The Four Primary Symptoms of Narcolepsy
Narcolepsy is a rare sleep disorder characterized by uncontrollable episodes of falling asleep at any place or time. After a 10 or 15 minute sleep attack, the person feels rested only brief period of time, then returns to an uncomfortable feeling of intense sleepiness. Many narcolepsy patients describe attempting to stay awake during the day like trying to stay awake after 3 days without sleep. Attacks may occur while driving, talking, or working. The central nervous system is involved. This disorder begins in adolescence or young adulthood and continues throughout life. Narcolepsy is a potentially disabling, life-long condition estimated to afflict about one in every one thousand people in the United States. Although it is not uncommon, narcolepsy is often misdiagnosed, or diagnosed years after symptoms first appear.
The four primary symptoms of narcolepsy are excessive daytime sleepiness (EDS) and cataplexy. People with narcolepsy are unable to resist the temptation of falling asleep and do so regardless of the number of hours slept the previous night. The excessive daytime sleepiness experienced by people with narcolepsy has been described as being like trying to stay awake after going several days without sleep. Frequently, people with narcolepsy fall asleep at inappropriate times, for example while eating or in the middle of a conversation. These moments often frequently occur during periods of intense emotion such as surprise, laughter, anger, or excitement (even in some of the most passionate situations).
Cataplexy is the sudden loss of strength in voluntary muscles triggered by these intense emotions. The cataplectic attack can range from partial muscle weakness in a few muscle joints to almost complete loss of muscle control and last for several minutes. Sleep paralysis and hypnagogic hallucinations are also extremely common among patients afflicted with narcolepsy. Although these four symptoms are considered the four key symptoms of narcolepsy, all four symptoms only occur in small portion of the patients most other patients experience some combination of the four symptoms.
A. Extensive Daytime Sleepiness (EDS)
This is probably one of the most persistent and disabling conditions that can be experienced by someone with narcoleopsy. This feeling typically lasts the entire day and occurs on a daily basis. When a patient with narcolepsy experiences a period where they do fall sleep it is more tan likely due to a failure to resist sleep instead of a sudden attack of sleepiness. Although this strong desire to sleep is constant, recent prior sleep does seem to relieve for momentary periods of time. Other factors that appear to prevent a sleep attack are physical activity and stimulants, but it also prolongs the period of feeling sleepiness.
EDS has had a rather significant negative affect on narcoleptics’ job performance at school and at the workplace. Narcoleptics experience severe problems with and are typically unable to work with automobiles and dangerous equipment. Narcoleptics are more impaired than epileptic patients in terms of job performance and how prone they are to accidents. Narcoleptics lack many physical, emotional, and family supportive needs, even when compared to patients with cerebral palsy and alcoholism.
Cataplexy is the condition in which the skeletal muscles experience extreme muscles. This can vary from paralysis in one limb or throughout the entire body. During an attack, the person is conscious and aware of the environment surrounding him or her and if the paralysis is only partial maybe capable of carrying on a conversation. After the attack, the patient is fully conscious and experiences no confusion. This nearly always triggered by some form of emotional stimulus. The occurrences of attacks vary from patient to patient; it can happen daily or happen only once in a patient’s life.
These are realistic dreamlike hallucinations that occur either from consciousness to sleep or sleep to consciousness. The hallucinations are typically visual with occasional auditory or other sensory components. It often occurs in conjunction with sleep paralysis (see below). One of the most common hallucinations is to get out of bed and moving about while simply lying in a bed and not even moving a leg. Other hallucinations are more threatening as if a possible attacker enters the room and the patient is unable to move.
This is form of paralysis that is the failure to move any skeletal muscle during the period from transition of consciousness to sleep or sleep to consciousness. This occurs frequently to narcoleptic patients. These experiences are extremely traumatizing to a patient and make it difficult for the patient to breathe. The attack usually lasts about 5 minutes but can be broke either by an extreme effort by the patient or external force such as being spoken to or touched.
The precise factor that causes of narcolepsy is not clearly understood. Narcolepsy seems to be a biological problem, possibly involving abnormalities of brain chemistry. Narcolepsy or a predisposition to it may run in families suggesting a genetic influence. However, the way the predisposition might be inherited remains unknown. There is no evidence for a psychological basis for the disorder.
The most accepted theory is that there is something disturbing REM sleep. The impaired REM system is the theory that explains EDS as well as cataplexy, hypnagogic hallucinations, and sleep paralysis. This was based upon the similarities between cataplexy and REM sleep. In both cases, skeletal muscles experience impairment, due to motor neuron blocking.
This blocking of motor neurons occurs along the spinal causing excitation of the neuron in the spinal cord.. Cataplexy occurs when this inhibition of mental neurons are blocked during consciousness. Sleep paralysis may occur when motor neuron occurs prior to actual sleep or extends beyond the waking up period. Hypnagogic hallucinations occur when shifting between REM and wakefulness, this results in the unusual hallucinations experienced during hypnagogic hallucinations. The precise neurological abnormality that causes the symptoms of narcolepsy.
The symptoms of narcolepsy are usually first noticed during teenage or young adult years although it can strike at any age. Most often the initial symptom to appear is excessive daytime sleepiness. Later, after several months or even years, cataplexy, hypnagogic hallucinations, or sleep paralysis typically develop. Different individuals experience wide variations in both the developments, the number and the severity of their symptoms. Family, friends, educators, employers and even those with narcolepsy often have a hard time understanding the problem and just what is happening.
There is no known cure for narcolepsy. Narcolepsy symptoms can be treated with varying degrees of success with medications and adjustments of life-style and educational. Treatment is primarily intended to cope with the symptoms of narcolepsy. Stimulants are often given to promote alertness and to cope with EDS. The two stimulants that are prescribed the most frequently are methyphenidate and pemoline. Dosage is usually scheduled to promote alertness at the most crucial times.
The one difficulty is that tolerance can rapidly develop to stimulants so it is recommended that stimulants be used only when truly needed. Adapting your work schedule to provide for naps at the time most crucial times of the most intense sleepiness can help prevent some of the affects of EDS. This also reduces the need and possible dependency upon medication. Funds for research are needed to advance knowledge about narcolepsy and test the effectiveness of methods of treatment and management.
