Narcolepsy

NARCOLEPSY: UNCONTROLLABLE DAYTIME SLEEPINESS

OVERVIEW: Narcolepsy is a disorder of the nervous system in which the brain cannot properly regulate the sleep/waking cycle. Narcolepsy is a very difficult condition for doctors to diagnose. The most prominent characteristic is excessive daytime sleepiness, which is sometimes shortened to EDS. When treating the problem, it is usually this condition of EDS that is the diagnosis. Excessive daytime sleepiness affects 100 per cent of the patients who have narcolepsy, but narcolepsy is characterized by other symptoms, too. It often takes 10 to 15 years for a diagnosis of narcolepsy to finally be made.

CAUSES: The causes of narcolepsy are not clearly defined, but research is gaining ground in understanding the disorder. For one thing, it tends to run in families, indicating some genetic involvement. More specifically, it is believed that narcolepsy is caused in part by abnormality in some of the cells of the part of the brain known as the hypothalamus. These cells are normally responsible for sending out chemicals called neurotransmitters, which carry "messages" from one part of the nervous system to another. The theory is that narcolepsy is caused by an autoimmune response that weakens or destroys these cells, so that the neurotransmitters that tell a person when to sleep and when to be awake are not able to do their job.

SYMPTOMS: The primary symptom of narcolepsy is EDS. People with narcolepsy will doze off at all sorts of undesired times, such as when they are in a conversation with a friend, driving, or in a meeting. It does not necessarily seem to be linked with inadequate nighttime sleep, either. They will probably only sleep a short time, from a few seconds to a few minutes, but sleep can last longer. The urge to sleep comes upon the patient when they least expect it, and it is practically irresistable. Another symptom of narcolepsy is cataplexy, which is a sudden loss of muscle tone brought about by emotional excitement. One more symptom is that the person with narcolepsy often has vivid hallucinations just before falling asleep or when waking up. These are called hypnogogic hallucinations.

DIAGNOSIS: For a diagnosis of narcolepsy to be made, other reasons for a person to be sleepy in the daytime have to be ruled out. Daytime sleepiness can be caused by underlying conditions like brain tumors, anemia, and heart disease. It can also be a symptom of a psychological condition like depression. It can be hard to tell the difference between narcolepsy and a condition like depression, but a thorough evaluation of a patient's lifestyle can shed light on the situation. The presence of periods of cataplexy and/or of hypnogogic hallucinations point to a diagnosis of narcolepsy.

TREATMENT OPTIONS: No cure has been found for narcolepsy. Generally it is treated symptomatically. Good sleep hygiene is a starting place. This involves making sure the patient is getting enough sleep at night, and going to bed and getting up at the same time each day. Many people with narcolepsy find improvement when they take a couple of 15 minute naps during the daytime. Sometimes drugs are prescribed. Usually these are stimulants that are taken in the morning to help combat those unwanted impulses to sleep.