect people of any age, the earliest signs of daytime sleepiness typically develop in adolescence or the early 20s. Narcolepsy may go years without a diagnosis and without treatment since its symptoms resemble those of depression, other sleep disorders, or other illnesses.
What are the types of narcolepsy？
Narcolepsy exists in two forms, namely:
- Type 1 narcolepsy (occurs with cataplexy)
- Type 2 narcolepsy (occurs without cataplexy)
Cataplexy is another term for abrupt muscle weakness. A weakening in one part of your body, such as an arm or a leg, slurred speech, or total immobility can all be symptoms of cataplexy.
What causes narcolepsy？
Hypocretin is a neurotransmitter that controls the REM (rapid eye movement) state and the sleep/wake cycle. Hypocretin levels are lost in narcoleptics.
Other factors that cause the condition are:
- Environmental factors like pesticides, secondhand smoke, and heavy metals
- Brain injury or a tumour affecting the area that controls REM sleep and wakefulness
- Positive family history
- Autoimmune conditions where the brain cells that make hypocretin are destroyed
What are the signs and symptoms of narcolepsy？
The main symptoms of narcolepsy include:
Cataplexy:
- This is the rapid onset of muscular weakness
- Your entire body may be affected by weakness or just a specific area
- Feeling ‘weak in the knees’, drooping eyelids, slurred speech, head dipping, arm or limb weakness, and even falling over are a few typical symptoms
- These weakening spells typically only last a brief period, sometimes only a few seconds
- Strong emotions like surprise, laughing, happiness, fear, or rage frequently cause cataplexy
Hallucinations:
- These visions resemble dreams and may involve hearing or seeing things that aren’t actually there
- Typically, you experience hallucinations right before sleeping or waking up
- These incidents are frequently characterised as horrifying or unpleasant
Excessive daytime sleeplessness:
- This tiredness makes it tough to stay awake during the day
- You might doze off while conversing with someone, operating a motor vehicle, eating, attending classes, or working
Sleep paralysis:
- This symptom is difficulty speaking or moving right before or right after waking up
- Typically, episodes of sleep paralysis last for a few seconds to a few minutes
Sleep disruption:
- You can have problems falling asleep, and you may wake up frequently at night
- Narcoleptics may find this difficult because they feel drowsy all day long yet can’t sleep through the night due to frequent wakings
How do people with narcolepsy sleep at night?
In roughly 50% of narcolepsy patients, nighttime sleep is characterised by a brief sleep latency. In addition to the brief sleep latency, it is characterised by difficulty staying asleep and frequent waking up during the night.
What is the peak age for narcolepsy?
How can narcolepsy be diagnosed？
Two main sleep tests are done to confirm the diagnosis of narcolepsy:
Polysomnogram (PSG):
- This test is usually done overnight by continuously measuring parameters like heart rate, oxygen level, breathing rate, eye and leg movements, and brain waves while you sleep
- Using this test, you can learn how quickly you fall asleep, how frequently you wake up at night, and how frequently your REM sleep is disturbed
Multiple sleep latency test (MSLT):
- In this test, you will be offered four or five opportunities to take naps throughout the day as you undergo this test, which involves having some of the same sensors attached during the sleep study
- Your ability to fall asleep at these nap times, how quickly you do so, and the stages of sleep you experience will all be recorded
What is the treatment for narcolepsy？
The main goal of narcolepsy medications is to improve alertness and reduce daytime sleepiness. These medications include:
- Wake-promoting medications: These medications aid patients in staying awake during the day but do not address cataplexy or other narcolepsy symptoms linked to REM sleep. Examples: Modafinil, Armodafinil
- Sodium oxybate: This is an FDA-approved drug for treating daytime drowsiness and cataplexy in narcolepsy patients. It is taken as a drink before bed and then again 2.5 to 4 hours later (not in the morning)
- Stimulants: These are also effective in treating narcolepsy, but they possess a higher risk of side effects like nervousness, agitation, and palpitation. Examples: amphetamine and methylphenidate
- Antidepressants: Drugs in this category, like selective serotonin reuptake inhibitors (SSRIs), or serotonin, and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants are used for narcolepsy.
Examples are fluoxetine, venlafaxine and protriptyline, imipramine
What lifestyle changes should I make to prevent narcolepsy？
- Have a consistent sleep time and wake-up time on all days including weekends
- Try to get at least 8 hours of sleep per night
- Try taking a few 15-minute naps during the day to recharge
- Avoid using substances like tobacco, alcohol, caffeine, and drugs that can interfere with your sleep
- Refrain from using electronics in bed or right before bed
- Avoid eating or drinking a lot right before going to bed
- Get regular exercise
How can a narcolepsy diagnosis help me live my daily life more effectively?
Driving
If you have narcolepsy, driving can be risky. Motor vehicle accidents are more likely to occur among narcoleptics. Here are some safety tips that should be taken during driving:
- Take a short nap before you drive
- Try to drive only short stretches of time
- Keep yourself engaged while driving
Work
Ask your employer to adjust your work schedule and also try to take a rest in between your work.
Support
Take the help of counsellors if you face difficulty coping with the disease.
