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What is Narcolepsy?
Narcolepsy is a non-communicable neurological condition, characterized by sleep disorders, such as excessive daytime sleepiness, temporary episodes of muscle weakness, sleep paralysis and hallucinations. Symptoms appear between childhood and adolescence, occur equally between men and women and affect around one in 2000 people.
The disease has been known for a long time, but only with an in-depth study of sleep physiology, carried out in the 1960s, was it possible to relate its symptoms to changes in sleep phases and characterize it as a pathology linked to the REM Rapid Eye Movement or Rapid Eye Movement, the last phase of the sleep cycle, when most dreams occur.
People with narcolepsy tend to have difficulty staying awake for long periods of time, even after a good night’s sleep, which can hinder concentration and perform common daily tasks. Sleep attacks can happen, even while driving a car or cooking, which puts the lives of the patient and those around him at risk.
Research indicates that low levels of the neurotransmitter hypocretin and also genetic factors are directly linked to the causes of the disease. Treatments and medications can help narcoleptics to resume a normal life of chores, but there is no reported cure
Types
Narcolepsy with Cataplexy
Combination of excessive sleepiness with cataplexy, sudden attack of muscle weakness triggered by strong emotions such as anger , joy, laughter and surprise.
Narcolepsy without Cataplexy
Rarer type of narcolepsy, with episodes of continuous excessive drowsiness, but without reports of cataplexy.
What are the causes of Narcolepsy?
In the natural sleep process, a person falls asleep and goes through four steps until reaching the REM Rapid Eye Movement . In this last phase, breathing becomes rapid and irregular, the muscles immobile, blood pressure increases and most dreams occur.
REM starts about 70 to 90 minutes after falling asleep and guarantees only 20% of sleep. Therefore, going through the entire cycle before reaching it is extremely important to ensure personal physical and mental balance. However, a narcoleptic skips all four initial steps and reaches REM more easily, day or night, so that he does not complete the essential sleep cycle.
The cause is still unknown, but research suggests that it is involved with genetic factors, in addition to being caused by a deficit in the neurotransmitter called hypocretin, located in the hypothalamus. This neurotransmitter is responsible for regulating arousal, wakefulness and appetite.
In the human brain, few cells produce hypocretin, so that if damaged or destroyed, either by injury, toxins or autoimmune reactions, they can cause low levels of this neurotransmitter. This consequently generates excessive drowsiness.
Other factors that can trigger the lack of hypocretin are:
- Infections induced by brain damage, tumors, accidents or viral infections, found in the brain as a result of a deficient immune system;
- Hormonal changes, such as puberty or menopause;
- Stress.
Groups of risk
Symptoms usually begin in childhood or adolescence, from 7 to 25 years old, and affect men and women equally. Only in rare cases can narcolepsy appear at a younger age or in older adults.
As there is evidence that the disease is caused by some genetic predisposition, if a family member has a history of narcolepsy, the individual is more likely to also have the disease.
Symptoms of Narcolepsy
In narcolepsy there is no common limit between being awake and asleep, so that certain characteristics of sleep occur while you are awake. Are they:
Cataplexia
This is the only specific symptom of narcolepsy and it will not occur in any other disease. Characterized by episodes of loss of muscle tone, that is, attacks of muscle weakness triggered by a strong emotional reaction, such as fear, anger, stress , excitement, mood, and, more often, laughter.
The loss of muscle tone during a cataplexy episode is similar to the natural muscle interruption that occurs during REM sleep, however, it occurs while awake and the person is fully aware of what happened. The attacks last from a few seconds to 10 minutes and can lead to slurred speech, kneeling or, in more severe cases, complete paralysis, causing the person to fall to the floor.
Excessive daytime sleepiness
Uncontrollable desire to sleep during the day, whether or not you have slept enough for one night. This is the most common and apparent symptom, which can be accompanied by exhaustion, drowsiness, memory lapses, difficulty concentrating and depressed mood.
Sleep attacks can happen throughout the day, last from a few minutes to half an hour, and invigorate the individual after giving in to these little naps until the fatigue returns, around one to two hours. During these attacks, narcoleptics are prone to automatic behavior if they are doing something at the moment, such as continuing to write, direct or cut, with no apparent interruption. Performance is often impaired and patients will rarely remember their actions.
Hallucinations
They are hallucinations of mainly visual content, such as seeing figures, animals, objects, people, etc., but which can involve any of the other senses. These experiences are usually vivid, frightening, and may or may not be associated with sleep paralysis.
- Hypnopomic hallucinations: hallucinations that happen on the principle of sleep (or when entering the state of deep sleep);
- Hypnagogic hallucinations: hallucinations that happen when you are waking up.
Sleep paralysis
Inability to move or speak while falling asleep or waking up. They are brief episodes, they last about seconds to 10 minutes with an average of 2 minutes – they end spontaneously and the person is aware of what happened. The individual will fully recover the ability to move and speak after the episode is over.
- Hypnopompic paralysis: episodes of paralysis that happen when you are waking up;
- Hypnagogic paralysis: episodes of paralysis that happen when you are falling asleep.
Read more: What are the symptoms and causes of sleep paralysis?
Interruption of night sleep
Most narcoleptics find it difficult to get a full night’s sleep, as they face several interruptions over the hours they sleep. These interruptions can be due to vivid dreams, talking while sleeping, insomnia and periodic movement of the legs.
What is the diagnosis for Narcolepsy?
Narcolepsy can be diagnosed from neurologists, sleep doctors, psychiatrists, psychologists, geneticists and infectologists. Drowsiness is the main symptom of several behavioral and sleep disorders, and only cataplexy is specific to narcolepsy, so the diagnosis must be made by a specialized doctor to avoid mistakes.
The disease will be recognized based on the study of the patient’s sleep history and from the following exams:
Polissonografia (PSG)
During the exam, the patient will sleep in a laboratory connected to machines that record several of his physiological parameters and his brain activity during night sleep. Because people with narcolepsy fall asleep much faster than people without it, the test can help reveal whether REM sleep occurs abnormally and eliminate symptoms that resemble other illnesses.
Multiple sleep latency test (TLMS)
The TLMS seeks to assess the occurrence of REM sleep and daytime sleepiness, monitoring the patient’s brief periods of sleep and awakening. The exam is performed in the laboratory and after having registered the polysomnography.
Electroencephalogram (EEG)
The exam analyzes spontaneous brain electrical activity, captured through the use of electrodes placed on the scalp.
Electrocardiogram (ECG)
The exam looks at cardiac electrical activity.
Read more: What is the Electrocardiogram (ECG) for?
Genetic testing
The test is performed to identify the narcolepsy gene.
Analysis of cerebrospinal fluid (CSF)
As a new diagnostic test, hypocretin-1 is analyzed and assayed in cerebrospinal fluid. The lack of hypocretin in the cerebrospinal fluid can be a marker for narcolepsy, allowing the early treatment of some complications of the disease.
Treatment for Narcolepsy
There is no cure and prevention for this disorder, but medications and changing behaviors and habits can help control symptoms.
Medicines
The drugs indicated for the treatment of cataplexy and excessive sleepiness are different, but they usually help to improve both symptoms. They are divided into two therapeutic classes: stimulants, which act on daytime sleepiness, and antidepressants, which act on cataplexy. One of the solutions found is the combination of lower doses of the two classes.
The most suitable drugs for narcolepsy are:
Stimulants
Used to reduce excessive daytime sleepiness.
- Ritalina ;
- Modafinila , has the advantage of not causing side effects on the cardiovascular system.
Antidepressants
Used to reduce episodes of cataplexy, sleep paralysis and hallucinations, antidepressants are divided into two classes:
- Tricyclics, such as Imipramine , Clomipramine , Desipramine and Protriptyline.
- Selective serotonin reuptake inhibitors, such as Venlafaxine , Atomoxetine and Fluoxetine .
Sodium oxybate (Xyrem)
Strong sedative, used in severe cases of cataplexy. Sodium oxybate should be taken at night, as it induces sleep and reduces the symptoms of daytime sleepiness.
Medicines can include side effects, so never self-medicate.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Changing behaviors and habits
When diagnosed with the disease, changes in habits must accompany the medications prescribed by your doctor.
Individual guidelines will be established according to the needs of each patient, but it is likely that the elaboration of programmed nap routines is also indicated. The patient usually wakes up more willingly after lying down for a few minutes throughout the day.
The following measures, if adopted, can help relieve drowsiness during the day:
- Adopt regular sleeping and waking habits, including on weekends;
- Avoid consumption of caffeine and energy drinks in the afternoon and at night;
- Avoid consumption of alcoholic beverages and medications that can promote sleep;
- Schedule short cochilos of 10 to 15 minutes during the afternoon, to prevent sudden crises of sound;
- Adopt healthy habits by controlling meals and performing physical activities;
- Practice relaxation techniques, such as breathing exercises and yoga. Some symptoms of narcolepsy are triggered by intense emotions, so you will benefit from this practice.
The support of friends and family is essential for the patient to improve during the treatment. Thus, both carriers and people in their community should be aware that:
- Narcolepsy requires continuous medication. Although there is no cure, medicines can reduce their symptoms and allow patients to have a productive life;
- If possible, narcoleptics should avoid jobs that require long attention spans, such as driving long distances and handling dangerous artifacts;
- The patient will be able to drive again if under medical treatment;
- Labels such as lazy and sleepy should be avoided so as not to offend those with the disorder.
Complications
In cases of narcolepsy, in most cases, the search for professional help is not considered. However, although it does not directly affect intelligence, the disease will have a negative impact on the ability to concentrate, memory and attention if it is not diagnosed and treated. Physical integrity is also at risk, due to the fact that the patient is prone to suffer accidents and injuries if sleep attacks occur at inappropriate times, as in the middle of performing some activity.
Added to the symptoms of narcolepsy are some side effects that patients may experience after taking the medication, such as orthostatic hypotension, dry mouth and erectile dysfunction .
Harsh diagnoses confuse drowsiness with a normal situation and, in several cases, narcoleptics tend to be labeled as lazy, leading to socio-professional complications without the knowledge that their condition is motivated by a disease. In such cases, individuals may have:
- Depression, loss of interest and pleasure;
- Anxiety, panic attacks and social phobia;
- Eating disorders, such as binge eating and restrictive eating behaviors.
Other possible complications:
- Obesity, with a higher prevalence in patients with early narcolepsy;
- Obstructive sleep apnea syndrome (OSAS);
- Migraine, with higher incidence in women.
Prevention
As there are no known ways to prevent narcolepsy, the patient must follow the treatment correctly to relieve symptoms and prevent the disease from getting worse.
Narcolepsy is a disease that can cause several difficulties if it is not treated. Avoid hasty diagnoses and judgments, share this article to alert others to your symptoms.
