Narcolepsy: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

The sleep disorder narcolepsy causes patients to sleep excessively during the day. Patients with narcolepsy have problems staying awake for a prolonged period of time. They fall asleep all of a sudden. As a result, they might experience significant disturbances to their routine.

Cataplexy, a sudden decrease of muscle tone, can occasionally be brought on by narcolepsy. This could be brought on by powerful feelings, especially laughter. There are two types of narcolepsy. Cataplexy is the most prevalent symptom of type 1 narcolepsy. Type 2 narcolepsy is the most common kind in people without cataplexy.

There is no recognized treatment for the persistent illness of narcolepsy. However, medication and a change in lifestyle can control the symptoms. Support from family, friends, colleagues, and other individuals can assist someone in coping up with the situation.

Causes Of Narcolepsy

Narcolepsy's specific cause is not known. Low levels of orexin, also known as hypocretin, are present in those with type 1 narcolepsy. A hormone called hypocretin helps regulate when you are awake and when you go into REM sleep.

Cataplexy sufferers have low levels of hypocretin. The disappearance of the hypocretin-producing cells in the brain is unknown. However, scientists think an immune reaction is at fault. When the immune system of the body attacks its own cells, it is known as an autoimmune reaction.

Genetics most certainly contributes to narcolepsy as well. However, there is extremely little chance, just 1% to 2%  that a parent would pass on this disease to their child.

Additionally, studies suggest that in some cases, contact with the H1N1 flu virus may be related to narcolepsy. It might possibly be connected to a specific type of the H1N1 vaccine. 

Symptoms Of Narcolepsy

Narcolepsy symptoms may get worse in the first several years of the disorder. They continue indefinitely after that. They are as follows:

• Extremely sleepy during the day. Narcoleptics have unexpected sleep attacks. It might happen anywhere and at any time. It can happen if you're bored or focused on a task. 
• For instance, you might be having a chat with friends or at work when you suddenly fall asleep. It could be highly dangerous to fall asleep while driving. You could sleep for a few minutes or up to 30 minutes. You regularly wake up feeling relaxed but immediately go back to sleep.
• You can experience a decrease in focus and alertness throughout the day. The first symptom to manifest is frequently experiencing midday weariness. It's challenging to focus and perform when you're exhausted.
• Narcoleptics frequently fall asleep while working and they occasionally do so. You might fall asleep while writing, typing, or driving, for instance. You could work on it while you sleep. You don't recall what you did when you woke up, and chances are you didn't do it very well.
• Sudden loss of muscular tone. The medical word for this condition is cataplexy. Possible effects include slurred speech or complete weakness of the majority of muscles. The symptoms could last just for a short duration.
• Cataplexy cannot be controlled. It is triggered by strong emotions. Pleasant emotions frequently cause cataplexy. It's possible that laughter or enthusiasm will bring on the symptoms.
• But occasionally, emotions like fury, surprise, or anxiety can lead to less toned muscles. For instance, you might not have any control over whether your head droops when you laugh. Or you might tumble if your knees suddenly become unstable.
• Only one or two cataplexy events may occur per year for some narcoleptics. Others experience numerous episodes per day. Typically, narcolepsy is not associated with these symptoms.
• Sleep paralysis. Narcoleptics frequently suffer from the condition of sleep paralysis. If you have sleep paralysis, you cannot move or speak before going to sleep or when you wake up. It usually just lasts a few seconds or minutes. It's possible that you were awake and remembered it later. Narcolepsy may not always be associated with sleep paralysis.
• Hallucinations. Occasionally, during sleep paralysis, people report seeing objects that are not there. Hallucinations can happen when you're in bed even if you don't have sleep paralysis. They are called hypnagogic hallucinations if they happen just before you fall asleep.
• Hallucinations that start soon after waking up are referred to as hypnopompic hallucinations. You might believe, for instance, that a stranger is in your bedroom. 
• REM (rapid eye movement) sleep changes. Most dreams take place during REM sleep. In most cases, REM sleep begins 60 to 90 minutes after people first go to sleep. Narcoleptics, however, frequently move into REM sleep. Within 15 minutes of falling asleep, they typically start to experience REM sleep. It's possible for REM sleep to occur at any time of day.

Narcolepsy versus Typical  sleeping pattern

NREM sleep, or slow-wave sleep, is the initial phase of regular sleep. During this time, the brain's waves become slower. The brain enters REM sleep after about an hour of NREM sleep. Dreams typically occur during REM sleep.

If you have narcolepsy, you might enter REM sleep right away without first going through NREM sleep. Both at night and during the day, this is possible. Changes that take place during REM sleep are akin to cataplexy, sleep paralysis, and hallucinations. But in narcolepsy, they happen while you're awake or drowsy.

Risk Factors of Narcolepsy

There are only a few known risk factors that could result in narcolepsy

• Age. Typically, narcolepsy develops between the ages of 10 and 30.
• Family background. If you have a close relative with narcolepsy, your risk is 20–40 times higher.

Diagnosis Of Narcolepsy

Your doctor may start looking into narcolepsy because of your extreme daytime sleepiness and sudden loss of muscle tone, often known as cataplexy. Your physician will probably refer you to a sleep expert. A formal diagnosis requires an overnight stay at a sleep center for a thorough sleep study.

A sleep expert will probably identify narcolepsy and gauge its severity depending on:

• History of your sleep. A comprehensive sleep history could help with the diagnosis. You'll probably finish the Epworth Sleepiness Scale. The scale asks brief questions to determine your level of sleepiness. You'll say how likely it is that you'd fall asleep at specific times, such as right after lunch.
• Your patterns of sleep. You might be asked to keep a written log of your sleeping patterns for a week or two. This makes it possible for your doctor to determine whether your sleep patterns may be connected to how awake you feel.
• Your healthcare provider may also want you to wear an actigraph. It is a waistband that has the appearance of a watch. It records the lengths of both work and downtime. It provides a rough estimate of when and how you sleep.
• A polysomnography is also referred to as a sleep study. With electrodes, and flat metal discs which are placed on your scalp, this test analyzes electrical signals that occur while you're sleeping. This test requires that you spend the night in a hospital. Your pulse rate, breathing rate, and brain waves are all recorded during the exam. It also records your eye and leg movements.
• Multiple sleep latency tests. This exercise gauges how long it takes you to nod off during the day. At a sleep clinic, you'll be required to take four or five naps. There must be a two-hour gap between each snooze. Your sleeping patterns will be observed by experts.The process of falling asleep and entering REM sleep is quick for narcoleptics.
• A spinal tap and genetic tests. On rare occasions, a genetic test may be administered to determine your risk for developing type 1 narcolepsy. If so, your sleep doctor might advise a lumbar puncture to measure the amount of hypocretin in your spinal fluid. Only specialized facilities do this test.

These examinations could help in excluding other potential reasons for your symptoms. Additionally, sleep apnea, using sedative medications, and sleep loss can all contribute to excessive daytime sleepiness.

Treatment Of Narcolepsy

Despite the fact that there is no known cure for narcolepsy, you can manage the symptoms with medicine and a change in lifestyle.

 Medication for narcolepsy includes:

• Stimulants. Drugs that stimulate the central nervous system are the mainstay of narcolepsy treatment. Your doctor might advise modafinil (Provigil) or armodafinil (Nuvigil). Unlike earlier stimulants, these medications don't have the same potential for addiction. 
• They also don't produce the highs and lows seen with earlier stimulants. Adverse effects, however uncommon, can include headaches, nausea, and anxiety. Pitolisant and solriamfetol, two more recent stimulants, are used to treat narcolepsy. Pitolisant may be beneficial for cataplexy as well.
• Some individuals receive prescriptions for amphetamines or methylphenidate These drugs are effective, but they also carry the risk of addiction. They could cause adverse effects including anxiousness and a pounding heart.
• SSRIs, also known as SNRIs (serotonin and norepinephrine reuptake inhibitors), are medications that selectively block the reuptake of serotonin. These drugs prevent REM sleep. 

These medications are recommended by doctors to help to treat the symptoms of sleep paralysis, hallucinations, and cataplexy. They consist of sertraline, fluoxetine, and venlafaxine. Weight gain, sleeplessness, and digestive problems are possible side effects.

• Tricyclic antidepressants. These antidepressants from the past can handle cataplexy. However, they can have adverse effects like dry mouth and dizziness. Protriptyline, imipramine (Tofranil), and clomipramine (Anafranil) are some of these medications.
• Oxybate salts and sodium oxybate. These drugs effectively treat cataplexy. They help in enhancing nocturnal sleep, which is frequently poor in narcolepsy. They might also be helpful in reducing daytime tiredness. You need to take two doses one before bed and one up to four hours later.
• Xywav is a more recent version with less sodium.
• These drugs may have unpleasant side effects, such as nausea, bedwetting, and sleepwalking. They might result in respiratory problems, a coma, or even death when coupled with other sleeping medications, narcotic painkillers, or alcohol.

If you use drugs for other medical conditions, talk to your doctor about any possible drug interactions.

There are certain over-the-counter medications that may make you sleepy. They consist of cold and allergy medications. Your doctor might advise avoiding taking these medications if you have narcolepsy.

Other narcolepsy remedies are being researched by scientists. The hypocretin chemical system is the target of some medications that are being researched. Immunotherapy is a topic of research as well. Before these drugs are made available, further research is required.

Complications Of Narcolepsy

Following are some of the complications of narcolepsy

• Public misunderstanding of the disease. Problems at work or in your personal life can result from narcolepsy. You might perform worse at work or school. Others could judge narcoleptics as being lazy or tired.
• The impact on close friendships. Strong emotions like fury or joy have the power to trigger cataplexy. This may lead to emotional withdrawal in narcoleptics.
• Physical injury. Unexpected sleepiness could cause harm. If you fall asleep while driving a vehicle, your probability of being in an accident rises. If you fall asleep while cooking, your risk of cuts and burns increases.
• Obesity. Overweightness is more common in narcoleptics. When symptoms of tiredness begin, weight might occasionally rise quickly.