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NARCOLEPSY

Narcolepsy – General Information

The cause that produces Narcolepsy is still unknown. The disease is a neurological disorder and is characterized by excessive sleepiness that is typically associated with cataplexy (a sudden loss of muscle tone and paralysis of voluntary muscles that is associated with a strong emotion) and other REM sleep abnormalities such as sleep paralysis, (Immobility of the body that occurs in the transition from sleep to wakefulness.) and hypnagogic hallucinations (pre-sleep dreams). The disease is not a fatal disorder in itself. Narcolepsy has a great impact on functionability. Due to the excessive sleepiness, narcoleptics may fall asleep while driving and that is sometimes fatal. There are different levels of severity. Some with this disorder may have mild sleepiness or rare cataplexy (less than once per week). Others may have moderate sleepiness or infrequent cataplexy (less than daily). Yet others may experience severe sleepiness or severe cataplexy (daily). Narcolepsy is usually treated with a medication to improve alertness and an anti-depressant that helps control cataplexy. Narcolepsy usually begins in the teens or early twenties (10 to 20 years old), but this varies; both young children and the elderly experience sleep attacks as well. Narcolepsy is a lifelong condition, but by implementing certain lifestyle changes and seeking medical help, narcoleptics can improve alertness and enjoy a full and active life. All of the symptoms of Narcolepsy may be present in various combinations and degrees of severity. Ask your personal physician for more information.

Narcolepsy – Symptoms

The main symptoms of Narcolepsy are usually sudden episodes of falling asleep and excessive daytime. The falling asleep episodes often take several seconds to more than thirty minutes. Symptoms also include loss of muscle control (cataplexy), hallucinations, sleep paralysis, microsleep, nighttime wakefulness, and rapid entry into REM sleep. Cataplexy is thought to occur during times of intense emotional states, for example, the shock of winning the lottery or extreme anger. This distinguishes cataplexy from its host condition, Narcolepsy, whose onset does not discriminate with regard to the patient's emotional state. During a cataplectic attack, the person is completely awake and later will have total recall of the entire event. Sleep paralysis is when you are not able to move immediately before falling asleep. People who experience sleep paralysis have described feeling afraid, as if some person or creature were sitting on their chest, holding them down. People with this disorder may have periods of wakefulness at night, with hot flashes, elevated heart rate, and sometimes intense alertness. This disrupted nighttime sleep adds to daytime sleepiness. Hallucinations are experiences that occur during the transition from wakefulness to sleep. These hallucinations can involve hearing, vision, touch, balance, even movement. They are usually bizarre, frightening, and disturbing for the patient, that’s why they can end fearful and also develop mental illness. Patients may refer to this symptom by any of the following descriptions: being tired, fatigued, or sleepy, feeling lazy, or having low energy.

Narcolepsy – Treatment

Officially, there is no cure for this disease, that’s why excessive sleepiness, cataplexy, sudden sleep onset are treated symptomatically. Therapies for this disorder involve the practice of getting sufficient nocturnal sleep, proper sleep hygiene practice, and drug therapy. Proper sleep hygiene, which includes a consistent sleep schedule and the avoidance of shift work and alcohol, is especially important. Sleep hygiene is very important. For example, many people have an improvement in their symptoms if they maintain a regular sleep schedule, usually seven to eight hours of sleep per night. Also, scheduled naps during the day also help. Studies suggest that the optimal sleep pattern is a combination of scheduled nighttime sleep (such as from 11:00 pm to 7:30 am) and 2-15 minute naps. Since the disease has no cure, medications and lifestyle modifications can help to manage the symptoms. Medication includes stimulants, antidepressants, and a medicament called sodium oxybate or Xyrem.

In the stimulants treatment, there are usually used drugs that stimulate the central nervous system, and are considered the primary treatment to help people with Narcolepsy stay awake during the day. A newer stimulant, called Modafinil or Provigil, isn’t as addictive and doesn’t produce thee lows and highs often associated with older stimulants. Some of the patients take methylphenidate or Ritalin. These medications are effective, but it can also appear the side effects, such as nervousness and heart palpitations, and can also be addictive. Antidepressants are often prescribed by the doctor, which suppress REM sleep, to help alleviate sleep paralysis, hypnagogic hallucinations and symptoms of cataplexy. This type of medication includes tricyclic antidepressants protriptyline or Vivactil and imipramine.

Xyrem, that is sodium oxybate, controls cataplexy, sleep paralysis, and hallucinations. This medication also helps to improve nighttime sleep, which is often poor in this disease. In high doses it may also help control daytime sleepiness, even though you take it only at night. However, because the use of this drug has been associated with serious side effects, such as trouble breathing during sleep, sleepwalking and bed-wetting, it's strictly regulated by the doctors. Using genetically engineered mice lacking the nerve cells in the brain that produce the brain chemical orexin, the research team experimented with introducing this chemical in the brain both genetically and by injection. Without orexin, the mice exhibited narcoleptic like symptoms including both overpowering sleepiness and cataplexy. When injected with orexin, they returned to full wakefulness. People with mild symptoms that do not require medication may be able to maintain alertness with sleep scheduling. In a 2001 study, scheduled sleep periods were also helpful for patients who were extremely sleepy in spite of medications. The benefits of scheduled naps, however, are not clear for patients whose condition responds to medication. In the same study, patients who took stimulants and were able to maintain alertness or were only moderately sleepy derived no additional benefit from the naps. Patients with Narcolepsy may have driving restrictions placed on them. These restrictions vary from state to state. Patients with Narcolepsy should also avoid heavy meals and alcohol (as it can interfere with sleep).


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