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Narcolepsy

Narcolepsy is a sleeping disorder that affects humans in a way that they experience overwhelming drowsiness. It is classified as a chronic sleep disorder. Individuals having Narcolepsy have episodes of falling asleep during the daytime with them having no control over it. It induces excessive sleepiness during the daytime. It is a neurological disorder that reduces the efficiency of an individual during their active hours.

Symptoms

The symptoms of Narcolepsy are not that evident as they are not recognized for a long time. It has been found that there might be a difference of a long 10 years between the start of the condition and the diagnosis of the condition. Even the diagnosis can show other disorders as they might have similar symptoms to Narcolepsy. Individuals who have this sleep disorder tend to become distant to the basic functioning including their relationships and careers due to the overwhelming sleepiness that hampers their day - to - day activities. Daytime sleepiness is one of the most common symptoms of the Narcolepsy sleep disorder and it is most of the times misinterpreted as being lethargic or lazy. Following the symptoms:

-  Sleep Paralysis: Individuals having Narcolepsy might also experience Sleep Paralysis. Though sleep paralysis can occur due to a range of various other factors, it is a symptom of Narcolepsy. Sleep Paralysis is the inability to speak or move while you are sleeping or falling asleep. It occurs during the REM cycle. Sleep paralysis affects the person’s movement and does not affect their ability to breathe or see. They are paralyzed leaving them unable to move but they are aware of their surroundings.

-  Hallucinating while falling asleep: Narcolepsy individuals might experience hallucinations when they are falling asleep. These hallucinations are caused as dreaming is a part of the Rapid - Eye - Movement sleep and if you dream during the REM cycle and you are only partially asleep, then those dreams would seem like they occurred in reality and thus the hallucinations.

-  Cataplexy: Cataplexy is one of the symptoms of Narcolepsy. Cataplexy is a disorder that causes a temporary loss of an individual’s muscle tone. This loss of muscle tone is triggered when the individual experiences intense emotions like fear, anger, excitement, laughter, etc. There might be other intense emotions that trigger Cataplexy too. Cataplexy is flexible in nature as it affects different people in different ways. Some people can have the symptoms many times a day while others experience it only a few times per year.

-  Sleepiness during the daytime: Experiencing excessive and uncontrollable sleepiness during the sunlit hours is one of the most common symptoms of the Narcolepsy disorder. It hampers with the normal functioning of a person during the daytime.

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Causes

The causes of Narcolepsy are more internal than external. This sleep disorder is known to have affect individuals who have genes that are associated with the sleep disorder. There are certain genes that are responsible for the control of the chemical production in the brain that affects the sleep cycles. The chemical Hypocretin is known to be responsible for the sleep and wake cycles and when there is a deficiency in the production of this chemical, an individual might get Narcolepsy. This is not the only factor that contributes to the sleep disorder; there are more conditions like the Rapid - Eye - Movement cycle.

Prevention

Narcolepsy is one of the disorders that cannot be prevented. But one can always avoid habits that would aggravate the symptoms or worsen the condition. The use of substances that make you drowsy should be avoided if you experience any such symptoms that could be diagnosed as Narcolepsy. There is no such prevention but there are habits that can better the condition.

How is it diagnosed?

-  Lumbar Punch or Spinal Tap: A spinal tap is performed on an individual to collect CSF - Cerebrospinal Fluid. This fluid is collected to test and measure the level of Hypocretin. If the levels of Hypocretin are low, then the individual could have Narcolepsy. How these test works are the doctor will insert a needle between two lumbar vertebrae in order to collect the CSF fluid.

-  Multiple Sleep Latency Test : The multiple sleep latency test is a continuation tests after the Polysomnogram. This test is also carried out in the lab in the morning after the PSG test is conducted the night before. The multiple sleep latency Test is used to measure the time that a person takes to fall asleep during the day. This test is carried out by asking the individual to take 4 to 5 naps that are scheduled every 2 hours. The first scheduled nap will be after 2 hours of waking up. If an individual has Narcolepsy, they will take much lesser time to fall asleep than the average time a person without Narcolepsy takes to fall into sleep. The normal time taken to fall asleep is 10 - 20 minutes.

What is it that you need to do for this test?

Keep a sleep diary: If you are going to be tested, you need to keep a diary and record your bedtime, wake up time and nap times every day for 2 weeks prior.

-  ActiGraph Monitoring: An ActiGraph is a home monitoring system that is used to check your sleep. This system will keep a track of when an individual falls asleep and how they fall asleep. The ActiGraph is a simple device that can be worn like a wristband or wristwatch. For more accurate results, it can be used along with a sleep diary test.

-  PSG - Polysomnogram : A Polysomnogram is also known as Sleep Study. This test is carried out in a sleep lab. The Polysomnogram records and transmits certain physical actions, electronically, of the body when the individual is sleeping. Actions like the movement of muscles, the brain activity as well as the breathing pattern are studied and examined. After examination, the recordings are analyzed to check the kind of sleep disorder that individual has. This test is carried out by a qualified and certified Sleep Specialist. During a Polysomnogram, the individual is assigned a private bedroom that they will be tested in. The results will be accurate only when they have a regular day without making any changes in their habits. They have to be at the lab 2 hours before their sleep time. The entire sleep of the person will be monitored, recorded and examined to check for the sleep disorder and the degree of it. It might seem difficult to fall asleep while you are hooked to monitoring equipment but your sleep time will help you fall asleep.

-  Epworth Sleepiness Scale: The Epworth Sleepiness Scale is a questionnaire test that the individual has to take. They will be asked a series of questions that they have to rank in accordance with how they feel about different sleep situations. The answers will be based on a scale of 0 to 3. 0: “Not at all likely to fall asleep and 3: “Very likely to fall asleep”. After taking the test, you are likely to get a result between the numbers of 0 to 24 which will determine the Narcolepsy levels. If you get a score between the numbers of 0 to 10, then your tests results are normal. Any score above 10 would require further diagnosis.

Treatment

Narcolepsy sleeping disorder has no permanent cure but it can be regulated and the effects of the disorder can be reduced by taking a certain medication and following certain practices. Stimulants are given to regulate sleep in a way that the individual gets a better sleep in order to stay alert during the day. One of the best ways to treat Narcolepsy is to make certain changes in the lifestyle so that external substances do not affect the condition and further worsen the symptoms. Eating healthy and having a good exercise routine can reduce the effects that the Narcolepsy sleep disorder can have on an individual suffering from it. Medication for Narcolepsy can only reduce the symptoms and not completely cure it. Following are the treatment options for Narcolepsy:

-  Selective Serotonin Reuptake Inhibitors: The Selective Serotonin reuptake inhibitors like Prozac (Fluoxetine) are given to individuals with Narcolepsy to better their mood and regulate their sleep.

-  Serotonin-Norepinephrine Reuptake Inhibitors: The Serotonin-Norepinephrine Reuptake Inhibitors like Effexor (Venlafaxine) is given in order to help the sleep and mood be regulated. Sleep paralysis, Cataplexy and hallucinations are treated by this medication.

-  Stimulants: Stimulants are used to improve wakefulness and reduce sleepiness. Stimulants like Ritalin (Methylphenidate), Nuvigil (Armodafinil) and Provigil (Modafinil) are given to the individuals suffering from Narcolepsy to reduce their symptoms. These medicines do not eliminate the disorder but they eliminate the symptoms of sleepiness temporarily.

-  Antidepressants: Individuals having Narcolepsy are prescribed Tricyclic Anti - Depressants that reduce the symptoms of Narcolepsy like hallucinations, sleep paralysis and cataplexy. This medication has side effects like any other medication can have. It might cause a dry mouth, constipation and urinary retention.

Practices to help reduce the effects of Narcolepsy:

- Alcohol and Nicotine should be avoided, at least during the daytime, to reduce the drowsiness that they cause

- Light meals or vegetarian meals could be eaten during the daytime to avoid feeling drowsier after food

- Eating anything heavy before important meetings, exams or activities should be avoided so that you can concentrate on work

- You can schedule naps throughout the day so that sudden sleep can be avoided

- A good exercise routine will help an individual to rest better at night; this will make them active during daytime

- Narcolepsy has also been associated with being overweight. Maintaining a weight that falls into the normal BMI for height and weight ratio could help.

- Taking a short nap for 15 mins after meals could help you to stay alert, later. But, make sure that you do not fall asleep for more than 15 minutes as people go into a deeper state of sleep after 20 minutes.

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Complications

-  Obesity: Individuals who suffer from Narcolepsy might also be obese due to the factors like inactivity due to laziness, the deficiency of hypocretin, and medications used to treat the condition.

-  Schooling and Career: Narcolepsy can affect not only your personal life but also your professional life. Due to extreme sleepiness and frequent naps, the individual suffering from it might be deemed as lazy which is not the truth as they cannot control the overwhelming feeling of sleepiness. It is a great complication if they fall asleep during a meeting in their office and their colleagues do not know about their condition.

-  Physical hurt: People with Narcolepsy are at a higher risk of getting hurt physically due to their condition that causes them to fall asleep with any control over the place, time and duration. If an individual with Narcolepsy starts feeling sleepy while on road, it can cause accidents.

-  Emotional withdrawal: Individuals with Narcolepsy become emotionally distant in case intense feeling like happiness or anger occur which trigger the signs of Cataplexy. It also affects the sex drive as the individual is extremely sleepy.

Myths

Myth #1: Individuals having Narcolepsy have depression

The symptoms of Narcolepsy might direct towards other disorders with similar symptoms. It takes a long time to properly diagnose the disorder if the symptoms are not clear.

Myth #2: Individuals having Narcolepsy sleep all the time

People with Narcolepsy definitely do not sleep all the time. They have the tendency to fall asleep during the daytime as well because of the drowsiness. They have a strong urge to sleep and can find it difficult to stay awake.

Conclusion

To be less affected by Narcolepsy, avowing things that make you drowsy should be avoided and a healthy lifestyle should be maintained.

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Last updated on : 25-10-2018

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