Narcolepsy: Treatment & Management

Introduction

Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, often accompanied by sudden loss of muscle tone. People with narcolepsy experience hypnagogic hallucinations—vivid dreams or visions—as they fall asleep or upon awakening. Narcolepsy affects around 20 million people worldwide, though it may go undiagnosed for years because its symptoms can be mistaken for other disorders. Effective treatment exists for narcolepsy; however, if left untreated it can lead to serious health consequences including high blood pressure and depression.

Daytime symptoms

Sleepiness or fatigue.
Sleep paralysis.
Sleep attacks (sudden loss of muscle tone while falling asleep or waking up).
Cataplexy (loss of voluntary muscle control triggered by strong emotions, such as laughter).
Hypnagogic hallucinations, which are vivid dream-like images that occur just before sleep begins.

If you have narcolepsy, it will usually be diagnosed by your doctor based on a thorough medical history and examination; however, there are other possible causes for these symptoms including multiple sclerosis, depression or anxiety disorder and sleep apnea. If you think that you may have narcolepsy because of the symptoms listed above then see your doctor for a proper diagnosis and treatment plan

Cataplexy

Cataplexy is the sudden loss of muscle tone, as well as control over your body. It usually occurs when you are feeling a strong emotion like laughter or surprise. The strength of this emotion determines how severe cataplexy will be and for how long it will last.

Your doctor may suspect that you have cataplexy if he/she has seen you have a sudden loss of muscle tone during an examination. Your doctor may also suspect that you have cataplexy if he/she notices that your eyes close when laughing or smiling at times when they shouldn’t (such as while driving). A sleep study may be used to diagnose cataplexy because it shows periods of REM sleep during which muscles become paralyzed due to loss in blood pressure. Cataplectic attacks can also be triggered by certain medications such as antidepressants or sedatives that make people drowsy and cause them not to wake up easily even after experiencing them

Sleep paralysis

Sleep paralysis is a condition that prevents you from moving or speaking when you are waking up or falling asleep. It can cause feelings of terror, but it may go away after a few seconds or minutes. Sleep paralysis is common and affects about 10 percent of people at some point in their lives. Sleep paralysis can occur because of narcolepsy, but it also can be caused by other sleep disorders such as obstructive sleep apnea or restless legs syndrome (RLS).

If you experience sleep paralysis frequently, talk with your doctor. He or she may recommend changes to your sleeping habits and medications that treat narcolepsy, RLS and other conditions linked to abnormal REM (rapid eye movement) sleep cycles

Hypnagogic hallucinations

Hypnagogic hallucinations occur when you’re going to sleep. When you are in the hypnagogic state, your brain is between being awake and asleep.

These hallucinations can occur before or after sleep, and they may be resolved by falling back asleep or waking up completely. If they do occur while you’re awake, they should dissipate as soon as you close your eyes again or get distracted by something else. Upon waking up in the morning, it’s common to feel tired or groggy due to having been woken up by a hallucination.

These hallucinations aren’t dangerous and aren’t a sign of mental illness or a brain tumor; however, if this type of activity continues for longer periods (over weeks), it could indicate narcolepsy—a neurological condition that affects around 1% of Americans but is often misdiagnosed due to its rarity

Nighttime symptoms

It can be hard for people with narcolepsy to make it through the day without falling asleep at random times. The nighttime symptoms, however, can be even more troublesome.

If you have narcolepsy, you are likely to have extreme difficulty staying awake during the day and night. This is because of changes in your brain chemicals and sleep-related hormones that control alertness (wakefulness). These changes cause your brain’s ability to regulate sleepiness during these periods:

Nighttime symptoms include:

Falling asleep suddenly—even when engaged in an activity like driving or eating
Waking up suddenly—even when engaged in an activity like driving or eating

Complications

Sleep deprivation can cause weight gain. This is because sleep deprivation affects your body’s metabolism, which slows down the rate at which you burn calories.
Weight gain can cause sleep deprivation. Because extra fat tissue produces more hormones than lean tissue, increased fat levels make it difficult to fall asleep and stay asleep at night.
Depression can also lead to weight problems, as well as a number of other complications that make it difficult for people with narcolepsy to manage their condition on their own—for example:
depression causes lifelong impairment in motivation and energy levels;
depression makes it harder for those who suffer from it to stick with treatment plans; and
depression makes it difficult for some patients who are already struggling with their symptoms (like cataplexy) to get out of bed each day.

Diagnosis

When diagnosing a patient, the first step is to perform a detailed medical history and examination. A sleep study may be required in order to diagnose narcolepsy based on clinical features and tests done during the study. The next step is to rule out other conditions that can cause symptoms similar to those seen in narcolepsy.

The American Academy of Sleep Medicine (AASM) has established guidelines for diagnosing narcolepsy and other hypersomnias; as of January 2018, these guidelines include:

Sleep study — If a person has been diagnosed with narcolepsy based on clinical features alone, he or she should be referred for an ASPSG-certified polysomnography (PSG) if cataplexy is suspected but not yet documented; this test will help determine whether the diagnosis is correct or should be changed.
Cataplexy — Patients who have cataplexy should have it confirmed by an ASPSG-certified PSG at some point after diagnosis; a second confirmatory test improves accuracy over time due to environmental restrictions like travel and stressors like family illness or bereavement that may affect sleep quality temporarily.

Narcolepsy is a sleep disorder that can affect your job, social interactions, and your ability to function during the day. Talk to your doctor if you think you might have narcolepsy.

Narcolepsy is a lifelong condition that can be managed by medications and lifestyle changes. If left untreated or under-treated, it could cause serious health problems like heart disease and depression in addition to impacting your life negatively on many levels.

Conclusion

Although narcolepsy can be a difficult condition to manage, it doesn’t have to hold you back from living your life. With proper treatment and management, you can live a normal and healthy life. If you’re experiencing any of these symptoms, talk to your doctor about getting tested for narcolepsy so that they can help you manage the disorder.