Monday, February 21, 2011

Narcolepsy is a Daytime Sleep Disorder

What is narcolepsy? According to WebMD, narcolepsy is a daytime sleep disorder which neurologically affects the control of sleep and wakefulness. In other words, people experience uncontrollable episodes of falling asleep easy during the day, anytime of day. Typically when we fall asleep it takes about ninety minutes for rapid eye movement sleep (REM), narcoleptics REM sleep occurs right away. Researchers have discovered irregularities in various parts of the brain involved in regulating REM sleep patterns. These irregularities apparently contribute to the occurrence of narcoleptic symptoms. Experts believe there are many factors causing narcolepsy that act together causing neurological dysfunction and REM sleep disturbances.

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The cause of narcolepsy is not known; however, scientists have made progress toward identifying genes strongly associated with the disorder that control the production of chemicals in the brain that may control our sleep/wake cycles. Some experts think narcolepsy may be due to a deficiency in the production of a chemical called hypocretin by the brain. Hypocretin neurons strongly stimulate various brain nuclei with important roles in wakefulness including the dopamine, norepinephrine, histamine and acetylcholine systems and appear to play an important role in stabilizing sleep/wake cycles. Narcoleptics also exhibit a specific genetic mutation in the T-cell receptor alpha locus. In conjunction, these genetic irregularities cause the autoimmune system to attack and kill the critical hypocretin neurons. Therefore, the absence of hypocretin-producing neurons in narcoleptics may be the result of an autoimmune disorder. They don’t know what triggers this cell destruction but it is hypothesized that it may be a viral infection.

Narcolepsy usually begins between the ages of 15 and 25, but it can become happen at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated. What are narcolepsy symptoms? Excessive daytime sleepiness or what is known as EDS can interfere with normal daily activities causing lack of energy, mental focus and exhaustion. Cataplexy a narcoleptic symptom defined as a sudden loss of muscle tone which leads to feelings of weakness or a loss of voluntary muscle control. Symptoms range from slurred speech to total body collapse depending on the muscles involved and usually triggered by an emotional response such as; anger, laughter or surprise. Hypnagogic hallucinations are brought on when the person is falling asleep and hypnopompic hallucinations occur when they are waking up. These hallucinations are delusional experiences that are quite vivid and often very frightening. Mostly visual, but sometimes other senses may be involved. Sleep paralysis is the temporary inability to move or speak while falling asleep or waking up. These episodes can last few seconds to several minutes.

If you or someone you know has any of these symptoms they should seek medical care. Your doctor will give you/them a physical exam and medical history to determine a proper diagnosis of narcolepsy. However, none of the major symptoms is exclusive to narcolepsy as they may be signs of other sleep disorders. Several specialized tests including those performed at a sleep clinic are recommended before a narcolepsy diagnosis. There is a blood test called HLA-DQB1*0602, which is usually positive in patients with clear-cut narcolepsy with cataplexy but this only shows that the disorder is probably an autoimmune disorder. And many people are positive for this test that never develops narcolepsy. It is not a test that is clinically very useful and is generally used only in research. Two tests that are essential in the diagnosis of narcolepsy are the polysomnogram (PSG) and the multiple sleep latency test (MSLT) both are performed in a sleep clinic. The PSG is an overnight test that monitors a patient while they sleep for irregularities in their sleep cycle. This can eliminate symptom result from another sleep disorder like sleep apnea. The MSLT is performed during the day and requires the individual to take four or five short naps, two hours apart. This test measures the person’s tendency to fall asleep easy and to determine whether remote factors of REM sleep interfere during waking hours.

Although there is no cure for narcolepsy, the most disabling symptoms of the disorder ED and abnormal REM sleep, such as cataplexy can be controlled in most people with drug treatment. Sleepiness is treated with amphetamine-like stimulants while the symptoms of abnormal REM sleep are treated using antidepressant drugs.

There has recently been a new medication approved for those who suffer from narcolepsy with cataplexy. This drug, called Xyrem, helps people with narcolepsy get a better night's sleep, allowing them to be less sleepy during the day. For daytime sleepiness, the drug modafinil, which is a wake-promoting agent that is far gentler with fewer side effects than the traditional amphetamines that were used for years. The newest drug to treat narcolepsy is sodium oxybate, which is a strong sedative that is used to consolidate sleep and help narcoleptic patients achieve more deep sleep.

Lifestyle changes such as avoiding caffeine, alcohol, nicotine, heavy meals, regulating sleep schedules, scheduling 10-20 minute daytime power naps and establishing a normal exercise and meal schedule may also help to reduce symptoms.

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In the past, many people with narcolepsy had symptoms for years before they got an accurate diagnosis. Often, they were told that they were lazy and unmotivated. Undiagnosed narcolepsy can have devastating effects on daytime activities such as work or schooling. Sometimes it was misdiagnosed as depression, drug abuse or, when hallucinations were reported, schizophrenia. Many patients with a clear history of cataplexy who were told they had seizure disorders or syncopal (fainting) episodes.

The good news is that narcolepsy is better recognized now by general practitioners. If you feel you are someone you know is afflicted with this disorder contact a physician to get a proper diagnosis and treatment. The content provided in Narcolepsy is a Daytime Sleep Disorder is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.
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