Everyone has a sleepy day now and then, but ongoing excessive sleepiness is cause for concern and needs to be discussed with your physician. Full discloser of sleep habits and experiences is an essential part of the diagnosis process. Often patients don’t realize that one little annoying symptom that isn’t disclosed could have been a defining factor in diagnosing a specific sleep disorder. This is especially true in the case of people with narcolepsy. Narcolepsy is a chronic sleep disorder that affects approximately one in every two-thousand people. Narcolepsy is made up of sleep attacks, cataplexy, sleep paralysis, and occasional hallucinations.
Sleep attacks are a significant component of a diagnosis of narcolepsy, occurring daily for narcoleptics that do not receive treatment. People without narcolepsy fall asleep in stages, moving from a lighter sleep known as NREM to the deepest sleep level where dreams occur (REM). Narcoleptics tend to either spend only a few minutes in NREM or fall directly into REM, causing sleep attacks. In some circumstances, generally, while doing something repetitive or second-nature, narcoleptics will continue functioning during a sleep attack, an occurrence known as an automatic behavior. This may seem to be a desirable trait, but performance during a sleep attack will drop significantly. A person with narcolepsy who uses automatic behavior will wake up with no memory of the time they were asleep.
About seventy percent of narcoleptics experience cataplexy as a symptom. Cataplexy is a sudden loss of muscle functioning, often occurring during intense emotions, especially laughter. Examples of cataplexy range from a simple drooping head or eyelids to dropping things or collapsing. A narcoleptic that is sleep-deprived will suffer from cataplexy much more often, often being more severe. Cataplexy usually develops well after the initial onset of the sleepiness associated with narcolepsy.
Two other symptoms that are associated with narcolepsy are sleep paralysis and hallucinations. Sleep paralysis is similar to the temporary paralysis of the human body during REM sleep; only it occurs just before a person falls asleep or directly after they wake up. Sleep paralysis lasts for around a minute and can be alarming. A person experiencing sleep paralysis may be conscious but completely unable to move or speak. While sleep paralysis is a symptom of narcolepsy, it can also appear in people without narcolepsy. Hallucinations occur in much the same way as sleep paralysis, looking just before or just after sleep. Hypnagogic hallucinations are what happens just before the body falls asleep, and hypnopompic hallucinations are experienced as one wakes up. As narcoleptics sometimes slip instantly into REM sleep, where dreams occur, the body sometimes begins dreaming before it is entirely asleep, causing the narcoleptic to experience their goals vividly as reality. Approximately twenty to forty percent of narcoleptics experience these hallucinations. In some cases, a narcoleptic will experience sleep paralysis and hallucinations simultaneously, a terrifying event for the narcoleptic.
The actual cause of narcolepsy is a mystery. Men and women are equally affected by narcolepsy, and symptoms typically start to appear between the ages of seven and twenty-five. Diagnosis is often delayed by ten or more years. About ten percent of people with narcolepsy have a close relative that also has it, but in most cases, narcolepsy simply appears. It is suspected that narcolepsy originates due to illness, hormonal changes, or an autoimmune disorder. Research has recently linked narcolepsy with low levels of the protein hypocretin in the brain. This has sparked theories that narcolepsy is an autoimmune disorder, meaning that the brain attacks the body’s hypocretin producing cells for some unknown reason.
Narcolepsy is generally diagnosed through sleep studies. The multiple sleep latency test (MSLT) and the polysomnogram (PSG) tests are given to patients in a standard sleep study facility. A PSG test monitors a patient overnight and records any abnormalities in the patient’s sleep cycle. This test eliminates the possibility that the patient’s sleepiness could be caused by another disorder, such as sleep apnea. During the day, the MSLT test is given, monitoring the patient’s tendency to slip into REM sleep throughout the day. During this test, the patient must take short naps every two hours. The typical sleep latency is twelve minutes, and if the patient’s latency is at eight minutes or less, narcolepsy is suggested. Also, if the patient was to enter REM sleep during two or more of the scheduled naps, they have narcolepsy.
Various medications treat narcolepsy, but, while the medicines help keep patients awake, they do not eliminate all symptoms at all times. Many narcoleptics make it a priority to take a few short naps throughout the day. It is also recommended that narcoleptics avoid alcohol and caffeine at night, avoid smoking, maintain a regular sleep schedule, keep a comfortable sleeping environment, and relax before bed. Exercise is also recommended, as it improves sleep quality and can help narcoleptics lose or keep off those extra pounds that can be gained with the disorder.
Narcolepsy is a devastating disorder without treatment, but with a proper diagnosis, medication, and steady sleep schedules, most narcoleptics can lead a happy and healthy life.
Dr. Dacelin St. Martin is board‐certified in sleep, internal, and pediatric medicine. He is the medical director of the “Sleep Clinic of America” in Lecanto, accredited by the American Academy of Sleep Medicine. If you have any questions, contact him at Sleep Clinic of America, 1980 N. Prospect Ave., Lecanto, FL 34461, call 352‐52SNORE (527‐6673), or visit www.SleepClinicAmerica.com.
