What Is Narcolepsy?

Narcolepsy is a chronic neurological sleep disorder that influences a person’s ability to control sleep and wakefulness. During normal sleep, rapid eye movement (REM) sleep follows the early and deeper sleep stages. With narcolepsy, however, REM sleep is excessive. This significantly decreases the amount of stage three deep sleep. In addition, sudden attacks of sleep and excessive daytime drowsiness happen at any time during any activity. There is no cure for narcolepsy, but the symptoms can be managed.

Causes of Narcolepsy

The cause of narcolepsy is unknown. Genetics, infections, deficiencies of hypocretin (brain chemical that regulates REM sleep), trauma to the head, and brain abnormalities are factors that may contribute to the development of narcolepsy.

Symptoms of Narcolepsy

The symptoms of narcolepsy usually begin between the ages of 10 and 25. Some or all of the symptoms listed may occur.
A person who has narcolepsy might fall asleep multiple times with no warning anytime, anywhere.  Occasionally, automatic behavior occurs and the person continues to function even though he or she is asleep. The sleep episodes affect “normal” daily activities by affecting the person’s ability to concentrate and function. Lack of energy, depression, memory lapses, and exhaustion are not uncommon. All patients with narcolepsy are excessively sleepy.
Uncontrollable, sudden loss of muscle tone, or cataplexy, can result in physical changes that may include feelings of weakness, slurred speech, loss of voluntary muscle control, and/or total body collapse. Cataplexy is often triggered by strong emotions including intense fear, surprise, anger, or laughter. It may last for a few seconds or for a few minutes.   About 70% of patients with narcolepsy experience cataplexy.
A person with narcolepsy may experience a temporary inability to move or speak while falling asleep or waking up. Although these episodes may be brief in duration and all faculties are rapidly recovered, they are nonetheless unnerving experiences. About 60% of patients with narcolepsy experience sleep paralysis.
Hallucinations that are brought about by narcolepsy are often so real and vivid that they are quite frightening. Hypnagogcic hallucinations occur as a person is falling asleep. Hypnopompic hallucinations occur as a person is awakening. About 65% of patients with narcolepsy experience hallucinations either during sleep onset or awakenings.
If any of the above mentioned symptoms are occurring in your life, it is time to see Dr. Nassar. Exhibited symptoms and a sleep history are the first clues to a narcolepsy diagnosis. An initial diagnosis of narcolepsy may be followed by a test to measure the levels of hypocretin in the fluid surrounding the spinal cord and in-depth overnight sleep testing at Jacksonville Sleep Center. Testing for narcolepsy will also detect any other possible causes of your symptoms.

To prepare for the sleep testing, you may be asked to journal the details of your sleep patterns for a designated time period. Overnight sleep testing involves a polysomnogram (to measure the electrical activity of your brain and heart as well as the movement of your muscles and eyes) and a multiple sleep latency test (to measure how long it takes you to fall asleep during the day).

Treatment for Narcolepsy

There is no cure for narcolepsy, but the symptoms can be managed by making lifestyle adjustments that contribute to good sleep hygiene or by taking medication.
Lifestyle measures to manage narcolepsy symptoms include

  • Establishing and adhering to a sleep schedule that has you going to sleep and waking up at the same time every day;
  • Taking short naps at regular times during the day;
  • Avoiding heavy meals, caffeine, nicotine, and alcohol;
  • Establishing and adhering to a meal schedule
  • Establishing and adhering to a regular exercise schedule.

Medications used to manage narcolepsy symptoms include stimulants to treat sleepiness; selective serotonin reuptake inhibitors; or serotonin and norepinephrine reuptake inhibitors to treat cataplexy, hypnagogic hallucinations, and sleep paralysis. Sodium oxybate (Xyrem) is a relatively new medication and is utilized only in the treatment of narcolepsy. This medication increases the amount of deep sleep, reduces REM sleep and decreases both cataplexy and daytime sleepiness.

If you are diagnosed with narcolepsy, Dr. Nassar will find a treatment or combination of treatments that will work for you and your circumstances. If narcolepsy makes it hard to go about your normal daily tasks, contact Dr. Nassar and his sleep team at Jacksonville Sleep Center. They will work with you to diagnose and treat your narcolepsy.
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