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Narcolepsy

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Narcolepsy is a neurological disorder enveloping a wide range of sleep-related symptoms, including daytime sleepiness attacks and a sudden relaxation of muscles, known as cataplexy. A deficiency in key neurotransmitters appears to be the cause of most narcoleptic symptoms. Narcolepsy afflicts people around the world, but some regions are more prone to narcolepsy than others. In Japan, for example, an estimated one in every six-hundred people have narcolepsy as opposed to America, where the condition plagues about one in every two-thousand individuals.[1] Narcoleptics may find that their condition greatly discombobulates and disrupts their personal and professional lives through the prevalence of the symptoms.

Symptoms

Excessive sleepiness throughout the day is a universal symptom of narcolepsy

Excessive sleepiness:

The most pervasive symptoms narcoleptic individuals suffer from includes experiences of excessive drowsiness throughout the day regardless of the amount of sleep obtained during the previous night. Strong emotions, such as excitement, rage, and even laughter can trigger episodes of excessive sleepiness which last typically up to thirty minutes. Many who suffer from this condition claim excessive sleepiness acts as a “fog” surrounding their mental comprehension, logic, and awareness. Some victims complain of an onset of depression and memory relapses as a result of their seemingly unending drowsiness. Many attacks of excessive sleepiness arrive as a victim engages in a more relaxing activity, reading a book or watching television for example. In some cases, however, narcoleptics may feel an oncoming of sleepiness when engaging in more active situations such as eating or during conversation. A common condition present during occurrences of excessive daytime sleepiness is the sudden relaxation of muscle tone, known as cataplexy. In its most moderate form, cataplexy often causes a person's head to nod and can even create difficulties when speaking. In more severe cases, cataplexy can cause weakness in the arms and legs, sometimes resulting in the collapse of the victim. Similar emotions which trigger episodes of excessive sleepiness also bring upon cataplexy. [2] An attack of cataplexy disables a person's ability to move for minutes at a time, but does not dissolve the victim's awareness. Facial twitching and lack of response during a cataplexic strike are commonly confused with epileptic shock. [3]

While no formal cure currently exists for excessive sleepiness or cataplexy, many changes in personal lifestyle have alleviated the effects of narcolepsy. Such changes typically include avoiding caffeine consumption, daily exercise, and wearing a medical bracelet or necklace so others in the area can identify the issue should a daytime onset of sudden sleep or cataplexic inability speak occur. [4]

Sleep Paralysis:

Those suffering from sleep paralysis are temporary rendered unable to physically move upon awakening or falling asleep despite the fact that a person remains conscious. These brief attacks generally last for a small amount of seconds, but can linger as long as several minutes. [5] During rapid eye movement sleep (REM), the brain induces a state of paralysis to prevent a body from physically acting out the events of a dream. In sleep paralysis cases, this function activates while a person is still conscious. Due to the dream-like state of consciousness that occurs during sleep paralysis, figments of imagination may appear as reality, resulting in illogical and sometimes terrifying hallucinations. [6] These visions are referred to as either hypnopompic or hypnagogic hallucinations, depending on whether they occur before or after sleep. While dreams typically follow some sort of storyline, a hallucination during sleep paralysis only is manifested in the form of a single image. [7]

Sleep paralysis can occur in anyone and is caused by an unstable sleeping schedule and stress. While sleep paralysis can be remedied in ordinary people through the use of better time-management in regards to sleep, narcoleptics are unable to solve this issue due to the brain's inability to manage sleep. [5]

REM Sleep-related issues:

Most people require an approximate ninety minutes of sleep before entering REM sleep. In narcoleptics, however, this state of sleep can occur almost immediately after falling into a resting state. This poses an issue for narcoleptics who succumb to daily urges to sleep, as waking up from REM sleep is more difficult. [2]

In addition, many narcoleptics also suffer from a condition known as sleep apnea. In cases like this, passageways to the lungs are restricted throughout periods of sleep. This causes episodes of choking and gasping for the sleeping victim. Contrary to the issue with sleep paralysis, some narcoleptics struggle with the issue of the brain's inability to impose paralysis during actual REM sleep. This causes the dreaming individual to physically act out the events of his/her dream by flailing limbs or sleepwalking. [6]

Causes

An exact cause for the onset of narcolepsy has not yet been determined. However, the diminished amounts of hypocretin, a neurotransmitter, has been linked to cataplexy and the inability to remain awake for long periods of time, one of the most common symptoms of narcolepsy. Along with wakefulness, hypocretin also aids in regulating duration of REM sleep. Tumors in the brain and strokes may also bring upon a decrease in this neurotransmitter. Family history analysis usually predicts a diminished level of hypocretin in a suspected narcoleptic. Some recent studies suggest external environmental forces, such as pesticides, could also be to blame for many cases od hypocretin deficiency. [8]

Diagnosis

The Elmhurst Memorial Sleep Center, an example of a location where polysomnogram tests and others are administered.

Narcolepsy's rarity and sometimes mild severity contribute to its difficulty in diagnosing. The fact that narcolepsy shares certain symptoms with various other conditions, such as depression or infection, further complicate the diagnosing process. By compiling a comprehensive analysis on family history and a physical examination, the disorder becomes more easily recognizable. If a doctor suspects the condition plaguing a patient could be narcolepsy, he will issue two tests: a polysomnogram test and a multiple sleep latency test.

Polysomnogram:

Many polysomnogram tests are conducted in specialized sleep research centers, where a specialist issues the test. The patient will be directed to a bed where several wires attach to the head and chest areas. After the patient falls asleep, the polysomnogram records various bodily activities such as brain wave action, respiratory rate, and oxygen content in blood.[9] In addition, a polysomnogram records eye movements, both REM (rapid eye movements) and non-REM. This data is compiled into an analysis of the type and severity of the sleeping disorder suspected. If traveling to a sleep center proves impossible for a patient, a polysomnogram test can also be conducted from home if a proper polysomnogram device is purchased from a physician or doctor. [10]

Multiple Sleep Latency Test:

The multiple sleep latency test, also called the MSLT, assess the patient's ability to fall asleep within a short period of time. A full test takes an entire day and is issued at your local sleep research center. During this test, a patient is scheduled to take five naps throughout the period of one day. Two hours separate each period of napping. Factors that making napping difficult, such as heat or noise, are eliminated to provide a somnolent environment. After fifteen minutes of uninterrupted napping the patient is woken up. Data such as time needed until napping is achieved are recorded and analyzed to diagnose symptoms of narcolepsy like excessive daytime sleepiness. [11]

Treatment

Drugs and Self-Help

While narcolepsy currently has no cure, several medicinal drugs and therapeutic practices have been shown to decrease the severity of the condition's symptoms. The severity of symptoms such as catalepsy can be mitigated through the use of various antidepressants. Brain and heart stimulants can be prescribed in response to excessive sleepiness. Avoidance of caffeine and beverages containing alcohol are recommended, especially before bedtime hours. In addition, nutrition therapists recommend a healthy diet and regular exercise to keep sleepiness at a minimum. Regular scheduled naps sometimes aid with diminishing daytime sleepiness.

Coping Methods:

In order to cope with the effects of narcolepsy, victims utilize a variety of coping mechanisms to reduce the amount of stress brought on by the condition. Many physicians stress the importance of joining a narcolepsy support group. Symptoms brought upon by narcolepsy in addition to a general public ignorance as to the effects of the condition can be seen by some narcoleptics as quite embarrassing. Wearing a medical bracelet can inform those in the area of the condition should an attack of excessive daytime sleepiness and catalepsy render the victim immobile. In extreme cases, a tape recorder should be brought to important events in the event that should daytime sleepiness occur, the information remains on record even if the victim falls asleep. [12]

Video

Nicole Jeray, victim of narcolepsy.

References

  1. Unknown Author. Narcolepsy GeneticsHomeReference. Web. Reviewed December 2010.
  2. 2.0 2.1 Author Unknown. What Are the Signs and Symptoms of Narcolepsy? National Heart, Blood, and Lung Institute. Web. Updated 1 November, 2010.
  3. Zeman, Adam. Narcolepsy and excessive daytime sleepiness US National Library of Medicine. Web. Posted 25 September, 2004.
  4. Robinson, Lawrence and Segal, Jeanne. Narcolepsy Helpguide. Web. Last updated December 2013.
  5. 5.0 5.1 Author Unknown. Sleep Paralysis WebMD. Web. Accessed 18 December, 2013.
  6. 6.0 6.1 Harms, Roger. Narcolepsy: Symptoms Mayoclinic. Web. Last updated 24 October, 2012.
  7. Author Unknown. What are hypnopompic hallucinations Wisegeek. Web. Accessed 18 December, 2013.
  8. Author Unknown. What Causes Narcolepsy? National Heart, Lung, and Blood Institute. Web. Originally Posted 1 November, 2010.
  9. Harms, Roger. Polysomnography MayoClinic. Web. Accessed 15 January, 2014.
  10. Hadjiliadis, Denis. Polysomnography MedlinePlus. Web. Updated 31 July, 2011.
  11. Author Unknown. Multiple Sleep Latency Test (MSLT) - Overview and Facts SleepEducation. Web. Accessed 15 January, 2014.
  12. Robinson, Lawrence and Segal, Jeanne. Narcolepsy HelpGuide. Web. Last Updated December 2013.

Other neurological disorders