Narcolepsy & its types

Overview 

The condition of Narcolepsy is uncommon. It affects around 1 in 2,000 people, according to experts. Narcolepsy symptoms often appear between the ages of 7 and 25, yet the disorder is frequently missed or incorrectly diagnosed. Usually, it begins around the middle of adolescence.

Significant daytime drowsiness, sleep attacks or intense impulses to sleep, and poor, fragmented sleep at night are all symptoms of Narcolepsy.

What is Narcolepsy?

Narcolepsy is a persistent neurological condition that disrupts the brain’s capacity to govern sleep-wake cycles. Individuals with Narcolepsy may feel rested when they first wake up but then experience extreme sleepiness for the majority of the day. Many people who have Narcolepsy also have unsteady, interrupted sleep, which can include frequent nighttime awakenings.

Narcolepsy can significantly impact daily tasks. People might unintentionally fall asleep while in the middle of an activity like talking, eating, or driving. Other signs could be rapid muscle weakness (Cataplexy) that renders a person immobile or limp. At the same time, they are awake, with vivid dream-like hallucinations or complete paralysis immediately before or just after waking up. (sleep paralysis).

Types of Narcolepsy 

Type 1 narcolepsy

The diagnosis of type 1 narcolepsy, formerly known as Narcolepsy with Cataplexy, is made based on the patient’s report of Cataplexy and excessive daytime drowsiness on a particular nap test or the person’s low levels of the brain hormone hypocretin.

Type 2 narcolepsy

Type 2 narcolepsy, formerly known as Narcolepsy without Cataplexy, is characterised by excessive daytime sleepiness but typically not by emotional-induced muscle paralysis. Average amounts of the brain hormone hypocretin and less severe symptoms are also common among them.

Secondary Narcolepsy

The hypothalamus, a deep-seated part of the brain that aids in controlling sleep, can sustain damage, leading to a disorder known as secondary Narcolepsy. Individuals with Narcolepsy may also have severe neurological issues in addition to the standard narcolepsy symptoms.

Symptoms of Narcolepsy 

In the first few years of the condition, the narcolepsy symptoms may develop worse. They then carry on indefinitely. They consist of

Excessive daytime sleepiness

Individuals with Narcolepsy frequently fall asleep suddenly. Anywhere and at any time, it can occur. It could happen during a task or when you’re bored. For instance, you might be working or chatting with friends when you unexpectedly nod off. 

If you doze off while driving, it might be hazardous. You could sleep for a few minutes or up to 30 minutes. You’ll typically feel rested when you wake up, but you’ll soon fall asleep again.

Additionally, you can feel less awake and concentrated during the day. The first symptom to manifest is frequent daytime tiredness. It’s challenging to focus and work while you’re sleepy.

Some individuals with Narcolepsy carry on working even after they momentarily doze off. You might sleep while typing, writing, or driving, for instance. You might carry on doing it while you sleep. You can’t recall what you did when you woke up, and, likely, you could have done it better.

Sudden loss of muscle tone

This ailment is known as Cataplexy. Slurred speech or severe muscular paralysis are both possible effects. Up to a few minutes may pass between symptoms. Cataplexy is uncontrollable. Powerful feelings bring it on. The feelings that trigger Cataplexy are frequently happy ones. The symptoms could be brought on by laughter or enthusiasm.

 However, there are situations when anger, surprise, or anxiety can lead to a decrease in muscular tone. For instance, you might not be in control of your head dropping when you laugh. Or you might tumble if your knees suddenly lose their strength.

Only one or two episodes of Cataplexy may occur for specific individuals with Narcolepsy each year. Others experience multiple bouts per day. Narcolepsy does not always cause these symptoms.

Sleep paralysis

Individuals with Narcolepsy frequently experience sleep paralysis. If you have sleep paralysis, you cannot move or speak while you go to sleep or when you wake up. It typically lasts for a few seconds or minutes. But it may not be very comforting. It’s possible that you were awake and remembered it later. Narcolepsy may not always accompany sleep paralysis.

Hallucinations

Occasionally, during sleep paralysis, people report seeing objects that are not there. Without sleep paralysis, hallucinations can also occur while in bed. If they appear as you are about to fall asleep, they are known as hypnagogic hallucinations.

If they occur right after waking up, they are known as hypnopompic hallucinations. For instance, you might think a stranger is in your bedroom. You cannot be completely asleep when you start dreaming, which makes these hallucinations vivid and terrifying.

How does Narcolepsy affect my body? 

Knowing more about the functioning of the human sleep cycle helps us understand Narcolepsy. The following phases make up that cycle.

Light sleep is stage one. This brief phase, which starts as soon as you nod off, lasts for only 5% of your overall sleep period.

More profound slumber in stage two. This more intense stage accounts for 45% to 50% of your sleep time.

Sleep in slow waves, stage three. About a quarter of the time you spend sleeping is during this phase. (this number goes down with age). Stage 3 sleep is exceedingly challenging to wake up from, and doing so frequently results in sleep inertia, a feeling of mental fog and slowed thinking.

REM sleep: Rapid eye movement stands for REM. In this phase, dreams occur. You can observe a person’s eyes moving just below their eyelids while experiencing REM sleep.

When you fall asleep without Narcolepsy, you usually start in stage 1 and progress to stages 2 and 3. 

You’ll alternate between these stages before entering REM sleep and beginning to dream. You start a fresh cycle and return to stage 1 or stage 2 after the first REM cycle. One cycle typically ends 90 minutes after the previous one. Each night, the average person goes through four to five cycles. (presuming they receive an entire eight hours).

Your sleep cycle is different if you have Narcolepsy. Instead, shortly after drifting off to sleep, you’ll enter the REM period. You won’t get much sleep the rest of the night and frequently won’t experience the regular sleep cycle. Although it’s usually impossible to resist the need to sleep, these naps during the day only last for a few minutes (15 to 30).

You’ll feel refreshed and prepared to pick up where you left off when you wake up. However, this frequently occurs during the day, which is why Narcolepsy is so troublesome.

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 go into REM sleep.

People who have experienced Cataplexy have low levels of hypocretin. It is unknown why the brain’s hypocretin-producing cells start to disappear. But scientists think an autoimmune reaction is to blame. When the immune system of the body attacks its cells, it is known as an autoimmune reaction.

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

Complications of Narcolepsy 

Public misunderstanding of the illness – Problems at work or in your personal life can result from Narcolepsy. At work or school, you might perform worse. Others may perceive individuals with Narcolepsy as being sluggish or sleepy.

Effects on close friendships – strong emotions like rage or joy can bring on Cataplexy. Individuals with Narcolepsy may become emotionally withdrawn as a result of this.

Injury to the body – Suddenly falling asleep could hurt you. If you doze off while driving, your chances of getting into an accident are high. You run a higher risk of burns and cuts if you nod off while preparing food.

Obesity –Overweight individuals are more prevalent in narcolepsy patients. When symptoms of tiredness first appear, weight can sometimes increase quickly.

Diagnosis of Narcolepsy 

A medical professional may be concerned about Narcolepsy based on your symptoms. Narcolepsy, however, has symptoms in common with several other disorders that affect the brain and sleep. Because of this, Narcolepsy can only be definitively diagnosed with specialised diagnostic techniques.

A healthcare professional will first make sure that you are receiving adequate sleep before performing the majority of the vital narcolepsy tests. Actigraphy is a typical example of a basic tracking technique for your sleep-wake patterns. This uses a watch-like gadget that you wear on your wrist to monitor movement patterns, such as when you’re awake and moving around versus when you’re sleeping.

Some possible tests for diagnosing Narcolepsy include

• Sleep study (polysomnogram).
• Multiple sleep latency test (MSLT).
• Spinal tap (lumbar puncture).
• Maintenance of wakefulness test

Treatment 

The primary way for treating Narcolepsy is medication. Most drugs target daytime sleepiness, although some also target additional symptoms.

Amphetamines and amphetamine-like stimulants– Drugs like methylphenidate or amphetamine/dextroamphetamine combinations.

Antidepressants – Medications such as serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, or tricyclic antidepressants like clomipramine or protriptyline (but these are less common).

Wakefulness medications – These are typically the first course of action. These medicines, such as modafinil and armodafinil, are examples. Your neurological system will be stimulated by these drugs, which may lessen the intensity or occurrence of daytime sleepiness.

Sodium Oxybate – This medication can aid sleep and lessen the frequency of cataplexy attacks. Due to its side effects, this medication is heavily regulated in the majority of nations, yet it is nevertheless routinely used to treat type 1 narcolepsy.

Histamine drugs – Pitolisant, a histamine receptor antagonist, is a representative medication of this class. Receptor antagonists prevent some substances from connecting to cells in your body. The cells’ ability to do 

particular tasks are slowed or blocked as a result.

Narcolepsy in children 

The consequences of Narcolepsy frequently pose difficulties for children. It might be challenging to maintain social connections, pay attention in class, and take part in extracurricular activities when you are sleepy during the day.

Narcolepsy, however, is a medical condition. As a result, children with Narcolepsy have legal safeguards, and the law mandates that schools provide reasonable accommodations. Changing class schedules, scheduling rest intervals or naps, and taking medication while in class are a few examples. The paediatrician of your kid or other specialists can assist you in navigating this and identifying options that will benefit your child.

Lifestyle changes

Maintain a regular sleep schedule

Your ability to sleep soundly can be improved by following a sleep routine.

Make sleep a priority

Choose a bedtime that enables you to obtain the quantity of sleep that is advised for your age. Additionally, you should schedule some downtime before bed to unwind and relax.

Avoid using tobacco, consuming caffeine or alcohol, or eating a meal too soon before bed.

A light snack might be the best option if you feel hungry before bedtime. It’s best to avoid alcohol entirely if you take certain medications. Experts also strongly recommend altogether quitting tobacco products (including vaping and smokeless tobacco).

Spend as little time as possible on electronics or around bright lights.

When these are excessively bright before bed, they can interfere with your body’s normal sleep-wake cycle.

Summary 

Narcolepsy can make daily life difficult. Experiencing spells of excessive sleepiness can be stressful. You can maintain your health by receiving the proper diagnosis, working with your doctor to choose the best course of treatment, and adhering to your treatment schedule as directed.

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