What Is Narcolepsy?
Narcolepsy is a sleep disorder. The principal symptoms are excessive daytime sleepiness (EDS), cataplexy (loss of muscle tone), hallucinations, sleep paralysis, and disrupted night-time sleep.
Narcolepsy is a sleep disorder. The principal symptoms are excessive daytime sleepiness (EDS), cataplexy (loss of muscle tone), hallucinations, sleep paralysis, and disrupted nighttime sleep. Doctors also diagnose narcolepsy by measuring how quickly the patient falls asleep and how often rapid eye movements are present at or near the onset of sleep.
Excessive daytime sleepiness occurs every day, regardless of the amount of sleep obtained at night. EDS is usually experienced as a heightened sensitivity (sometimes an almost irresistible susceptibility) to becoming sleepy or falling asleep, especially in sleep-inducing situations. Patients describe the problem as a sleepiness, tiredness, lack of energy, exhaustion, or a combination of these feelings, either continuously or at various times throughout the day. Sometimes sleepiness occurs so suddenly and with such overwhelming power that it is referred to as a "sleep attack." Some patients have several "attacks" each day. When the attack occurs during the day, sleep usually last for less than 30 minutes, but sometimes the patient stays asleep for several hours.
Cataplexy is an abrupt loss of voluntary muscle tone, usually triggered by emotional arousal. Attacks can range in severity from a brief sensation of weakness to total physical collapse lasting several minutes. Hallucinations are intense, vivid, sometimes accompanied by frightening auditory, visual, and tactile sensations, and these hallucinations occur just when awakening or falling asleep. Occasionally, they are extremely difficult to distinguish from reality. Sleep paralysis is a momentary inability to move when waking up or falling asleep. This condition can be terrifying, especially if it occurs with a frightening hallucination.
Narcolepsy is a lifelong illness. There is no known cure, and no report of lasting remission has been confirmed. Typically, symptoms (usually EDS) first become noticeable between the ages of 10 and 30. Symptoms are subtle at first but become increasingly severe over the years. Patients usually learn to pinpoint conditions likely to induce sleep or cataplexy, and they try either to avoid such conditions or, with proper medication, control the symptoms. Control is especially important when patients are driving or engaging in other potentially dangerous activities.
The mild beginning symptoms of narcolepsy may cause no more than minor inconveniences. As they become increasingly severe, however, symptoms cause greater disruptions in patients' social and professional lives and may become profoundly disabling. EDS often occurs at inopportune times: in the classroom, at business meetings, during a meal, or even in the middle of a conversation.
Learning, for children and adults alike, may be hampered because the abilities to read, study, and concentrate are periodically (or in some cases, continually) impaired. Parents, teachers, spouses, and employers often mistake the patient's sleepiness for lack of interest, or misconstrue it as a sign of hostility, rejection, or laziness.
Cataplectic attacks commonly occur in situations involving perfectly normal emotions, such as humor (hearing a joke); competitiveness (bidding in a game of bridge); excitement (viewing, or especially participating in, a sports event); and stress of self-assertion (asking for a pay raise). Patients' efforts to stave off cataplectic attacks by avoiding these emotions may greatly diminish the quality of their lives, and they may become severely restricted emotionally.
Although symptoms are usually clear-cut, most patients have narcolepsy for 10 to 15 years before the disorder is correctly diagnosed. For one thing, patients may not suspect a medical disorder and usually do not seek help until symptoms become quite severe. Also, physicians often misdiagnose narcolepsy, mistaking the symptoms for those of other disorders, like depression.
A clear understanding of recent developments in sleep disorders medicine is essential for treatment. Any physician in general practice can easily acquire this knowledge and provide narcolepsy patients with proper medical care. Although there is no known cure for narcolepsy, several drugs help to control the symptoms. Stimulants are usually prescribed to treat EDS and sleep attacks, and certain antidepressants help control the cataplexy, sleep paralysis, and hallucinations. Narcolepsy symptoms vary from person to person, as do response to medications; also, both symptoms and response are likely to change gradually over time. Medications used to treat narcolepsy usually have some undesirable effects, in some cases serious enough to preclude drug treatment. However, for most patients, medication is helpful.
Sleep habits are important for the patient with narcolepsy. Bed times should be regular and nighttime sleep uninterrupted. Some patients find that naps at various intervals in the day help to offset excessive daytime sleepiness. A physician can work with the patient to establish the sleep schedule that is most effective and appropriate.