Narcolepsy Neurological Disorder : Symptoms, Causes & Treatment

What is Narcolepsy?

Narcolepsy is a long-term neurological disorder that impairs the brain's ability to regulate sleep-wake cycles. People with narcolepsy may feel sleepy after waking up, but then sleepy for the rest of the day. Many people who have narcolepsy have infrequent and interrupted sleep, which can include waking up frequently during the night.

Narcolepsy can have a significant impact on daily activities. Even if they are focused in an activity such as driving, eating, or having a conversation, people may unintentionally fall asleep. Other symptoms may include sudden muscle weakness while awake that causes a person to become limp or unable to move (cataplexy), vivid dream-like images or hallucinations, and total unconsciousness just before falling asleep or shortly after waking up (sleep paralysis).

After about 60 to 90 minutes in a normal sleep cycle, a person joins rapid eye movement (REM) sleep. Dreams occur during Deep sleep, and the brain calms muscles during this stage of sleep, preventing people from acting out their imaginings. Narcolepsy patients frequently enter REM sleep quickly, within 15 minutes of falling asleep. Deep sleep muscle weakness or dream activity can also occur during slow-wave sleep or be absent during sleep.

Narcolepsy, if undiagnosed or untreated, can impair psychological, social, and cognitive function and development, as well as inhibit academic, work, and social activities.

Types of narcolepsy

Narcolepsy can be categorized into two types:

Narcolepsy Type 1

Type 1 Narcolepsy is known (previously termed narcolepsy with cataplexy). This diagnosis is based on the person reporting cataplexy and excessive daytime sleepiness on a specific nap test or having low levels of a brain hormone This diagnosis is based on the person reporting cataplexy and excessive daytime sleepiness on a specific nap test or having low levels of a brain hormone (hypocretin).

This diagnosis is based on the person reporting cataplexy and excessive daytime sleepiness on a specific nap test or having low levels of a brain hormone.

Narcolepsy Type 2

Type 2 Narcolepsy is called (previously termed narcolepsy without cataplexy). People with this disease have extensive daytime sleepiness but do not generally have muscle weakness caused by emotions. They typically have clinical symptoms and normal levels of the brain hormone hypocretin.

Damage to the hypothalamus, a deep area of the brain that helps control sleep, can cause secondary narcolepsy. Individuals with narcolepsy may have significant cognitive difficulties as well as a sleep for extended durations (more than 10 hours) each night, in addition to the typical symptoms.

Narcolepsy Symptoms

The symptoms of narcolepsy can sometimes worsen in the first few years and then survive for the rest of one's life. They are as follows:

1. Excessive sleepiness during the day. People with narcolepsy feel sleepy quickly, anywhere, and at any time. For example, you could be working or conversing with friends when you nod off and fall asleep for a few minutes to a half-hour. You feel refreshed when you wake up, but you soon fall back asleep. 
2. You may also observe a reduction in your alertness and focus throughout the day. Excessive daytime sleepiness is usually the first symptom to appear and is often the most troubling, making it difficult to concentrate and function normally. 
3. Muscle tone is suddenly lost. Cataplexy (KAT-uh-plek-see) is a syndrome that can induce a variety of bodily changes, ranging from slurred speech to full muscle weakness, and can last for a few minutes. 
4.  Cataplexy is uncontrollable and is caused by intense emotions, most of which are positive, such as laughter or excitement, but can also be fear, surprise, or anger. Some people with narcolepsy suffer only one or two episodes of cataplexy each year, whilst others suffer many episodes every day.
5. Some people with narcolepsy have only one or two episodes of cataplexy per year, while others have multiple episodes every day. Cataplexy does not affect everyone who has narcolepsy. 
6. Paralysis caused by sleep. When falling asleep or waking up, people with narcolepsy often experience a temporary inability to move or speak. These episodes are usually brief (a few seconds or minutes), but they can be scary. Even if you had no control over what happened to you, you may be conscious of the situation and recall it easily later. This sleep paralysis is similar to the type of temporary paralysis that occurs during rapid eye movement (REM) sleep. REM sleep immobility may prevent your body from acting out dream activity. Narcolepsy does not affect everyone who has sleep paralysis. Many people who do not have narcolepsy develop sleep paralysis episodes. 
7.  Rapid eye movement (REM) sleep changes. The majority of dreams occur during REM sleep. In people with narcolepsy, REM sleep can occur at any time of day. Narcolepsy patients frequently transition to REM sleep quickly, usually within 15 minutes of falling asleep. 
8. Hallucinations. These hallucinations are termed hypnagogic hallucinations if they occur during sleep and hypnopompic hallucinations if they occur upon awakening. One example is having the feeling that there is a guest in your room.  Because you may not be fully asleep when you begin dreaming and you understand your dreams as reality, these hallucinations can be especially vivid and frightening.

Narcolepsy causes

Doctors are unclear as to what causes narcolepsy. They believe it is the result of many factors converging to cause issues in your brain and disrupt your REM sleep.

Scientists are getting closer to identifying genes linked to the disease. These genes control the release of chemicals in your brain that may predict sleep and waking cycles.

Some experts believe narcolepsy occurs because your brain has difficulty producing a chemical called hypocretin. They've also identified issues in areas of the brain that control REM sleep.

Your age is one of the risk factors for narcolepsy. Narcolepsy typically develops between the ages of 15 and 25, however, it can appear at any age. If you have a family history of narcolepsy, your chances of getting it are 20 to 40 times higher.

Conditions and Behaviors Related to Narcolepsy

Some persons with narcolepsy also have the following problems:

•      Periodic limb movement disorder (PLMD) develops when your leg muscles move regularly during the night without your control. Sleep apnea occurs when your breathing constantly stops and restarts while you sleep.

•     Automatic actions: You fall asleep while doing anything routine, such as driving, walking, or talking. You continue the activity while sleeping and awaken with no memory of what you did.

Narcolepsy Tests and diagnosis:

Tests and Diagnosis of narcolepsy include:

Physical exam and medical history

Sleep records: Your doctor might require you to keep note of your symptoms and when you’re sleeping for a number of weeks.

Polysomnogram (PSG)

This is done in a sleep problem clinic or a sleep lab. It’s an overnight test that takes constant readings while you’re asleep to identify issues in your sleep pattern. A PSG can assist indicate whether you go into REM sleep at unexpected moments in your sleep cycle. It helps rule out other conditions that might be causing your symptoms.

Multiple sleep latency tests (MSLT)

This is also done at a specific clinic or lab. The test takes place during the day to measure your tendency to fall asleep and find out whether specific aspects of REM sleep occurs at abnormal times during the day. You’ll take four or five short naps, about two hours apart.

Treatment of narcolepsy

There is no cure for either type 1 or type 2 narcolepsy. The objectives of narcolepsy treatment are to improve patient safety, reduce symptoms, and enhance their lives.

Many patients with narcolepsy find that their condition improves over time. Certain symptoms may improve as the patient ages, and in rare situations, remission of symptoms may occur spontaneously. Doctors are still unclear as to why the disease develops differently in various people.

Treatments for NT1 and NT2 are identical, with the exception that NT2 does not require the use of cataplexy medicines.

A combination of medication and behavioral therapies can reduce symptoms significantly but not completely. 

Despite treatment, some level of EDS was implemented to ensure. All therapies should be performed under the supervision of a doctor who can best tailor a treatment plan to the patient's unique situation.

Behavioral Treatment Approaches

Behavioral therapies are non-medical kinds of therapy that can be applied to the everyday routines of people with narcolepsy in a variety of different ways.

•  Short naps are relaxing for persons with narcolepsy, so scheduling time for naps during the day can help minimize EDS. Making accommodations at school or work to allow for naps may be necessary.

•  Having good sleep hygiene: People with narcolepsy can benefit from excellent sleep habits to combat sleep deprivation at night. A consistent sleep schedule (for bedtime and getting up), a sleep environment with few distractions and disruptions, and limited usage of electronic devices before bed are all examples of good sleep hygiene.

•  Avoiding sedatives and alcohol: Any chemical that causes sleepiness may cause daytime narcolepsy symptoms.

•   Driving with caution: People suffering from narcolepsy should see their doctor about safe driving practices. Napping before driving and avoiding long or monotonous drives are two examples of safety.

•   Eating a balanced diet: Because people with narcolepsy are more likely to become obese, eating correctly is a critical part of their overall health.

•  Exercising: Being physically active can help avoid obesity and contribute to better sleep at night.

•  Seeking help: Support groups and mental health specialists can help persons with narcolepsy improve their emotional health and reduce the risks of social disengagement, despair, and anxiety.  

Narcolepsy medication

Although behavioral techniques are frequently beneficial, the majority of people with narcolepsy also receive medication to help reduce one or more symptoms.

Medications for narcolepsy generally relieve symptoms, but they can sometimes create side effects. These medications require a prescription and should be used with caution and in following the instructions provided by a doctor and pharmacist.

Some of the most commonly given narcolepsy medications are:

1.       Modafinil and Armodafinil are chemically identical wakefulness-promoting medications that are commonly used as the first line of treatment for EDS.
2.       Methylphenidate is an amphetamine that can help with EDS.
3.      Solriamfetol: This medicine was approved by the FDA in 2019 and has proven effects on EDS similar to modafinil.
4.     Sodium oxybate: This medicine can help with cataplexy, EDS, and nightly sleep difficulties, although it can take several weeks to work.
5.    Pitolisant: Pitolisant, which was approved by the FDA in 2019, is a wakefulness-promoting medicine that has also been found to help with cataplexy.

Not all treatments are effective for all individuals, and some people may experience more annoying side effects or drug interactions. Working closely with the doctor can assist in determining the drug and dosage that provides the optimal balance of benefits and drawbacks.

Children and Narcolepsy Treatment

Treatment for children with narcolepsy is similar to that for adults, although special measures must be taken when selecting drugs and dosages. The American Academy of Pediatrics recommends a cardiovascular assessment.

Narcolepsy in Pregnancy Treatment

Most medicines used to treat narcolepsy in pregnant, trying to get pregnant, or breastfeeding women have insufficient data on their safety. According to a poll, the majority of professionals advise quitting narcolepsy medicines when trying to conceive, pregnant, or breastfeed. To safely live with symptoms without medication, discontinuing the medication may need a change in behavioral methods and other accommodations.

Narcolepsy with cataplexy

Cataplexy. This quick loss of muscle tone while awake causes weakness and loss of voluntary muscle control. It is further by powerful, unexpected emotions such as laughs, fear, wrath, stress, or enthusiasm.

Cataplexy symptoms can develop weeks or even years after the onset of EDS. Some people may only have one or two attacks in their lives, whilst others may have many attacks per day. Cataplexy is the first symptom of narcolepsy in roughly 10% of cases and might be misinterpreted as a seizure disease.

Milder attacks may feature merely a brief impression of little weakening in a small number of muscles, such as a slight drooping of the eyelids. The most severe attacks include total body collapse, leaving people unable to move, speak, or keep their eyes open.

People remain fully conscious even during the most severe bouts, which distinguishes cataplexy from fainting or seizure disorders. The reduction of muscular tone during cataplexy is similar to the paralysis of muscle action that occurs spontaneously during REM sleep. Episodes last only a few minutes and resolve virtually immediately on their own. While scary, the episodes are not harmful if the individual finds a safe place to collapse.

Frequently Asked Questions

How do I know if I'm a narcoleptic?

The first sign of narcolepsy is usually daytime sleepiness.  It has the possibility to have a major impact on daily life. It's difficult to focus at work or school when you're tired all day and struggling to remain awake. People with narcolepsy may be misunderstood as lazy or unpleasant.

What are the three types of narcolepsy?

Narcolepsy is classified into two types: type 1 and type 2. Type 1 narcolepsy was consistently referred to as "narcolepsy with cataplexy." Type 2 was earlier called "narcolepsy without cataplexy"." Secondary narcolepsy is a kind of narcolepsy that occurs in extremely rare cases.

What happens if narcolepsy goes untreated?

Narcolepsy can be socially isolating and disabling if left untreated. It frequently results in the onset of depression. Type 2 diabetes mellitus may be more common in those who have narcolepsy. Making lifestyle changes can help with symptom management.

What can be mistaken for narcolepsy?

In a physician survey and retrospective chart review study of 252 narcolepsy patients, 60% were first diagnosed with another disease. Untreatable conditions included depression (31%), sleeplessness (18%), and obstructive sleep apnea (OSA) (13%).

What triggers narcolepsy attacks?

This immediate loss of muscular tone while awake causes weakness and loss of voluntary muscle control. It is further by powerful, unpredictable emotions such as laughs, fear, hate, stress, or excitement.

Who is most likely to get narcolepsy?

Narcolepsy is a chronic disease that affects one in every 1,000 to 1,500 persons. Although it affects both men and women, men are slightly more likely to be affected. The illness can start at any age, but symptoms typically develop between the ages of 10 and 20.