What is narcolepsy, causes, symptoms & treatments
The sudden sleep attacks caused by narcolepsy can be very difficult to live a normal life with from the severe disruptions caused numerous times through out a day. It is studied that 1 out of 2000 people are afflicted by this disorder. (Black S.W, Yamanaka A and Kilduff, T. S.) and that between 25 and 50 individuals out of 100,00 have narcolepsy with cataplexy (Longstreth WT Jr1, Koepsell TD, Ton TG, Hendrickson AF, van Belle G.). In the following paragraphs, I will demystify the definition of narcolepsy, it’s history and I will be explaining the symptoms, causes and treatments.
Narcolepsy is a chronic neurological sleep disorder that affect many. There are two major types of narcolepsy, Type 1 is linked with cataplexy and Type 2 is when it’s not. Narcolepsy interferes with the person’s ability to control their sleep-wakes cycles which results in them feeling sleepy through out the day. Cataplexy is linked with narcolepsy in about two-thirds of patients. We characterize it by a loss of control in the muscles which can be triggered by intense emotions such as laughing. Normally, people enter a sleep zone called rapid eye movement (REM) where dreams and muscles deficiency occur, approximately 60 to 90 minutes after falling asleep. A narcoleptic enters this stage of sleep within about 15 minutes of sleeping. Researchers tend to think this may explain some of the symptoms of narcolepsy itself. The term of narcolepsy was first used in 1880, by a physician named Jean-Baptiste-Edouard Gélineau. In his published papers, Gélineau talked about a man who was affected by sleepiness and short sleep attacks during his life. (Todman D.) It is studied that there would be about three million narcoleptics worldwide in which many cases aren’t diagnosed. (Todman D.) There is about 0.07 percent of Americans suffering from this disorder in which 0.06 percent of them would be undiagnosed. The common first experience symptoms age is in between 15 to 30 years old and about 10 percent of narcoleptics have a close relative with the same disease. In Canada, it is suggested by extrapolated prevalence that there would be approximately 24,000 people with Narcolepsy. (Statistic Brain) Living with Narcolepsy can greatly affect daily life by causing the person to fall asleep instantly during activities such as eating or even driving. Ashley Starr, a 28-year-old narcoleptic, tells us that emotionally it wasn’t easy. Medication did help but she still had to make many changes in her life. “Narcolepsy is an invisible disability, and it takes time to figure out how to best manage it. Although I feel I'm doing pretty well, it's a struggle sometimes. I wish people without it knew how lucky they are to get a good night's rest.” (Starr A.)
According to the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic criteria for Narcolepsy is firstly, “recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day”. These symptoms need to be happening at least three times a week for over 3 months. Secondly, there needs to be a few episodes of cataplexy triggered by emotion such as laughter. Other symptoms present in a patient would be a deficiency in hypocretin, which needs to be less or equal to one-third of healthy values and/or falling into REM sleep in less or equal to 15 minutes. In rare cases, Narcolepsy can co-occur with schizophrenia. About 20 to 60 percent of people experience sleep paralysis when waking up or falling asleep. However, many healthy people experience sleep paralysis too, hence the symptom not being determinant in a narcoleptic diagnostic.
There is a special group of neurons in the brain that promote the state of wakefulness and regulate sleep-wake cycles in a person. These neurons extend from the lateral hypothalamus to various parts of the brain, such as the reticular activating system (RAS). In narcoleptic people, there is less of these neurons which results in fewer neuropeptides, orexin A and orexin B (also called hypocretin 1 and hypocretin 2), transmitted. The orexins usually increase activity in the alerting regions of the brain and prevent inappropriate sleep transitions. In narcolepsy, the cells that usually produce the hypocretin are very damaged. Researcher think that an autoimmune process maybe be damaging these neurons in narcoleptic individuals, hence the sleep-related symptoms, mentioned previously, occurring.
There are two kinds of approaches of treatment for narcolepsy, pharmacological and cognitive behaviour therapy. The most effective is often a combination of both. Drug therapy consists primarily of prescribed stimulants which increase alertness and wakefulness. The most common are dextroamphetamine and methylphenidate. However, side effects include insomnia, hypertension and palpitations. Recently, Modafinil has been more recommended because of the fewer side effects. All these stimulants are great but do not help cataplexy. In those cases, antidepressants or serotonin inhibitors are prescribed. Amongst non-pharmaceutical treatments we find changing day to day habits such as avoiding nicotine and caffeine. (Feldman, N.T.) Cognitive behaviour therapy consists of various treatments. Psychologist use Sleep satiation which consists of expending sleep periods and maintaining a regular sleep and short planned naps schedule. In some cases, hypnosis has showed some level of effectiveness. (Hernán A.M.A, Ulises J.C, Juan C.S.S, Pandi P. and Carlos H.) Many argue that the CBT is a better option because there is no side effect and a tolerance can be developed in drug therapy by the patient resulting in an increase of dosage which can in-danger them.
In conclusion, Narcolepsy is often misunderstood, unrecognized and many go undiagnosed. It is a complex disease that has no definite cure yet, but physicians and psychologists are doing their best to treat the narcoleptics either by drug or cognitive behaviour therapy. Informing people of the most common symptoms is a step to helping recognition happen more quickly. Research is still being done by institutes such as the National Institute of Neurological Disorders and Stroke who seek knowledge about the brain and nervous system, to reduce the troubles caused by the diseases.