Sleep Disorders: Narcolepsy

Narcolepsy is a sleep disorder that often makes you feel sleepy. People with narcolepsy can fall asleep very easily and suddenly, even during inappropriate times.  For example, they can fall asleep while they are in the middle of activities, such as eating, talking or driving.

People usually develop narcolepsy during their teens or early 20s. Some people get it earlier, and others later. Once the disorder starts, it can make it hard to perform daily activities such as work, schoolwork or other normal activities.

What are the signs and symptoms?

  • Sleepiness during the day
  • Falling asleep suddenly, often at inappropriate times – Some people call these "sleep attacks."
  • Suddenly falling down, going limp, or feeling weak, especially when excited, angry or laughing – The term for this is "cataplexy."
  • Being unable to move or speak in the few moments right after waking or just before falling asleep
  • Seeing, feeling or hearing things that are not really there in the few moments before falling asleep or right after waking up.

Some people with narcolepsy also have problems with depression or anxiety. Symptoms of depression include feeling sad most of the time or losing interest in things you used to like to do. Symptoms of anxiety include feeling worried or anxious most of the time.

What are the risk factors and triggers?

Risk factors for insomnia include stress, certain medications which act as stimulants, drinking too much caffeine or alcohol, as well as foods such as chocolate. Contributing conditions include anxiety, depression, post-traumatic stress disorder, and medical conditions such as congestive heart failure, asthma, chronic bronchitis, restless leg syndrome and high levels of thyroid hormone (a condition known as hyperthyroidism).

How is it diagnosed?

Typically, you will be sent for an overnight sleep study followed by a daytime study known as a Multiple Sleep Latency Test (MSLT). For an overnight study, you go to a sleep lab where you are hooked up to different machines that monitor your heart rate, breathing, brain activity, and other body functions while you sleep at night. A couple of hours after the overnight sleep study is finished, the MSLT is done. This consists of a series of four or five naps, each of them lasting 20 minutes and spaced two hours apart.  Patients with narcolepsy are pathologically sleepy after having had a normal night’s sleep the night before and also show evidence of REM sleep during the daytime naps, which normal people do not.

What is the treatment?

Narcolepsy is sometimes treated initially with behavior changes. People with the disorder should:

  • Avoid medicines that can make people sleepy, such as some allergy medicines
  • Take naps just before important events and at scheduled times during the day (prophylactic napping)
  • Keep a regular sleep schedule
  • Make sure they get enough hours of sleep at night

People who are still very sleepy, even if they make behavioral changes, can be treated with medicines to help them stay awake. These medicines can help, but people can still feel sleepy even with treatment. That's why even people who are being treated have to be careful about their daily activities. Driving, flying or operating machinery, for example, can be dangerous for people with narcolepsy. The medicines used to help people stay awake can sometimes cause high blood pressure, decreased appetite, and other issues. Understand there are risks and benefits with any medication.

People with muscle weakness or who go limp when they feel strong emotions (cataplexy) can also get medicine to help with that problem.

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