The Management of Narcolepsy

Narcolepsy is defined as a chronic sleep disorder that is characterized by sudden attacks of wanting to sleep and increased daytime drowsiness. Individuals affected by this condition struggle to stay awake for prolonged periods of time.

Causes

There may be many causes for narcolepsy but the exact one still eludes healthcare professionals.

Some of the suspected causes include:

• Genetics – a family history of the disease may play a role in the development of the condition.
• Low hypocretin levels – patients diagnosed with narcolepsy are known to have a deficiency in this neurotransmitter or hormone produced by the brain that helps to regulate REM sleep and wakefulness in humans. The exact reason why hypocretin levels would be low is not known but there is a theory that an autoimmune process may be responsible.
• The H1N1 virus – research has pointed towards a possible link between narcolepsy and exposure to the H1N1 (swine flu) virus although definitive proof has not been established.

Symptoms and Signs

Symptoms and signs of narcolepsy tend to develop in people between the ages of 10 and 25. These may become worse in the first few years after their onset and tend to continue for life. These may include the following:

• Increased daytime sleepiness – patients with narcolepsy may fall asleep without any warning, anytime, and even anywhere. Patients state that they can fall asleep for a few minutes up to 30 minutes at a time and when they wake up they feel refreshed. However, they do eventually fall asleep again.
• Decreased concentration throughout the day – excessive daytime sleepiness can cause this problem.
• Muscle tone that is suddenly lost – also known as cataplexy, affected individuals may experience sudden muscle tone loss as well as slurred speech.
• Hallucinations – affected patients mention that they experience vivid and sometimes frightening hallucinations when they are in a semi-awake state when they are either suddenly falling asleep or waking up.
• Sleep paralysis – narcoleptics often experience a state where they are temporarily unable to speak or move while falling asleep or waking up and this can last for a few seconds to a few minutes at a time.

Management

Unfortunately, there is no cure for narcolepsy but there are medications and recommendations for lifestyle modifications that can help affected people manage their symptoms effectively enough.

Medications

• Selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) – these antidepressants are prescribed to help suppress REM sleep and this helps to relieve the symptoms such as sleep paralysis, hallucinations, and cataplexy.
• Central nervous system stimulants – these medications help patients to stay awake during the day.
• Sodium oxybate – this agent helps specifically for cataplexy and improves nighttime sleep.

Lifestyle modifications

• Go to bed and wake up at around the same time every day. This is a conditioning technique that helps the body get into a regular routine.
• Take short naps at regular intervals during the day as this helps to reduce daytime sleepiness.
• Try exercising regularly around a few hours before bedtime as this helps one to sleep better at night and feel more awake during the day.
• Try avoiding substances such as alcohol and nicotine, especially at night.

Individuals affected by this condition should consult with their primary care doctors so that they can be assessed, investigated, and managed further.