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Narcolepsy is a disease whose symptoms include: on falling asleep several times a day against your will. Narcolepsy is a neuropsychiatric disease and its causes are not fully known. Its first symptoms are already noticeable in adolescents and young adults. The life expectancy of narcolepsy patients remains unchanged.
Narcolepsy is a neurological condition characterized by sleep disturbance. People with this condition develop uncontrolled sleepiness during the day, which affects both men and women.
Narcolepsy can begin at any age and last a lifetime, but the first symptoms appear in adolescents. The disease is believed to be hereditary. Living with narcolepsy is very burdensome because patients fall asleep even during the day, in the course of their daily activities.
In addition, sleep problems also appear at night. Unfortunately, although narcolepsy is not progressive, it remains incurable and patients live with it, although it is not normal functioning.
In the treatment of narcolepsy, pharmacological agents can be used – methylphenidate or modafinil. In addition, antidepressants are used.
See also: Polyphasic sleep – definition, forms of sleep, effects
Narcolepsy – types
The symptoms of narcolepsy can vary from person to person, and some cases are more severe than others. There are two main types of narcolepsy:
Narcolepsy with cataplexy
In addition to the other symptoms of narcolepsy, people who have narcolepsy with cataplexy experience sudden muscle weakness and loss of muscle control in the face, arms, legs, or torso. This causes the person to gibberish, have a drooping jaw, fall over, and cannot move. During cataplexy, the person is awake. This episode can last for a few seconds or one to two minutes, and is often triggered by strong emotions such as excitement or laughter.
Narcolepsy without cataplexy
A person with narcolepsy without cataplexy has all the symptoms of narcolepsy (extreme sleepiness, sleep attacks, sleep hallucinations and paralysis while falling asleep or waking up, and disturbed nighttime sleep) but no episodes of sudden muscle weakness caused by strong emotions. This type of narcolepsy may be less severe than that of cataplexy.
Also read: Sleep phases – description of the phases, sleep disturbances
Narcolepsy – causes
The causes of narcolepsy are not fully known, but it is known that it is a neurological disease. There are some suspicions that its symptoms are related to inappropriate regulation of the REM phase in patients. REM is a very deep sleep state that occurs before you fall asleep and causes hallucinations. During normal sleep cycles, a healthy person goes through sleep phases without rapid eye movements (NREM) and eventually falls asleep with rapid eye movements (REM). When we enter REM sleep, we are more likely to be dreaming, most of the body’s muscles become paralyzed, and our eyes move back and forth under the eyelids.
For a person with narcolepsy, aspects of REM sleep overlap with awakening. Therefore, during the day when a person is awake, strong emotions can trigger cataplexy and REM paralysis, resulting in the loss of muscle control seen in cataplexy. A person with narcolepsy experiences intense sleep-like hallucinations and paralysis while falling asleep or waking up.
The conducted research has also shown that the recently discovered protein (neurotransmitter) in narcoleptics is produced in lower amounts than in completely healthy people. It probably has to do with an autoimmune reaction. According to researchers in type 1 narcolepsy, cells in the immune system can attack specific brain cells that produce a hormone known as hypocretin. It plays a role in regulating sleep cycles. Interestingly, one study published in the journal Neurology found that people with type 2 narcolepsy were more likely to develop other types of autoimmune disease than people without narcolepsy.
Still others argue that narcolepsy is hereditary. According to the National Organization for Rare Disorders, research has shown that people with narcolepsy have mutations in the T-cell receptor gene. Narcolepsy has also been linked to certain genetic variants in a group of genes known as the human leukocyte antigen complex.
According to experts, narcolepsy can also be caused by damage to the brain. If there is a head injury that damages a part of the brain called the hypothalamus, symptoms of narcolepsy can develop. Brain tumors can also cause this condition.
Of course, psychological problems may arise in the course of the diseaseespecially when the patient has problems understanding the nature of the disease. Also, people around the patient are very often unable to understand that it is simply impossible to control attacks of sleepiness. Thus, the lack of understanding significantly disturbs the self-esteem of narcoleptics and contacts with other people. Mental problems are relieved through special educational programs, conducted in schools or among health professionals.
Find out more: The secret of a good night’s sleep
Symptoms of narcolepsy
Narcolepsy is a disease of sudden, involuntary bouts of sleep during the day. Scientists’ research allows it to be associated with the issue of genetics. Symptoms of narcolepsy most often first appear in adolescence or around the age of 20. If the course of the disease is typical, there are attacks of a sudden, very strong need for sleep during the day.
A person with narcolepsy resists falling asleep in vain, but eventually falls asleep. This often happens in inappropriate places (e.g. at work, at a disco). Such a person immediately enters REM sleep (rapid eye movement phase), the one in which most remembered dreams occur. These dreams are usually very vivid and people with narcolepsy remember them in great detail, even if they last only a few seconds.
Such a “forced” nap, however, usually lasts about 10-20 minutes and may be repeated several times a day. The seizure is usually accompanied by a sudden loss of muscle tone (cataplexy), hallucinations (hypnagogic hallucinations) and spontaneous behavior. After a short sleep, the patient wakes up.
Very often people suffering from narcolepsy hear everything during a sleep attack during the day, and when their eyes are open they can see, but because of katapleksji cannot move. Self-acting behavior means that the person continues to carry out an activity (e.g. watching TV, arranging things, talking on the phone) during the episode of sleep. When she wakes up, she doesn’t remember doing it.
This symptom occurs in about 40% of people with narcolepsy. Cataplexy and hypnagogic hallucinations they also occur in people who do not have narcolepsy. This is especially true for people suffering from chronic sleep deprivation.
The seizures described above cannot be considered as unconsciousness, such as in epilepsy. In narcolepsy, the brain of a sick person shows disturbed sleep patterns during the night (too little REM sleep, or deep sleep). Therefore, the brain tries to make up for its deficiencies during the day. Narcoleptic naps usually feel refreshed, but only for a few hours.
If you or anyone around you notice sudden sleep attacks during the day, be sure to consult your GP. If he deems it appropriate, he will refer you to a neurologist who will offer you appropriate pharmacological treatment.
Grades of severity of symptoms
- weak intensity – the patient feels a little sleepy during the day; cataplexy occurs less than once a week;
- moderate intensity – patients are sleepy, but still able to function normally; cataplexy attacks occur less than once a day;
- strong intensity – people have a strong need for sleep during the day, and cataplexy attacks occur more than once a day.
Also read: Sleep deprivation and its importance for health. What can sleep disturbances lead to?
Excessive sleepiness is very often the first and only symptom of narcolepsy. However, it should be remembered that drowsiness is a symptom that also occurs in the course of other ailments.
In contrast, cataplexy only occurs in narcolepsy. Most often, the coexistence of these two symptoms allows for a proper diagnosis.
In most patients, there are indications for specialized tests to confirm the diagnosis and to select the appropriate treatment method. First of all, in a specialized laboratory, sleep tests are performed PSG polysomnographic examination, the aim of which is to objectify the occurrence of somnolence and to find possible other causes of the disease. On the day following this examination, it is performed sleep latencywhose task is to assess the speed at which the patient falls asleep and how quickly REM sleep occurs (this test is commonly used in the diagnosis of narcolepsy).
In addition to the above-mentioned tests, a blood test is also used to determine the antigens of the immune system, which are present in narcoleptics. A positive test result – it does not confirm that we are dealing with narcolepsy. In case of diagnostic doubts, the level of orexin in the cerebrospinal fluid should be determined.
Narcolepsy – treatment
Treatment of narcolepsy focuses on its symptoms and consists in administering psychostimulants whose task is to combat excessive sleepiness by stimulating the central nervous system. The psychostimulants mainly include: methamphetamine, methylphenidate and penoline. For cataplexy symptoms, clomipramine, imipramine, venlafaxine and fluoxetine are used. In addition, sodium oxybate is also used in the most severe cases of narcolepsy.
In addition to taking medications, people with narcolepsy must pay attention to maintaining a regular rhythm of sleep and wakefulness, and this involves short XNUMX-minute naps throughout the day. People with narcolepsy must also avoid alcohol and other drugs, which can also disrupt the rhythm of sleep and wakefulness. Regular exercise is also recommended.
Worth knowing: Insomnia after 50, or why does the quality of our sleep decline with age?
1. Narcoleptics should avoid falling asleep alone, ideally when asked for company.
2. People who feel an attack coming should stop what they are doing and go to a nap. The impending attack is indicated, for example, by visual and auditory hallucinations as well as weakening of motor functions.
3. Patients suffering from narcolepsy should inform their employer about their problem. Ideally, a medical certificate of illness should be presented. Then it will be possible to set a work plan that will take into account possible naps.
4. Narcoleptics should not get behind the wheel unless their doctor allows them.
5. Patients should avoid both alcohol and caffeine. These two elements affect how the medications work and can cause insomnia or excessive daytime sleepiness.
6. The preparations prescribed by the doctor should not be ignored, especially when the narcoleptic has to drive a car for a long time.
7. Sick people should inform their relatives about their illness. It is better if they find out about it before being scared by the sudden loss of consciousness. In addition, they will know how to behave during a cataplexy attack and how to help if necessary.
8. The body of a narcoleptic can be stimulated by physical activity, such as walking.
9. People facing larger tasks should take a nap in order to have enough energy to perform them.
10. In preventing narcolepsy, it is useful to keep regular hours of getting up and falling asleep. Make sure you get enough sleep at night.
11. Narcoleptic physicians should follow the latest information and research on narcolepsy constantly. The more they know about the disease, the better their quality of life is.
Narcolepsy a IQ
Although narcolepsy does not directly affect intelligence, the symptoms of the disease can interfere with learning. Concentration, memory, and the duration of attention may be significantly disturbed from time to time by sleepiness. Children suspected of having narcolepsy should be diagnosed as soon as possible in order to avoid lowered self-esteem in the future and to change unfavorable learning habits. Adults with narcolepsy can seek support from the National Association of People with Narcolepsy.
Complications of narcolepsy
Narcolepsy has many consequences. Sleep attacks and cataplexy that attack patients in public places are very embarrassing and often lead to social problems and disturbed interpersonal relationships. People often find it difficult to stay awake in social gatherings or lose muscle control while laughing. In addition, the disease can interfere with physical activity. Perhaps because of a lower level of activity or a slower metabolism, many people with narcolepsy are overweight. Adults with narcolepsy on average weigh about 15 to 20 percent more than the general population.
The disease takes away the ability to function normally, such as working or driving. Due to this, the patient loses his independence, financial problems arise. In such a situation, the drug addict becomes depressed very often. Additionally, research suggests that people with narcolepsy may have an increased risk of suicidal behavior. To avoid all these complications, patients should work closely with their doctor to resolve any disturbing symptoms or side effects from treatment.
Narcolepsy and the brain
Narcolepsy affects the systems in the brain that help us stay awake. Typically, the warning signals come from the brainstem, an area deep inside the brain that is responsible for many basic functions. These signals spread and “wake up” the rest of the brain. Meanwhile, a group of cells in another nearby region called the hypothalamus produces the chemical hypocretin. Hypocretin activates and maintains the warning signals coming from the brainstem.
In the person with narcolepsy, cells in this specialized region of the hypothalamus died. Even though they are a relatively small group of cells, their effect on wakefulness and sleep is dramatic. Without hypocretin, it is difficult to stay awake for a long time, and awakening and sleep overlap, which is why people with narcolepsy experience hallucinations and paralysis when falling asleep or waking up. Losing hypocretin also affects the action of other key chemicals in the brainsuch as dopamine, serotonin, and norepinephrine. Therefore, antidepressants (which act on these neurotransmitters) are sometimes prescribed for narcolepsy.
Scientists are working on ways to target and stimulate hypocretin receptors to mimic the presence of this chemical. They are also working to understand how hypocretin cells are primarily lost (autoimmune response) so that they can target the first step of the process and stop the symptoms of narcolepsy from developing.
Narcolepsy during pregnancy and lactation
Women with narcolepsy who are or would like to become pregnant should be under close medical supervision. Your doctor will decide which medications should be continued, which doses should be changed, or whether they should be stopped altogether.
It should also be mentioned that in the case of drugs used to treat the symptoms of narcolepsy, these are able to cross the placenta. Consequently, the medications taken by the woman also affect the unborn child. This is also the case for women who are breastfeeding, as the active ingredient in drugs for narcolepsy is passed on to the newborn through breast milk. For these reasons, most doctors advise women to stop taking drugs used to treat narcolepsy while pregnant or breastfeeding.
It should also be mentioned that women with narcolepsy face various complications during pregnancy. Occasionally, cataplexy may occur during labor, which may affect the course of labor. In addition, according to doctors, pregnant women suffering from narcolepsy are more likely to have problems with diabetes than healthy pregnant women. Also more often the weight of the newborn is greater. Induction of labor is also more common in pregnant women with narcolepsy.
It is also worth noting that the very care of a newborn baby due to illness is more difficult. This is because the sick woman experiences daytime sleepiness and involuntary falling asleep while breastfeeding or feeding a baby.
Narcolepsy in children
In the case of children with narcolepsy, it should be noted that the symptoms of this disease are very often misinterpreted, which in turn will have a negative impact on the child’s condition. Anyone can suffer from narcolepsy, and nearly 20 percent of all people with this condition are 10 years or younger at the time of the onset of the disease.
Proper diagnosis of the disease is quite difficult for children. This is because it is difficult to assess a child’s normal sleep needs. It also doesn’t help that children can compensate for their sleepiness with hyperactivity, which is sometimes diagnosed instead of narcolepsy. It is also sometimes confused with laziness, epilepsy, neurological diseases or intellectual disability. It also happens that during cataplexy and the resulting falls are interpreted as clumsiness.
It should be remembered that narcolepsy in children can cause a feeling of helplessness, shame and depression. Therefore, it is important for the child to feel understood and not judged, especially by those around him. In addition, the drowsiness resulting from narcolepsy may have a negative impact on the memory and concentration of the child, which will be noticeable in lower academic performance.
Narcolepsy and traveling
People with narcolepsy should follow a few simple rules to make it easier for them to travel. First, they should not travel alone, but with someone they trust. It is worth adding that many airports and railway stations offer assistance in the form of support staff and wheelchairs. Thanks to this, the patient will avoid physical exertion as well as agitation that can cause cataplexy. In addition, it is good for a patient with narcolepsy to always have the patient’s information card with him, thanks to which it will be possible to treat quickly and correctly.
It should also be mentioned that some drugs for narcolepsy are subject to the regulations on controlled substances, and traveling with them is associated with certain formalities. If a sick person travels within the Schengen area for up to 30 days, he or she must have information from the ordering physician, confirmed by the district physician. When it comes to traveling outside the Schengen area, the patient must check the legal situation in the country or countries to which he or she is traveling and, therefore, must take appropriate measures to comply with the regulations.
Narkolepsja – epidemiology
The frequency range estimate is between 0,2 per 100 in Israel and 000 per 600 in Japan. In the United States, it is estimated that as many as 100 Americans suffer from narcolepsy, but fewer than 000 are diagnosed. The incidence of narcolepsy is approximately 1 in 2000 people. Narcolepsy is often confused with depression, epilepsy, drug side effects, poor sleep habits, recreational drug use, or laziness, making misdiagnosis likely.
Narcolepsy can occur in both men and women of any agealthough typical symptoms appear during adolescence and early adulthood. It is worth noting, however, that there is a delay of about ten years in the diagnosis of narcolepsy in adults. Particularly devastating is that narcolepsy emerges during the key teenage years, when education, personal development, and career choice are taking place.
Narcolepsy myths
Thanks in large part to the exaggerated and inaccurate portrayals of narcolepsy in movies and TV shows, there are persistent misconceptions about the condition. Some of the more common myths about narcolepsy include:
People with narcolepsy just need more sleep
In people diagnosed with narcolepsy, sleeping longer will not necessarily alleviate symptoms. This is because, in addition to narcolepsy, many people experience fragmented sleep, insomnia, and sleep apnea all seriously affecting sleep quality.
Narcolepsy is just a state of constant fatigue
Narcolepsy has a wide variety of symptoms, ranging from relatively minor to extremely dangerous, depending on the person and type of narcolepsy. While all people with narcolepsy experience constant fatigue throughout the day, only about 10 to 25 percent of people with narcolepsy experience all the associated symptoms, including sleep paralysis, hallucinations, and cataplexy. Narcolepsy can also affect night sleep. When a person falls asleep or wakes up, they may experience brief episodes of sleep paralysis and hallucinations that may be frightening to them. When this happens, sufferers cannot move their bodies and remain semi-conscious, similar to cataplexy.
In some cases, people with narcolepsy either physically enact their dreams or go to sleep for a while while doing daily activities such as writing or speaking. These are automatic behaviors.
Narcolepsy is not dangerous
There are many dangers with narcolepsy, especially if people with disease engage in activities that put themselves and others at risk (such as driving a motor vehicle). Type 1 narcolepsy can lead to serious injury if a person hits their head or there is no safe place to fall. Other potential narcolepsy risks include:
- food (risk of choking);
- smoking (fire hazard);
- machine operation (occupational safety / health hazard);
- walking (e.g. at pedestrian crossings or in traffic).
The life of a person with narcolepsy will always be limited. Patients will not be able to carry out normal activities such as going to school or work.
Narcolepsy is a chronic disease, such as diabetes or hypertension, and must be treated. Most patients can be treated and managed sufficiently to lead a fulfilling and productive life. According to the Stanford Center for Narcolepsy, most patients are able to continue to participate in as much as 80 percent of their lives with appropriate treatment, and scientists are working daily to find better treatments.
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