Narcolepsy is a disorder that precipitates bout of severe daytime sleepiness in those that are afflicted with it, no matter what they are doing or where they are. Narcolepsy is such that it can take up to ten years for it to be properly diagnosed. Typically occurring between the ages of fifteen and thirty, narcolepsy can seriously disrupt someone’s life and it is often mistaken for fainting, depression, laziness, or seizures. Narcolepsy never completely goes away, but it can be treated with medications and lifestyle adjustments to be made more manageable.
No one is quite sure what causes narcolepsy, but research has shown that genetics and brain chemicals could be involved. When someone normally falls asleep, they begin with a stage called non-rapid eye movement sleep, as the brain waves slow down. After an hour or two of this type of sleep, the brain waves pick up again; rapid eye movement, or REM sleep, is when most dreaming occurs. If you suffer from narcolepsy, you go right into REM sleep suddenly, without the non-REM phase, and it can happen at abnormal times during the day. Researchers feel that those with narcolepsy that can drop right off into REM sleep share imbalances in certain brain chemicals that regulate sleep. One would be hypocretin, which arouses you from sleeping and keeps you awake. Hypocretin levels in people with narcolepsy are found to be low; as a matter of fact, hypocretin is often missing altogether in the spinal fluid of those with narcolepsy as opposed to those who do not have the condition. Whether an abnormal gene is responsible for this is currently under study, with research focusing on dogs that have the disorder.
Males and females alike are affected by narcolepsy, and it crosses all ethnic and racial boundaries. But the rate of its occurrence varies from country to country; Japan has a level of one in six hundred diagnosed with narcolepsy while the American rate is one in two thousand. The main characteristic of narcolepsy is great drowsiness and an uncontrollable requirement to sleep during the day. Narcolepsy makes people fall asleep without warning, irregardless of where they are or what activity they are participating in. Needless to say, this can have awful consequences. For instance, you could fall asleep while driving or while in the middle of an important meeting at work. The sleep can last as long as half an hour or may be only for a few minutes. Daytime sleepiness is the first warning sign to appear in most narcolepsy cases, and nine out of ten with this ailment have this as a symptom.
Another narcolepsy symptom is cataplexy, which can be triggered by emotions such as laughter or excitement, fear or surprise. Cataplexy is the sudden loss of muscle tone, which can result in the complete weakness of most of your muscles. It shows up in three quarters of narcolepsy sufferers, and can last for a few seconds or ten minutes. Some narcoleptics with cataplexy have several attacks each day; others can have just one or two each year. One quarter of those with narcolepsy experience what is known as sleep paralysis, where they lose the ability to move or speak as they are falling asleep or waking up. These individuals know what is going on around them but cannot control what is happening to themselves for these seconds or minutes depending on the severity of the event. Sleep paralysis can happen to those without narcolepsy as well, and frequently does, especially to young adults. One in three diagnosed with narcolepsy has hallucinations, seemingly real dreamlike episodes as they are falling asleep or waking.
Restless sleep during the night is commonly a symptom of narcolepsy, as is what is called automatic behavior. This describes a condition where you are able to function while asleep, perhaps even talking while performing some task, usually not all that well, but you will have no recollection of any of it when awakened. As many as forty percent of individuals with narcolepsy experience this, and they may also “act out” their nighttime dreams by screaming or waving their arms! Most people with this disorder will begin to exhibit narcolepsy symptoms between the ages of ten and twenty-five years old, but those younger than ten or in their thirties can develop it also. Seldom does someone over forty develop narcolepsy, and once you are come down with it, narcolepsy never fully goes away. The diagnosis of narcolepsy may require someone exhibiting these symptoms to stay overnight in a sleep center, where they will undergo a variety of tests. One is a polysomnagram, which depends on electrodes placed on your head to relay information about your brain’s activity while you sleep. A multiple sleep latency test determines how long it takes you to fall asleep during the day, several times in one day, to see if you can do it easily or not. The Epworth Sleepiness Scale is a questionnaire designed to find out if someone has a potential sleep problem, as it asks questions about falling asleep in certain situations and has you answer them with a rating of zero to three depending on how easily you can doze off during that circumstance. A score of over ten means there could be trouble. Often those diagnosed with narcolepsy realize that they have had it for years without being able to put their finger on it.
Narcolepsy has no cure, but there are certain medications that can combat the possibility of falling asleep in a bad setting. Stimulants such as Ritalin and a more recent, less addictive one called Modafinil, can stimulate the nervous system enough to keep you awake. Antidepressants can suppress REM sleep and are often prescribed to treat the cataplexy, sleep paralysis, and hallucinations associated with narcolepsy. Xyrem, or sodium oxybate, helps to better nighttime sleep, and if taken in high doses, can carry over and control daytime sleepiness as well. It comes with serious side effects and is strictly regulated by the Food and Drug Administration. Many of the medications used for narcolepsy have side effects, and need to be taken with this in mind.
If you have narcolepsy, it can help to stick to a strict sleep schedule, going to sleep and waking up at the same time each day, even on the weekends. Take short naps that you can fit into your day, as they may refresh you and keep episodes of falling asleep at bay. Avoid alcohol and nicotine products, as they can make things worse and get enough exercise to make you feel more awake. Safeguards must be put in place, especially where driving is concerned. If your medications are not totally effective, use your head and stop for naps when going long distances. At school or at work, let people know about your condition. The Americans with Disabilities Act protects the rights of those with conditions such as narcolepsy. Those with the disorder often are accused of being lazy or thought to be under the influence of drugs, and it can be a hard stigma to climb out from under. Anyone taking medications for narcolepsy needs to inform their teachers and employers, especially if they are subject to drug screening. Narcolepsy can be an embarrassing and tough condition to live with, but with proper treatment and knowledge of the affliction, it can be made much more tolerable.
