Narcolepsy is a sleep disorder defined by constant sleepiness and a tendency to sleep at inappropriate times. Typically, a person with narcolepsy suffers sleep attacks as well as continual and a feeling of tiredness that is not relieved by any amount of sleep .If not recognized and appropriately managed, narcolepsy can drastically and negatively affect the quality of a person’s life.

Although the exact cause is not known, narcolepsy appears to be a disorder of the part of the brain that controls sleep and wakefulness. As a result , sleep or parts of sleep intrude into the times they are awake. The symptom most easily understood is the sleepiness, which is just the brain being unable to control when the individual falls asleep. Other symptoms, such as cataplexy, hypnagogic hallucinations and sleep paralysis are similar to the loss of muscle tone or dreaming that accompanies a normal part of sleep called REM. In people with narcolepsy, these events ( the lack of muscle tone or the dream experiences) occur at inappropriate times while they are awake.

Narcolepsy is not caused by psychiatric or psychological problems. Sometimes narcolepsy runs in families, but many people with narcolepsy do not have relatives who are affected. Recent studies have found low levels of a brain chemical called hypocretin in people with narcolepsy. Some researchers have suggested that a problem with the gene responsible for making hypocretin, combined with other factors in a person’s in a person’s life, may cause the disorder.

The four most symptoms of narcolepsy are: excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. In most causes, excessive daytime sleepiness is the most bothersome symptom.

Excessive daytime sleepiness— Daytime sleepiness is present in all narcoleptics and is usually the first symptom that appears. People with narcolepsy report feeling tired or sleepy all the time . They tend to fall asleep not only in situations in which many people normally feel sleepy (after meals or during a dull lecture), but also when most people would remain awake (while having a conversation , writing a letter, or watching a movie). These “naps” tend to be short and may be refreshing, at least for a short period of time. People with narcolepsy may become drowsy or feel foggy at very unusual times, even in dangerous situations, such as while driving.

Cataplexy— Attacks of cataplexy –sudden, brief losses of muscle strength- are sometimes the first symptom of narcolepsy, but more often develop months or years after the onset of sleepiness. Cataplexy can be mild – such as a brief feeling of weakness in the knees—or it may cause a complete physical collapse, resulting in a fall. A person having such an attack is fully awake and knows what is happening . Cataplexy is usually triggered by strong emotion, such as laughter, anger, or surprise. In some individuals, simply remembering or anticipating an emotional or anxiety – producing situation can produce attacks.

Sleep Paralysis— Sleep paralysis is also brief loss of muscle strength, but occurs when a person is falling asleep or waking up. The person may be somewhat aware of his or her surroundings, but is unable to move or speak. Sleep paralysis can be frightening but is not dangerous, since the muscles that maintain life( the main breathing muscles and the heart) are not affected.

Hypnagogic Hallucinations— Hypnagogic hallucinations are vivid dreams that occur when a person is drowsy. The hallucinations may involve disturbing images or sounds, such as of strange animals or prowlers. These hallucinations may be frightening because the person has no control over the events. The dreams can also be upsetting if they are mistaken for hallucinations caused by mental illness.

Automatic behaviors are routine tasks performed by a person who is not aware of doing the activity. Sometimes a person may actually fall asleep and continue doing an activity, but not remembering it after waking up. Automatic behaviors can be a symptom of narcolepsy, and can be dangerous if a person is involved in a potentially hazardous activity, such as driving or cooking.

Disturbed nighttime sleep- Paradoxically, people with narcolepsy often have trouble staying asleep at night due
to the brain inability to properly control waking and sleeping. In such cases, their daytime sleepiness is made worse by the many nighttime awakenings.

People with narcolepsy also report symptoms of double vision, an inability to concentrate, memory loss, and headaches. Children with the disorder are often unable to keep up with their friends or schoolwork, and adults may be unable to fulfill normal obligations relating to work or family. Depression may develop due to the social and occupational difficulties. In addition, other sleep disorders such as sleep apnea and periodic limb movement disorder occur more frequently in people with narcolepsy.

The first step in diagnosing this disorder would be an evaluation by your healthcare professional to make sur that some other medical illness is not the cause. The next step is usually a visit to a sleep specialist.

At a sleep disorders center, the specialist would thoroughly review your medical history and perform a complete physical examination. If the specialist suspects narcolepsy, you will usually be asked to under go testing at the sleep center. Two tests, a polysomnogram and a multiple sleep latency test (MSLT), are commonly performed to confirm the diagnosis of narcolepsy and determine its severity.

During a polysomnogram, you will spend the night at the sleep center in a comfortable and private room. Small electrodes placed on your skin record brain waves, muscle activity, heart rate, and eye movements, while other devices measure breathing. The procedure is painless and does not involve needles. This test is needed to determine whether you have other disorders that may be contributing to your symptoms.

An MSLT is conducted the following day. With the electrodes still in place, you will be asked to take four or five 20 minute naps at two –hour intervals. The MSLT monitors how quickly you fall asleep and also your sleep pattern, since people with narcolepsy frequently have REM ( dreaming ) sleep even during a brief nap. Consequently, these two test-together with your symptoms and sometimes a blood test called HLA typing – help the sleep specialist determine whether your symptoms are caused by narcolepsy or by another disorder that shares some of its features.

Although narcolepsy cannot yet be cured, its symptoms can usually be controlled or improved so that sufferers experience symptoms less frequently and lead fairly normal lives. If you are diagnosed with narcolepsy, your treatment plan will likely have several parts: medication, behavioral treatment, and management of your environment.

For further information on how to treat narcolepsy, please consult with your sleep medicine specialist.

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