Early symptoms of narcolepsy
There are four early symptoms of narcolepsy; excessive daytime sleepiness, cataplexy, sleep paralysis, and hallucinations. They usually appear between the ages of 10 and 30, become worse for the first few years, and ultimately continue permanently. They can also begin earlier and affect both men and women. Approximately 60% of people with narcolepsy have a combination if the first two symptoms, while less than one third experience all four symptoms. This condition is characterized by skipping the non-rapid eye movement phase (NREM) of sleep and go directly to the rapid eye movement (REM) phase at unexpected and inappropriate times.
Signs of narcolepsy in detail:
· Excessive daytime sleepiness. The first and most obvious symptom, shared by all cases of narcolepsy. Patients experience episodes of sleepiness and decreased alertness lasting 30 minutes or less, and which may be triggered by intense emotions (anger, fear, laughter, excitement). These patients usually complain of mental cloudiness, memory problems, problems focusing, lack of energy, severe exhaustion, and depression. More worrisome, they may literally fall asleep in the middle of a sentence. Sleep episodes typically take place during periods of inactivity – for instance while reading, watching TV, or at a meeting. However, they may also happen while talking or eating, regardless of the time and place.
· Cataplexy. A sudden and temporary loss of muscle tone caused by strong emotions – both negative and positive – like fear, surprise, and anger, or laughter and excitement. Cataplexy may begin weeks to years after the onset of extreme daytime sleepiness and occur as often as several times a day or as rarely as once or twice a year. Depending on the severity of the attack, the patient may experience slurred speech or stuttering, drooping eyelids, hand weakness, knees buckling, collapse. However, the patient remains awake throughout.
· Hallucinations. Lifelike, vivid, and frightening dreams that occur while falling asleep (hypnagogic hallucinations) or waking up (hypnopompic hallucinations).
· Sleep paralysis. Temporary paralysis during the REM phase prevents the body from acting out dream activity, but sleep paralysis in narcolepsy occurs while the patient is falling asleep and waking up and they are fully aware of what is going on. This inability to move can be brief but also frightening.
The actual cause of narcolepsy has not been established but it is believed that genetics may be at the root of the problem. Certain people may inherit a gene that affects the production of hypocretin, a chemical in the brain that people with narcolepsy have in low levels. Hypocretin helps to regulate wakefulness and REM sleep. Other factors that may contribute to low levels of hypocretin are brain injuries caused by brain tumors, strokes, or trauma; autoimmune disorders; and low levels of histamine.
Up to 10% of people with this condition report that a relative also has the early symptoms of narcolepsy. Heredity is not the sole cause, though, so a proper diagnosis is needed to confirm whether you have this problem as well as discard other conditions like sleep apnea. A doctor will ask you about your family, medical, and sleep history, and may ask you to keep a journal of your sleep patterns. Additionally, the physician may run a few tests:
· Polysomnogram (PSG)
An overnight tests in which electrodes placed on the scalp measure brain and heart electrical activity, muscle and eye movements, and breathing. A PSG can also determine how quickly you fall asleep, how soon after falling asleep you go into REM, and how often you wake up during the night.
· Multiple sleep latency test
Performed the day after a PSG, the patient is asked to nap for 20 minutes 4 or 5 times throughout the day, each nap being separated by two-hour periods. Normal sleepers fall asleep within 12-14 minutes, whereas people with narcolepsy fall asleep within 5 minutes or less.
· Hypocretin test
A needle is inserted into the lower back (known as spinal tap or lumbar puncture) to collect a sample of spinal fluid and measure the levels of hypocretin.
There is no cure for narcolepsy but the condition may be managed with medications and lifestyle changes.
· SSRIs or SNRIs*
· Tricyclic antidepressants
· Soudium oxybate
· A regular schedule of going to bed and waking up at the same time every day.
· A relaxing activity before going to bed.
· A quiet, comfortable, dark, distraction-free bedroom.
· Regular exercise (though not within 3 hours of bed time).
· No tobacco, alcohol, chocolate, or caffeine in the hours before going to bed.
· No large meals or beverages right before going to bed.
· No bright lights before going to bed.
*Selective serotonin reuptake inhibitors and serotonin and noripinephrine reuptake inhibitors.
People who have narcolepsy do not need extra hours of sleep – in fact, they may wake up from an episode of extreme daytime sleepiness feeling refreshed – but they do need to take regularly scheduled naps during the day.
In addition to being incurable, narcolepsy is not preventable. The best patients can do is to avoid the triggers that can provoke episodes, especially during activities that may result in physical harm, such as driving. Patients should ask their doctors whether it is safe for them to drive, and if not, get rides from relatives, and friends, or co-workers. Other recommendations include taking naps before driving and stopping often during long drives. Narcolepsy can also have an impact on work, relationships, and life in general. Several laws such as the Americans with Disabilities Act and the Family and Medical Leave Act help ensure that narcoleptics remain gainfully employed, and Social Security Disability Insurance or Supplemental Security Income can provide financial aid to people who can’t work due to their condition.
Narcoleptics can not only fall asleep at their jobs, though, but also during sexual intercourse. Moreover, narcolepsy can lead to decreased libido and erectile dysfunction, all of which can deteriorate an intimate relationship. More generally speaking, this disease can bring about fear anxiety, depression, and stress. The best advice here is to talk openly about the condition to partners, employers, and healthcare providers, and with a professional counselor too, if necessary.