Narcolepsy may be a disorder that's often misunderstood. it's characterized by severe and protracted daytime sleepiness which will cause impairments in class, work, and social settings also heighten the danger of great accidents and injuries. Although rare as compared to several other sleep disorders, narcolepsy affects many thousands of world citizens, including both children and adults. Understanding the kinds of narcolepsy and their symptoms, causes, diagnosis, and treatment can empower patients and their loved ones to deal with it more effectively.
What is Narcolepsy?
Narcolepsy may be a disorder that disrupts sleep-wake processes. Its primary symptom is excessive daytime sleepiness (EDS), which occurs because the brain is unable to properly regulate wakefulness and sleep1. Normal sleep unfolds through a series of stages, with rapid eye movement (REM) sleep occurring within the end, usually an hour or more after falling asleep. In narcolepsy, paradoxical sleep is irregular and sometimes begins within minutes after falling asleep, which is far before normal. REM occurs quickly in people with narcolepsy due to changes within the brain that disrupt how sleep works. These disruptions also cause daytime sleepiness and other symptoms of narcolepsy.
What Are the Types of Narcolepsy?
Narcolepsy Type 1
NT1 is related to the symptom of cataplexy, which is that the sudden loss of muscular tonus. NT1 was formerly referred to as “narcolepsy with cataplexy.” Not all patients who are diagnosed with NT1 experience episodes of cataplexy. NT1 also can be diagnosed when an individual has low levels of hypocretin-1, a chemical within the body that helps control wakefulness. Even when not present at diagnosis, cataplexy eventually occurs3 during a significant number of individuals with low levels of hypocretin-1.
Narcolepsy Type 2
NT2 was formerly referred to as “narcolepsy without cataplexy.” People with NT2 have many similar symptoms as people with NT1, but they are doing not have cataplexy or low levels of hypocretin-1. If an individual with NT2 later develops cataplexy or low hypocretin-1 levels, their diagnosis is often reclassified as NT1. this alteration in diagnosis is estimated to occur in about 10% of cases.
What Are the Symptoms of Narcolepsy?
The symptoms of narcolepsy can have notable effects during both daytime and already dark. the foremost common symptoms include.
- Excessive daytime sleepiness (EDS): EDS is that the cardinal symptom of narcolepsy, affecting all people with the disorder. EDS involves an urge to sleep which will feel irresistible, and it arises most often in monotonous situations. Severe drowsiness often causes lapses in attention. Narcolepsy can cause “sleep attacks,” which involve falling asleep all of sudden. After short naps, people with narcolepsy usually feel temporarily refreshed.
- Automatic behaviors: Trying to avoid sleepiness can trigger automatic behaviors that occur while an individual is unaware. for instance, a student in school may continue writing but is really just scrawling lines of gibberish on the page.
- Disrupted nighttime sleep: Sleep fragmentation is common in people with narcolepsy who may awaken multiple times during the night. Other bothersome sleep problems like excess physical movements and apnea also are more common in narcoleptics.
- Sleep paralysis: People with narcolepsy have a better rate of sleep paralysis, which may be a feeling of being unable to maneuver that happens while falling asleep or awakening.
- Sleep-related hallucinations: Vivid imagery can occur while falling asleep (hypnagogic hallucinations) or when awakening (hypnopompic hallucinations). this might accompany sleep paralysis, which may be particularly disturbing or frightening.
What Are the Effects of Narcolepsy?
The symptoms of narcolepsy can have significant consequences for a patient’s health and wellness. Accidents are a pressing concern as sleep attacks, drowsiness, and cataplexy are often life-threatening when driving or in other environments where safety is critical. it's estimated that folks with narcolepsy are three to fourfold more likely to be involved during a car accident11. Narcolepsy also can interfere with school and work. Sleepiness and pauses in attention can harm performance and should be interpreted as behavioral problems, especially in children. Many patients with narcolepsy feel the stigma associated with the condition which will cause social withdrawal. Without proper support, this might contribute to psychological state disorders and negatively affect school, work, and relationships. People with narcolepsy are at higher risk of other health conditions including obesity, cardiovascular problems like a high vital sign, and psychiatric issues like depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD)
How is Narcolepsy Diagnosed?
Diagnosis of narcolepsy requires careful analysis by a doctor conversant in the disease. Because it's rare and symptoms could also be mistakenly attributed to other causes, narcolepsy can go undiagnosed for several years. The diagnostic process starts with a review of symptoms and medical records. This step helps the doctor understand the patient’s sleep habits and therefore the nature of their EDS. In many cases, especially with children, relations are involved so as to supply more context about the patient’s symptoms. Tests could also be conducted to gauge EDS and sleep. A test called the Epworth Sleepiness Scale (ESS) is predicated on the patient’s subjective sense of their symptoms. Polysomnography (PSG), an in-depth test during which sensors monitor brain and body activity, could also be necessary. this type of sleep study is completed overnight during a specialized clinic. The day after the PSG test, another exam called the Multiple Sleep Latency Test (MSLT) is often wont to objectively assess sleepiness. During the MSLT, the patient is instructed to undertake to nod off at five different intervals while remaining connected to the sensors utilized in the PSG. People with narcolepsy tend to nod off quickly and to rapidly begin paradoxical sleep during the MSLT. Another test could also be wont to remove spinal fluid (CSF) and assess its level of hypocretin. this is often through with a procedure called a spinal puncture or lumbar puncture. Low levels of hypocretin are indicative of NT1 and help distinguish it from NT2.