Narcolepsy is a long-term neurological condition that impacts the brain’s capability to control sleep-wake cycles. It may lead to severe daytime fatigue, abrupt sleep episodes, and muscle weakness. Symptoms Daytime fatigue: Individuals with narcolepsy might feel energized after waking up, yet subsequently experience significant sleepiness throughout the day. Sleep episodes: Individuals with narcolepsy might unexpectedly fall asleep without any forewarning. Cataplexy: A temporary inability to control muscles that can be provoked by intense feelings, such as joy or frustration. Sleep paralysis: A short-term inability to move or communicate upon waking or drifting off to sleep. Interrupted sleep: Individuals with narcolepsy may struggle to maintain sleep for extended durations. Intense dreaming: Individuals with narcolepsy may encounter vivid dreams, particularly during the process of falling asleep or awakening.
Causes
The precise reason for narcolepsy remains unclear.
A genetic mutation related to low quantities of hypocretin, a brain protein responsible for managing sleep-wake cycles, may influence the onset of narcolepsy.
Additional elements, including stress, brain injuries, exposure to harmful substances, and infections, might also be significant. Treatment
While there is no remedy for narcolepsy, medications and healthy lifestyle adjustments can assist in controlling the condition.
Narcolepsy is a long-lasting neurological condition that impacts the brain’s capacity to manage sleep-wake patterns. Individuals with narcolepsy might feel refreshed upon rising but then experience significant drowsiness for a large portion of the day.
Narcolepsy-afterall what is it ?
Narcolepsyis a neurological disorder that causes excessive daytime sleepiness and sudden attacks of sleep.
Narcolepsy is a neurological disorder that causes excessive daytime sleepiness and sudden attacks of sleep. It is caused by the brain’s inability to regulate the production of the sleep-inducing hormone, melatonin. The most common symptoms are excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), hypnagogic hallucinations (vivid dreams at the onset of sleep), and disrupted nighttime sleep with frequent awakenings.
Narcolepsy is a long-term neurological condition that impacts the brain’s capacity to manage sleep-wake patterns. Individuals with narcolepsy might feel refreshed upon awakening yet experience significant drowsiness for a large portion of the day.
Image of Narcolepsy
It is a long term neurological condition that causes excess day time sleepiness.
Incidence of narcolepsy –
Interesting the United States it is 50 percent more likely to affect females than males .
Around 1 in 2000 people have narcolepsy.
Around 135000 to 2 lakh people in the United States are affected by narcolepsy at any time.
Eitiology of Narcolepsy –
Till date modern medical science does not know the cause of narcolepsy. The precise origin of narcolepsy remains unclear, yet it is thought to result from a mixture of elements, such as:
A genetic mutation resulting in decreased amounts of hypocretin, a brain protein that manages sleep-wake patterns
An autoimmune problem that prompts the immune system to target healthy cells
Stress
Brain injury
Contact with toxins
Infection
1-There are possibilities that it is due to the deficiency of hypocrites or orexin.
These are chemical substances required by brain to stay awake.
Hypocretin is produced by hypothalamus.
It is neurotransmitter.
It acts on various neurons of the brain and is responsible for us to remain awake.
Type 1 narcolepsy has low levels of hypocretin.
Type -2 narcolepsy does not have hypocretin deficiency.
In this there is excessive day time sleepiness but usually there is no sudden weakness.
2-Genetic
Narcolepsy is due to combination of genetic and environmental factors.
It runs in families.
3-In type -1 Narcolepsy there is deficiency of hypocretin.
Hypocretin is a neurotransmitter.
It is produced by hypothalamus.
Patients with type 1 narcolepsy have low levels of hypocretin.
Patients with type 2 narcolepsy do not have low levels of hypocretin.
Hypocretin acts various neurons of brain and controls whether the individual will be awake or asleep .
When there is deficiency of hypocretin, the brain allows REM sleep phenomenon to intrude into normal waking periods and so the individual gets excess sleep during the routine awake period of the day as well as night time sleeping problems.
As hypocretin is produced by hypothalamus of brain
Any injury to brain
Any tumour of brain
Any condition of brain affecting the hypothalamus will affect the production of hypocretin and thus lead to narcolepsy.
Narcolepsy might be associated with exposure to the H1N1 influenza, often referred to as the swine flu. It may also be connected to a specific version of the H1N1 vaccine that was administered in Europe.
Risk factors for Narcolepsy –
There are just a handful of identified risk factors for narcolepsy, such as:
Age. Narcolepsy generally starts between the ages of 10 and 30.
Family history. If you have a close relative with narcolepsy, your risk is 20 to 40 times greater.
Is narcolepsy contagious?
Narcolepsy is not contagious. It cannot be transmitted to or acquired from other individuals.
Diagnosis of narcolepsy –
Any patient suffering from above mentioned problems should always consult a qualified and experienced Neurologist doctor.
You should enquire in the region where you live as to which Neurologist is having good reputation.
Things have occurred as such in which till 10 yrs diagnosis of the patient could not be made and then patients have consulted 10-15 doctors in this period with no relief .
Differential diagnosis-
Restless legs syndrome
Sleep apnoea
Some psychological disorder
In any case accurate and timely diagnosis by neurophysician is very important so that treatment can be started at the earliest.
The neurologist will take a thorough medical history,
Will do a complete physical examination .
Will conduct sleep studies like
Polysomnography
Multiple sleep latency tests .
During polysomnography the patient sleeps in a sleep clinic overnight and the polysomnography machine measures the sleep patterns.
The multiple sleep latency test is done after polysomnography.
Diagnosis and Tests How is narcolepsy diagnosed?
A Neurologist may suspect narcolepsy depending on your symptoms. However, narcolepsy exhibits symptoms that overlap with numerous other brain- and sleep-related disorders. Because of this, the only definitive way to diagnose narcolepsy is through specialized diagnostic evaluations.Prior to conducting most of the primary tests for narcolepsy, a Neurologist will first verify that you’re obtaining sufficient sleep. This typically involves straightforward tracking methods for your sleep-wake patterns, such as actigraphy. This generally uses a watch-like device that you wear on your wrist to monitor movement patterns (such as when you’re asleep versus when you’re awake and moving around).
What tests will be done to diagnose narcolepsy?
Some potential tests for diagnosing narcolepsy include:
Sleep study (polysomnogram). Multiple sleep latency test (MSLT). Maintenance of wakefulness test. Spinal tap (lumbar puncture). Sleep study (polysomnogram)
A sleep study includes various types of sensors that monitor your sleep patterns. A central component of a comprehensive sleep study, officially referred to as a polysomnogram, is that it incorporates electroencephalogram (EEG) sensors.These sensors track your brain activity, enabling healthcare providers to identify which stage of sleep you’re experiencing at any given moment.
A sleep study can assist in diagnosing narcolepsy because individuals with this disorder enter the REM stage of sleep unusually quickly in comparison to individuals without it. They will also experience sleep interruptions with periods of wakefulness, which the sleep study can likewise detect and document.
Another essential reason for conducting a sleep study is that excessive daytime sleepiness is also a primary symptom of sleep apnea. A sleep study can eliminate the possibility of sleep apnea.
Multiple sleep latency test
This test assesses whether or not you are likely to fall asleep during the day. This evaluation consists of timed naps that are scheduled within a specific timeframe. This test can help ascertain if a person experiences excessive daytime sleepiness, which is an essential symptom of narcolepsy. This test often occurs the day after an overnight sleep study.
Maintenance of wakefulness test
This test evaluates if you can remain awake during the day, even in situations where it would be simple to drift off to sleep. Although it’s not commonly used in testing for narcolepsy, it remains possible and can rule out other concerns. It’s also beneficial for assessing whether stimulant treatments are effective.
Spinal tap (lumbar puncture)
This test can determine if the orexin levels in your cerebrospinal fluid (CSF) are low. This is a crucial method for diagnosing type 1 narcolepsy. Low orexin levels can also indicate that an individual with narcolepsy may develop cataplexy, even in the absence of that symptom so far. Unfortunately, orexin levels do not fluctuate in individuals with type 2 narcolepsy, so it isn’t always a diagnostic aid.
Other tests
Many additional tests are also prevalent for individuals diagnosed with narcolepsy. A reason for this may be the presence of cataplexy as a symptom. Cataplexy resembles various other motor (movement-related) symptoms associated with brain disorders, such as atonic seizures (also referred to as drop attacks).
Due to this, Neurologist may initially examine for more critical conditions such as seizures and epilepsy,
Symptoms of narcolepsy
Following are the symptoms of narcolepsy
Symptoms of narcolepsy can be either mild ,moderate or severe.
There is interrupted night time sleep.
-The main symptom is excessive daytime sleepiness.
REM (Rapid eye movement) sleep intervenes during the waking periods of day, resulting in excess sleep during the day period.
This has effects on the social activities and overall health of the individual.
The individual can fall asleep any time even while taking or driving.
Automatic behaviour-
Some individuals with narcolepsykeep performing an activity even when they momentarily fall asleep. For instance, they might doze off while writing, typing, or driving. They could continue to execute that task while they are asleep. Upon waking, they are unable to recall what they have done, and they likely did not do it effectively
Cataplexy-Cataplexy is the sudden weakness of the muscles of the face ,neck ,knee. This can be triggered by a strong emotion, mostly one that causes laughter. But sometimes fear, surprise or anger may be responsible for the loss of muscle tone.
It is sudden and usually lasts for less duration -around 2 minutes or less but it can lead to jaw drop,head drop, sudden fall and accidents .It can result in slurred speech or total weakness of most muscles for a duration of a few minutes. It’s initiated by strong emotions — frequently positive feelings. Laughter or excitement might lead to sudden muscle weakness. However, occasionally fear, surprise, or anger can trigger a loss of muscle tone. For instance, when you laugh, your head may drop beyond your control. Alternatively, your knees might suddenly become weak, leading you to fall. Some individuals with narcolepsy encounter only one or two cataplexy episodes annually. Others may have multiple episodes daily. Not everyone with narcolepsy experiences these symptoms.
The narcolepsy patient may collapse to the ground.
Hypnagogic hallucinations .-These are frightening sensory hallucinations which occur at the time of falling asleep due to mixing of wakefulness and then REM sleep during which dreaming occurs.
Hallucinations. Occasionally, individuals perceive things that do not exist during sleep paralysis. Hallucinations can also occur in bed without the presence of sleep paralysis. If they take place as you are falling asleep, they are referred to as hypnagogic hallucinations. If they occur upon awakening, they are known as hypnopompic hallucinations. For instance, a person might believe they observe an unfamiliar figure in the bedroom who is not present. These hallucinations can be intense and terrifying because you might not be entirely asleep when you start dreaming.
Sleep paralysis.-
Sleep paralysis. Individuals diagnosed with narcolepsy might encounter sleep paralysis. In the case of sleep paralysis, the individual is unable to move or talk while either falling asleep or awakening. The paralysis generally lasts for a short duration — from a few seconds to a couple of minutes. However, it can be frightening. You might be conscious of the occurrence and can remember it later. Not every person experiencing sleep paralysis has narcolepsy.
When an individual undergoes sleep process during night he first enters the early stage of sleep ,
and then the deeper stages of sleep.
REM sleep occurs during the deeper stages of sleep.
This usually occurs 60-90 minutes after the onset of sleep.
In a narcolepsy patient the sleep cycle at night is disturbed and the REM sleep occurs within 15 minutes of onset of sleep cycle.
It also occurs in the routine waking hours of the day.
Changes in rapid eye movement (REM) sleep. REM sleep is the phase during which the majority of dreaming occurs. Usually, individuals transition into REM sleep 60 to 90 minutes after they have fallen asleep.
Dreams and muscle paralysis occur during this REM stage of sleep.
Other sleep symptoms
Individuals with narcolepsy may experience additional sleep disorders. They could have obstructive sleep apnea, where breathing intermittently ceases during the night. Alternatively, they may manifest their dreams, a condition referred to as REM sleep behavior disorder. They may also face difficulties in initiating or maintaining sleep, referred to as insomnia.
Types of narcolepsy –
It is of 2 types –
a-Type 1 narcolepsy and
b-Type 2 narcolepsy
In type 1 there is sleepiness and cataplexy .
There is total absence of neurotransmitter -hypocretin.
This may occur after an infection that leads to autoimmune response.
In type 2 narcolepsy there is no sudden weakness but there is excess daytime sleepiness.
As discussed earlier in this article secondary narcolepsy can occur when there is damage to the brain due to trauma or brain tumors that can damage the hypothalamus thus affecting the hypocretin production.
The total duration of night sleep in a narcolepsy patient and a normal individual is the same.
Excessive day time sleepiness –
Due to excessive daytime sleepiness the patient of narcolepsy may experience –
Decreased energy
Memories lapse
Exhaustion
Brain fog
Poor concentration
Hypnogogic hallucinations –These are vivid frightening sensory hallucinations which can occur during sleep .
In Cataplexy there is sudden muscle weakness that affects the face, neck, and knees.
Some people will have only mild weakness, such as a head or jaw drop, but some may collapse to the ground.
This weakness is transient lasting for 2 minutes or less, but it can lead to falls and other accidents.
Triggering factors include strong emotions, such as surprise, laughter, or anger.
Sleep paralysis –
In this the narcolepsy patient is not able to move or speak during falling asleep or during waking up and duration of these episodes vary from few seconds to several minutes.
This is transient and the individual recovers later.
Treatment of narcolepsy
At present there is no cure for narcolepsy.
To date, there are several diseases and disorders for whom there is no treatment in modern medicine.
Narcolepsy is one of these.
So it is entirely the luck of the individual.
Medical treatment and lifestyle changes can just help.
For sleepiness –
The individual may take naps of 15-20 minutes throughout the day.
Central nervous system stimulants are advised by neurophysician but none of the medicines are totally effective.
Modafinil
Armodafinil
Dexamphetamine
Methylphenidate
First choice of treatment is given to Modafinil and Armodafinil ,as the other drugs are having side effects like
Habit forming
Irritability
Anxiety
Changes in heart rhythm ,etc.
For Cataplexy –
Sodium oxybate is given for this feature of narcolepsy
It is used in the treatment of excess day time sleepiness ,night time sleep disturbances and cataplexy.
If antidepressants are given for cataplexy they can cause side effects like hypertension and changes in heart rhythm.
For improvement in quality of life –
The patient should get emotional support from his family members.
Mental health counselling should be done
Disability formalities should be completed .
Driving or machinery must be avoided.
Regular sleep schedule should be followed.
Regular physical exercise minimum 20 minutes per day.
Avoid caffeine or alcohol several hours before going to bed.
Avoid smoking, especially before bedtime.
Avoid eating heavy meals near bedtime.
At the present time research is still going on on narcolepsy so as to find effective cure for it.
Complications Narcolepsy can lead to complications, including:Misconceptions about the condition.Narcolepsy can impact work, education, or your personal life. Others may perceive individuals with narcolepsy as lethargic or unmotivated. Effects on romantic relationships. Strong emotions, such as anger or happiness, can trigger cataplexy. This may lead individuals with narcolepsy to distance themselves from emotional connections. Physical injury. Sudden sleep onset can lead to harm. There is a heightened chance of a car accident if you doze off while driving. Your likelihood of sustaining cuts and burns increases if you fall asleep while preparing food. Weight gain. Individuals with narcolepsy are more prone to being overweight. Sometimes weight increases rapidly when symptoms first appear.
What causes narcolepsy?
Narcolepsy is frequently triggered by a deficiency of the brain chemical hypocretin (also referred to as orexin), which manages wakefulness. This deficiency of hypocretin is believed to result from the immune system erroneously attacking the cells that generate it or the receptors that enable it to function.
Can You Wake Someone with Narcolepsy?
While rousing a person with narcolepsy does not pose any health hazards by itself, it can be quite challenging. If it is necessary to wake someone with narcolepsy for safety purposes, keep in mind that they might be bewildered and disoriented.
What are the 5 signs of narcolepsy?
There are five primary symptoms of narcolepsy, which are identified by the acronym CHESS (Cataplexy, Hallucinations, Excessive daytime sleepiness, Sleep paralysis, Sleep disruption). Although every individual with narcolepsy encounters excessive daytime sleepiness, they might not show all five symptoms.
