Narcolepsy: characteristics, causes, and clinical management

¶ … narcolepsy and its treatment. Narcolepsy is a sleep disorder that may have its origins as a neurological disorder. Narcoleptics can fall asleep uncontrollably during the day, and suffer from sleeplessness at night. Often, this disease is undiagnosed and untreated. It usually becomes apparent between the ages of 15 and 25, but it can occur at any time in a person's life. Narcolepsy is a serious illness that requires treatment, but there is no cure. It can be managed with drugs and lifestyle changes.

Normally, a person enters REM (Rapid Eye Movement) sleep about 90 minutes after falling asleep. This is the deepest form of sleep, and it is when dreams usually occur. During this time, sleepers may experience a loss in muscle tone, sleep paralysis, and especially vivid dreams. In a narcoleptic patient, REM occurs almost immediately after falling asleep, and it can reoccur throughout the day, as well. The symptoms associated with REM sleep can also reoccur throughout the day. For example, a doctor writes, "A variety of symptoms have been said to distinguish narcolepsy from other sleep disorders, including cataplexy, character of daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and automatic behavior" (Aldrich, 1998). The problem with these symptoms is that many other sleep disorders can have some of the same symptoms, so it is often difficult to diagnose narcolepsy.

Other symptoms include excessive daytime sleepiness (EDS), and this can interfere with normal daytime activities. The Web site WebMD notes, "People with EDS report mental cloudiness, a lack of energy and concentration, memory lapses, a depressed mood, and/or extreme exhaustion" ("Narcolepsy," 2009). Cataplexy is a loss of muscle tone and control, and it can create many other symptoms, such as slurred speech. Patients often experience hallucinations, too. They can occur at night or during the daytime, and they can be quite frightening. Patients often experience sleep paralysis, as well. When a patient falls asleep or wakes up, they may not be able to move or speak for a few seconds to several minutes. After that, they are fine ("Narcolepsy," 2009). Another symptom is automatic behavior. For example, the sufferer finishes folding laundry or some other automatic activity, but later has no recollection of the event. In effect, they were asleep while they performed the task. The Mayo Clinic Web site notes, "People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your daily routine" (Mayo Clinic Staff, 2009). Because of this, many people with severe narcolepsy find it difficult to hold down jobs or maintain a daily routine.

Researchers really do not know what causes narcolepsy, although they have identified the genes involved in it, along with abnormalities in the brain that may help cause the disease. One Web site notes, "These abnormalities apparently contribute to symptom development. According to experts, it is likely narcolepsy involves multiple factors that interact to cause neurological dysfunction and REM sleep disturbances" ("Narcolepsy," 2009). Researchers do know there is some kind of chemical imbalance in the brain that contributes to the disease. The Mayo Clinic notes, "Hypocretin is an important chemical in your brain that helps regulate staying awake and keeps REM sleep stable and occurring at the appropriate time during sleep" (Mayo Clinic Staff, 2009). They know there is an imbalance in the brain in narcoleptic patients, but they do not know what causes that imbalance to occur. As research into the disease continues, researchers should make headway into learning what causes narcolepsy and how to more efficiently treat the disease.

It is also difficult to diagnose the disease. WebMD continues, "However, none of the major symptoms is exclusive to narcolepsy. Several specialized tests, which can be performed in a sleep disorders clinic, usually are required before a diagnosis can be established" ("Narcolepsy," 2009). It is common for the disease to be misdiagnosed because of the similarity of symptoms, or for the disease to go undiagnosed and untreated. In addition, many older patients report that the daytime symptoms increase as they age, particularly over 60.

Scientists have found there are certain risk factors for the disease. For example, if someone in your family has narcolepsy, you stand a higher risk for developing it. It is more common in men than in women, and it occurs throughout racial and ethnic groups. It is interesting to note that Japan has the highest rate of narcolepsy in the world, at about one in 600. The U.S. rate is about one in 2,000, while the rate in Israel is about one in 500,000. Scientists do not know why the rates for different countries vary so much (Mayo Clinic Staff, 2009).

There is no cure for the disease, although there are treatments for at least some of the symptoms. The National Institute of Neurological Disorders (NIND) notes, "Two classes of antidepressant drugs have proved effective in controlling cataplexy in many patients: tricyclics (including imipramine, desipramine, clomipramine, and protriptyline) and selective serotonin reuptake inhibitors (including fluoxetine and sertraline). Drug therapy should be supplemented by behavioral strategies" ("Narcolepsy Information," 2009). Another author notes, "Psychostimulants are used to prevent sleep attacks during everyday activities, and in the latter they are used to improve attention and energy levels" (Schmetzer, 2004). While medications can help with some of the symptoms, they cannot help with all of them. Many patients find taking short naps during the day helps them maintain their attention. Patients can also modify other areas of their lifestyle to help reduce the symptoms. WebMD continues, "Lifestyle adjustments such as avoiding caffeine, alcohol, nicotine, and heavy meals, regulating sleep schedules, scheduling daytime naps (10-15 minutes in length), and establishing a normal exercise and meal schedule may also help to reduce symptoms" ("Narcolepsy," 2009). None of these is a cure; however, there is no cure for narcolepsy once it begins to occur.