Narcolepsy: Symptoms, Causes, Risks, Diagnosis and Treatment

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A woman who sleeping on her computer because she has narcolepsy

1Overview

Narcolepsy is a serious sleeping disorder that can affect the daily life of the person.
A sudden sleeping episode during the day can be a symptom of narcolepsy, it is usually detected in early teens to young adults.

The normal sleeping pattern of a person undergoes a process, there is the early stage in which you can be easily awakened. The second stage of sleep occurs after 20 minutes,
the functions of the body lowers as the body relaxes. The third stage puts your body into a deep sleep and then the REM stage follows. The rapid eye movement stage (REM stage) or also known as paradoxical sleep is the last stage of sleep, the body is in a deep sleep and usually, dreams occur at this stage. Persons who have Narcolepsy tend to go under the rapid eye movement stage right after they went to sleep.

Narcolepsy with cataplexy is a condition that involves the muscles of the body when this type of narcolepsy occurs, the muscles tend to buckle (cataplexy). It is said to be associated when the person is feeling an extreme emotion. The other type is the narcolepsy without cataplexy, the person only feels sleepy during the day and after waking up they feel rested.

2Symptoms

Sleeping occurs when the body needs rest to recover from a day of working, but for a person with narcolepsy, symptoms are excessive and can affect the daily life of the person.

Cataplexy

It involves the loss of function of muscle tone of the body. Some people experience cataplexy when they are excited, extremely happy or even when angry. Cataplexy can occur multiple times during the day or some will have single episode within the year.

Sleepiness during the day

In a narcoleptic person, they experience the extreme need for sleep during the day. They may sleep during working hours or even when the person is out with friends.
The unpredictability of this condition can affect the person especially when he or she has an active lifestyle. When the person wakes up from a nap, they may feel the extreme sleepiness of the person is the primary symptom to determine the kind of condition.

Paralysis

Sleep paralysis happens only for a few moments, where the person is not able to move his or her body and in special cases, the person may not be able to talk during the episode. This sudden paralysis is just like in the rapid eye movement stage where the body is in the state of immobility to prevent it from moving when the person has a dream.

Hallucinations

There are two types of hallucinations one of them is the hypnopompic hallucinations which occurs upon waking up. The second type is the hypnagogic hallucinations which occur when the person is sleeping. They may interpret the hallucinations as the reality and can confuse the person.

Problems with memory

The person may have problems remembering the task he or she was doing when he or she was asleep.

3Causes

Although the exact cause is still not known many causes can add to the occurrence of narcolepsy to a person like

Physiological issues or problem.

Having a stress can greatly affect the brain, and it can lead to the imbalance of the homeostasis in the brain and can cause of overproduction of chemicals that can affect the brain.

Hormones

The sudden surge of hormones during puberty stage and the decline of the hormones during late adulthood can cause or trigger narcolepsy.

Hypocretin levels

The hypocretin is a chemical that is responsible for the sleeping stage which is the REM stage and the wakefulness of the person. In a person with narcolepsy, the hypocretin levels are low and or the cell is destroyed which cause problems in the sleeping can pattern of the person. It is said that the immune system plays a role in the destruction of the cells, it detects and interprets it as an invader thus destroying it in the process.

Infection specifically the H1N1

According to the researchers, the exposure to the virus can be associated with having or developing Narcolepsy. A certain vaccine of H1N1 can also be a contributing factor to having the condition.

4Risk Factors

Certain risk factors can increase the chance of having narcolepsy like:

Gender

Narcolepsy can affect both genders, men, and women, there is no significant difference between men and women when it comes to the risk of having the neurological disorder.

Age

The age where narcolepsy can develop is during the early teens to late adulthood, ages 15- 40 years old. There are rare instances that during the infant stage, the baby is likely to develop narcolepsy.

Other neurological disorder

Having a disorder involving the central nervous system can increase the chance of developing narcolepsy.

5Diagnosis

When the patient seeks help, the physician will obtain the complete medical history of the patient and ask about the sleeping habits of the patient including the changes involving their sleeping pattern. There are also different ways to diagnose narcolepsy by:

Polysomnogram

It requires the patient to stay at the lab for observation while sleeping. Electrodes are attached to the body of the person for the technician to measure the brain waves and vital signs during sleep. This test can also help the physician rule out potential disorders that may cause the symptoms that the person is experiencing.

In Polysomnogram, several tests are conducted too like, Electrocardiogram to monitor the heartbeat, Electroencephalography used to measure the brain waves, Electromyography for the muscles, electrooculography for the eye movements and to measure the oxygen saturation in the blood, pulse oximetry is used.

Epworth sleepiness scale

This is a series of questionnaires that are given to the patient to answer. It will allow the patient to assess and grade themselves in which situations they are most likely to fall asleep. If the total score is above 10, the doctor will be endorsed to a specialist for further care and assistance.

Multiple Sleep Latency Test

This test measures the time the person will fall asleep during the day. The patient will be then observed during sleep, for a narcoleptic person, they will easily fall asleep and goes into the REM stage without a problem.

Blood test

It is done to determine if there are chemicals in the blood that may indicate narcolepsy. HLA DQB *0602 is usually found in a narcoleptic patient and if this is present in the blood, there is a possibility that the patient may have the condition.

Hypocretin level measurement

The test is done by obtaining a small sample of the cerebrospinal fluid or CSF by puncturing the lumbar area on the spinal cord. A sterile needle is injected into the spinal column aseptically to get an ample amount of the fluid and then this sample will be sent to the laboratory to test for the hypocretin level. If the levels of the hypocretin are low, the physician can diagnose that the patient has narcolepsy.

6Treatment

As for now, there is no known exact treatment to address directly narcolepsy but there are some medications and also non-pharmacological treatments like lifestyle changes that can help minimize the symptoms and help the person live a better quality of life.

Medication

Stimulants-This drugs will help the person stay up during the day and reduce the symptom of excessive sleepiness. It will stimulate the body and can help increase the level of alertness of the person. Modafinil and amphetamines are examples of stimulants.

Antidepressants-This is used for patients who have cataplexy to reduce the occurrence of sleep paralysis, hallucinations and sleep apnea.

Medications to aid in sleeping at night is also recommended by the doctor.

Lifestyle

  • Avoid drinking caffeine or foods containing caffeine at night, this substance can keep you up and will not allow you to sleep,
  • Avoid eating large meals at night
  • Have a regular exercise during the day, performing activities of daily living are one of them or walking early in the morning is also beneficial. The exercise helps the body to be active during the day and to maintain the optimal health or condition of the body.
  • Have a sleeping schedule and make sure to follow it. Take naps at a certain time during the day.
  • At bedtime, make sure to relax first before going to bed. Avoid watching the television or listening to music, this will cause distractions and can affect the sleeping schedule.
  • Keep the room dark during night time, a room with the lights switched on will cause the brain to detect and interpret that it is still daytime and the person can have a difficult time falling asleep.
  • If you suddenly wake up, just stay on the bed and try to fall back to sleep, if you cannot still sleep, do some reading, the eyes will be tired and can help you get sleepy.
  • Avoid drinking too much water hours before sleeping, it will disrupt your sleep because you will feel the urge to urinate, and this will keep you up during the night.