The Science and Symptoms of Narcolepsy
If you’ve ever pulled an all-nighter, you probably know what it feels like to have an overwhelming, almost compulsive desire to sleep the next day. But what if that feeling might strike you any day, whether you’d rested the night before or not? That’s what pretty much what narcolepsy is.
Narcolepsy is a sleep disorder affecting an estimated 1 in 3,000 Americans; however, with increased education about the disease, the prevalence is expected to increase.
What is narcolepsy?
Narcolepsy is a type of neurological disorder that affects how the brain monitors waking and sleeping cycles. The condition is particularly associated with abnormalities in REM sleep cycles.
Whereas most people begin REM sleep about an hour and a half after falling sleep, those suffering with narcolepsy may enter the REM phase immediately or even during the day.
Scientists are not entirely sure what causes this sleep disorder, but some believe that it is linked to a deficiency of the neurotransmitter hypocretin, which helps regulate and maintain wakefulness.
Lack of hypocretin can be the result of a genetic or autoimmune disorder.
1. Irregular sleep
The main characteristic of narcolepsy is the irregular—and spontaneous—sleep schedule.
People with the disorder may have trouble sleeping soundly at night, only to experience uncontrollable bouts of drowsiness during typical waking hours. People with narcolepsy don’t actually sleep more, but they have fragmented and irregular sleep throughout the day and night.
2. Excessive daytime sleepiness
The most common symptom of narcolepsy is EDS, Excessive Daytime Sleepiness, which is closely related to fatigue. EDS is a sensation of persistent drowsiness that results in impaired concentration and lack of energy. It can be punctuated by periods of “microsleep”, in which individuals may drift off for a short time without realizing at, and maybe without even interrupting their current task, such as driving or typing.
Another fairly common effect of narcolepsy is cataplexy, or sudden loss of muscle control. Severity can range from a drooping of the eyelids to complete loss of bodily control.
4. Sleep paralysis
Sleep paralysis is a condition in which a person is mentally conscious but physically unable to move. It is sometimes accompanied by hallucinations (see below) of frightening invaders in the bedroom. The result is a scary, almost nightmarish experience of sensing an intruder but being unable to respond (learn more about sleep paralysis here).
Hypnogogic hallucinations happen during the transition from wakefulness to sleep. For someone with narcolepsy, these transitions may happen sporadically during the daytime and can be very frightening, dreamlike experiences that incorporate the real environment.
Julie Flygare is a narcolepsy advocate who vividly describes her experience with sleep paralysis and hallucinations.
Diagnosis and Treatment of Narcolepsy
Narcolepsy is tricky to diagnose because all of its symptoms can also proceed from other disorders. Identifying it requires extensive self-reported medical history and at least two sleep tests, a polysomnogram (PSG) and a multiple sleep latency test (MSLT).
The PSG is the same test that is used to diagnose sleep apnea; it is an overnight examination that records factors like heart rate, breathing, and electrical impulses in the brain. An MSLT is administered the following day and helps determine the subject’s daytime drowsiness (learn more about the test here).
Narcolepsy is incurable, but in many cases symptoms can be alleviated with medications and lifestyle changes.
Doctors may prescribe stimulants, anti-depressants, or a strong sedative at nighttime to improve wakefulness during the day and improve sleep quality at night.
Behavioral measures can also help manage narcolepsy, such as following a strict sleep timetable, which may include scheduled naps during the day, seeking counseling, and avoiding caffeine, alcohol, and large meals.
Are you concerned that you or a loved on is excessively sleepy during the day?
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