Narcolepsy

Last updated: April 11, 2019

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Narcolepsy is a neurological disorder. It causes a disruption in the sleep and wakefulness state of the affected person. As a result, someone with narcolepsy experiences excessive sleepiness and sleep paralysis. This sleep disorder is also characterized by hallucinations. In rare cases, a patient suffering from narcolepsy might experience episodes of cataplexy.

Narcolepsy is a sleep disorder that affects both genders. Most of the symptoms of narcolepsy appear during childhood or adolescence. In most cases, a person with narcolepsy has exhibited symptoms for years before getting diagnosed for the disorder.

What is narcolepsy?

Narcolepsy is a sleep disorder that affects the way a person controls sleep and wakefulness. The most unique characteristic of this disorder is the uncontrollable episodes of falling asleep during wakeful hours. These are sudden attacks and can occur at any time of the day. When an episode occurs, the person affected will suddenly fall asleep. This can happen no matter what activity he or she is doing at that moment.

In the normal sleep cycle, a person goes through the sleep cycle in a chronological way. When a person sleeps, he enters the early stages of sleep. This is then followed by the deeper stages of sleep. Finally, after around 90 minutes of deep sleep, he enters the Rapid Eye Movement (REM) Sleep.

When a person has narcolepsy, he bypasses the initial stages of the sleep cycle. This means that he enters REM sleep almost immediately. REM sleep is the stage of the sleep cycle where a person experiences dreams and sleep paralysis. This might explain why a person with narcolepsy experiences loss of muscle control when an episode occurs.

What causes narcolepsy?

Although the exact cause of narcolepsy is unknown, many cases point to the lack of hypocretin, also called orexin, as the possible cause of narcolepsy. Hypocretin or Orexin is a brain chemical that regulates sleep. The theory is that the immune system erroneously attacks parts of the brain that produce hypocretin. This results in hypocretin deficiency. However, not all cases of narcolepsy stem from the lack of hypocretin.

Other possible narcolepsy triggers

A person’s susceptibility to narcolepsy is affected by a number of other factors. These factors can also cause an autoimmune problem. Included are:

  • Inherited genetic fault
  • Hormonal changes as a result of puberty or menopause
  • Sudden changes in sleep patterns
  • Infections like swine flu or streptococcal infection
  • Psychological stress
  • Getting vaccinated with Pandemrix

Pandemrix and narcolepsy

Pandemrix is a vaccine developed by GlaxoSmithKline. This is a vaccine developed as a possible protection against the swine flu pandemic that swept across Europe in 2009. However, the dissemination of the said vaccine was followed by a peculiar rise in cases of narcolepsy. Other disorders that disrupt the Circadian Rhythm or the Sleep-wake cycle were also reported.

According to a study published in Science Translational Medicine, Pandemrix triggered the production of antibodies that targeted the Swine Flu Virus. However, it also targeted a population of brain cells that are vital to the control and regulation of the sleep-wake cycles.

Although the risk of developing narcolepsy is very small, Pandemrix is no longer given to those who are under 20 years of age.

What are the signs and symptoms of narcolepsy?

Signs and symptoms of narcolepsy begin manifesting between the ages of 15 to 25. Although it is not impossible for someone to start manifesting symptoms at a much younger or older age. The symptoms of narcolepsy can progress and worsen after a few years. A person with narcolepsy may experience any or all of the following:

Excessive Daytime Sleepiness

This is a primary symptom of narcolepsy. Someone with narcolepsy may feel fatigued during the day even if they had a full night’s sleep. This is a kind of sleepiness that is difficult to control. The degree of sleepiness may vary from person to person. The degree of sleepiness that patient experiences is not consistent throughout the day. Taking a brief nap may relieve the sleepiness but it will eventually return.

Hallucinations

Some patients with narcolepsy reported experiencing vivid hallucinations. These hallucinations are often experienced at sleep onset. These hallucinations are mainly visual but may also involve a person’s sense of touch, sound, taste, and smell.

Sleep paralysis

This is a condition where a person loses his ability to move. A person with narcolepsy may feel paralyzed when he is falling asleep or waking up. These episodes often last for a few seconds or even minutes. Episodes of sleep paralysis often occur simultaneously with vivid hallucinations which can make the experience quite upsetting.

Memory problems

A person with narcolepsy may have trouble remembering things that other people tell them. This is because a person with narcolepsy is not fully awake during these interactions.

Cataplexy

Cataplexy is a condition wherein a person suddenly loses muscle tone. This condition is only present when a person has narcolepsy with cataplexy. An episode of cataplexy occurs when a person has a sleep attack triggered by a strong emotion. Episodes can occur if the patient gets surprised, or extremely happy. It can even happen while someone is being intimate with a partner. The degree of cataplexy may vary. Some may lose control of their limbs and experience slurred speech. Others may become completely paralyzed.

How is narcolepsy treated?

There is still no known cure for narcolepsy. However, there are medications and lifestyle changes that can help a patient manage the symptoms of narcolepsy.

Medications include:

  • Stimulants. These are medications that can stimulate the central nervous system. This is the primary treatment that can help a patient stay awake during times of wakefulness.
  • Tricyclic antidepressants. These are medications that are effective in combating cataplexy. However, there are side effects associated with them such as lightheadedness or a dry mouth.
  • Sodium Oxybate. This is another medication that has high efficacy in dealing with cataplexy. This medication can help improve the quality of nighttime sleep. It can also help control daytime sleepiness when taken in higher doses. There are side effects associated with this medication though. Common side effects include nausea, bed-wetting, and sleepwalking. A patient should not take these together with other sleep medications, alcohol, or narcotic pain relievers. Doing so can lead to breathing difficulties, coma, or even death.
  • Selective serotonin reuptake inhibitors (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI). These medications are often prescribed in order to relieve a patient from the symptoms of cataplexy. They are also effective in alleviating the symptoms of hypnagogic or vivid hallucinations and sleep paralysis.

On top of the medications listed above, some lifestyle changes can help manage the symptoms of this sleep disorder. These include:

  • Consistent sleep schedule. Going to sleep and waking up at the same times every day.
  • Naps. Taking short naps throughout the day can help a patient feel refreshed. These naps should have regular intervals in order to reduce daytime sleepiness.
  • Avoidance of nicotine, caffeine, and alcohol. These substances can worsen the symptoms of narcolepsy. Patients should avoid these, especially during the night or close to bedtime.
  • Regular exercises. Exercising regularly can help a patient feel more alert and awake during the day. However, a person with narcolepsy should only perform moderate exercises. It is also important to ensure that exercises are done at least four to five hours before bedtime.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

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