What is Narcolepsy? 

Narcolepsy is a disease of the central nervous system that causes excessive uncontrollable daytime sleepiness. It is due to the deficiency (or shortage) of a protein called hypocretin (hi-poe-kree-tin), which is important in controlling the timing, expression and occurrence of normal sleep. When hypocretin is deficient, components of rapid-eye movement sleep will suddenly occur during waking hours. 

Signs and Symptoms of Narcolepsy, A Disease In Which You Fall Asleep 

There are several types of symptoms that may indicate you have narcolepsy: 

Falling asleep randomly and other forms of excessive daytime sleepiness occurs in the form of sudden irresistible sleep attacks, continual disabling drowsiness and microsleeps. Microsleeps are brief intrusions of sleep into wakefulness which can make driving hazardous. Uncontrollable sleep can be seen as laziness and negatively affect work performance and personal relationships. 

Catalepsy is the sudden loss of voluntary muscle control caused by severe fatigue, stress, or a strong emotion like laughter, anger or fear. Loss of muscle control can be as obvious as total body collapse or as subtle as buckling of the knees or sagging of the jaw and facial muscles. Narcolepsy with cataplexy episodes can be momentary or last as long as half an hour, after which there is complete recovery. Episodes are unexpected, often embarrassing and can create life-threatening situations. 

Sleep paralysis is the sudden, unexpected inability to move during wakefulness that normally occurs in the period of time while falling asleep and waking up. These episodes resolve spontaneously without side effects. 

Hypnagogic hallucinations occur during the drowsy periods that intervene as you fall asleep and wake up. They can be visual (seen) and sometimes auditory (heard). These narcolepsy hallucinations represent dream fragments that continue from sleep into wakefulness. 

All of these symptoms represent the actual intrusion of sleep components into wakefulness. They do not represent psychological problems. 

Diagnosis 

While Narcolepsy can affect any gender and age, it is most common in adolescents and above. Many times symptoms will begin in childhood and adolescence but will not be properly diagnosed until much later. 

Your doctor may diagnose you with Narcolepsy based on the presence of excessive daytime sleepiness alone, but in some cases a formal sleep study is recommended or required. In addition, a physician will use the following to help determine a diagnosis of Narcolepsy. 

Polysomnography: A test performed in the sleep lab or a home sleep study that measures your breathing and signals in your brain, heart, muscles and eyes during sleep. 

Sleep Journal: You will be asked to record your sleep for a couple weeks to determine how rested or tired you are and what times you go to bed and wake up throughout the night. 

Sleep History: Your doctor will ask you for a detailed history of your sleep. A couple tools to help with this are the Epworth Sleepiness Scale and Stop-BANG. 

What Causes Narcolepsy?

While the exact cause of narcolepsy is unknown, the common factor among those with this sleep disorder is a low level of a chemical called hypocretin. Hypocretin is responsible for helping regulate sleep, specifically REM, and wakefulness. This deficiency is thought to be a result of the immune system attacking the part of the brain that produces the chemical and there is some data that points to the H1N1 virus (swine flu) as a catalyst to triggering the disorder. It is important to note that there may be many causes of narcolepsy and genetics may play a part as well. 

Prevention 

While it is not possible to prevent Narcolepsy it is possible to take steps to ensure your sleep habits are healthy. By following the items below you can make sure you are taking care of yourself and developing positive sleep habits. 

• Avoid sugar, caffeine, alcohol and nicotine at night. 
• Exercise regularly. 
• Nap at the same time each day for short periods to reduce daytime sleepiness. 
• Sleep/Wake at the same time each night/day to set your internal clock. 

Prognosis 

Narcolepsy is chronic and while it cannot be cured, its symptoms can be managed with treatment and some normal daily activities can continue for most people. 

Treatment and Recovery for Falling Asleep Disorder

Narcolepsy is a permanent disease. At this time, treatment through medication is aimed only at symptom control and not direct treatment of the disease itself. Stimulants (such as Ritalin and Dexedrine) and the alertness-promoting drug Provigil are used to promote wakefulness. Serotonin reuptake inhibitors (SSRI) are used to control catalepsy and the other symptoms of narcolepsy. 

Adjustments to lifestyle include:

• Having regular sleep and awake times.
• Scheduling short naps at lunch and the early evening. 
• Avoiding the use of alcohol. 
• Preventing exhaustion. 
• Ceasing driving or other potentially hazardous activities, if symptoms are not controlled. 
• Notifying school officials or work supervisors, so the condition can be understood and accommodations can be made. 

Appointments can be made to speak with any of our physicians by calling the sleep center, however you may need a referral to have a study or other tests performed, which can be obtained from your primary care physician.

Learn More About Narcolepsy from Baptist Health

Narcolepsy can be conquered. Start by scheduling an appointment with a Baptist Health primary care or sleep specialist today.