What is Narcolepsy? It’s Symptoms, Diagnosis & Treatment

Narcolepsy is a chronic brain disorder related to sleep-wake dysfunction. The disorder leads to excessive sleepiness during the day, sudden attacks of sleep, and other issues with sleep. While many believe that the symptoms of narcolepsy do not impact the quality of life, they have the potential to do so drastically. So diagnosis and a treatment plan become highly important.

The awareness of the definition of narcolepsy, the pathologies of the disorder, and the available treatment modalities can assist the afflicted individuals in managing the disorder in a positive way. The blog addresses the intricate details of the definition of what is narcolepsy, its diagnosis, and treatment, and the social support that can improve the quality of life of an individual with this condition.

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What is Narcolepsy?

In general, narcolepsy is a disorder that predisposes to excessive drowsiness during the day. Sleep attacks are beyond control, and they may occur at any time of the day. These episodes can last between a few seconds and a few minutes and may sometimes be confused with when a person is awake.

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Unlike the usual tiredness, the inability to stay awake long enough, regardless of the conditions and the environment, should also be listed under what is narcolepsy.

Common somatic symptoms of the condition include sleep disturbance, such as cataplexy, or being unable to maintain muscle tone due to strong feelings of laughter, astonishment, etc. Other narcolepsy symptoms include sleep paralysis and vivid dreams during sleep or upon awakening.

Narcolepsy Causes

Narcolepsy symptoms are not fully understood as to the exact cause, but research has shown that there are a myriad of potential causes that may culminate in the occurrence of this disorder. They are genetic predispositions, autoimmune responses, and so-called derailments of the brain’s response to sleep.

Hypocretin Deficiency

Deficiency of a neurotransmitter called hypocretin that controls wakefulness and REM sleep is one of the narcolepsy causes. The inability to remain awake and alert during the day is a result of a reduction in the levels of hypocretin through the loss of hypocretin-producing cells in the brain. 

This is a weakness that is more pronounced in people with narcolepsy and, in many cases, is regarded as the primary cause of the condition.

Genetics and Family History

The disease of Narcolepsy is highly genetically dependent. The study indicates that people who have a relative affected by narcolepsy are prone to the disorder. Some genetic variations have also been linked to Narcolepsy, specifically, the existence of the HLA-DQB1 06:02 gene. 

The cause of genetics is, however, not the causal agent in its entirety, as not all individuals with such genetic characteristics are affected by the disorder.

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Autoimmune Response

The autoimmune reactions may also be another cause of narcolepsy. There are also other instances where the body can attack the brain cells that produce the hypocretin, thus causing a shortage of this neurotransmitter.

This genetically predisposed defense is assumed to predispose a person to narcolepsy. It has also been proposed that in genetically susceptible individuals, these autoimmune responses can be elicited by an infection (e.g., the H1N1 flu).

Brain Injuries or Damage

In other instances, narcolepsy may be credited to injury or damage to the brain or part of the brain that regulates sleep and wakefulness, known as the hypothalamus. Damage to this portion of the brain could also interfere with the normal control of this mechanism of sleep, resulting in excessive daytime drowsiness and other narcolepsy symptoms.

Such a form of narcolepsy is deemed to be an acquired rather than an inherited type of the disorder and is usually linked to physical trauma or injury.

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Hormonal Changes

Narcolepsy can also be caused by , particularly during puberty or pregnancy. These alterations could change the balance between neurotransmitters that control sleep. 

Hormonal changes might cause narcolepsy in predisposed people or exacerbatethe symptoms of the disorder, making them more apparent.

Early identification of signs of narcolepsy is the key to its diagnosis and appropriate treatment. Some patients could be having minor cases of narcolepsy disturbance, whereas others have instances that are crippling and severe.

The symptoms may include the following in narcolepsy: 

• Excessive daytime sleepiness: Narcolepsy is defined as excessive drowsiness. Individuals can even sleep during activities that demand a lot of concentration, such as driving or at work.
• Cataplexy: Cataplexy is a loss of muscle control or weakness (normally as a result of emotions. e.g., laughter, anger, excitement, etc.). This may be a minute obsession to the extent that the knees become so weak that they collapse.
• Sleep paralysis: A temporary ability to move or speak that takes place when one falls asleep or wakes up, typically accompanied by dramatic hallucinations.
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• Vivid dreams: Narcolepsy patients claim to see images of dreams as they undergo the transitions between sleep and wakefulness or hysterical hypnagogic images.
• Problem sleeping at night: A narcoleptic will experience problematic sleep at night, having frequent unwanted night awakenings.

Such narcolepsy symptoms need to be identified early, and you can seek effective medical attention and cure the disease.

Diagnosis of Narcolepsy

It’s difficult to diagnose narcolepsy since its symptoms overlap with those of other sleep disorders or medical diseases. Clinical examination, sleep tests, and patient history are usually a diagnostic mix.

Polysomnography (PSG)

One of the methods used to signify the existence of narcolepsy is an overnight sleep study technique called polysomnography (PSG). In the test, heart rate, eye movements, and muscle activity are monitored with sensors that are attached to the patient during sleep. This assists physicians with monitoring the sleep-wake cycle.

In the PSG, the abnormalities that doctors are examining include fast transit to REM sleep, which is one of the hallmarks of narcolepsy. Narcoleptic people also go into REM sleep too fast, thus interfering with their sleep patterns.

The outcomes of the PSG are examined by a sleep specialist, and based on the data, he interprets whether narcolepsy is present or not. It has become the initial stage of the diagnostic process.

Multiple Sleep Latency Test (MSLT)

The multiple sleep latency test (MSLT) is a daytime test that, according to chronology, comes second in order of use, after polysomnography. This test measures the speed at which a person sleeps during scheduled naps. It also catalogs how long it takes to reach REM sleep, an essential indicator of narcolepsy.

The narcoleptic person falls asleep very easily compared to the average person, and they would easily fall into REM sleep after a minute or two. A characteristic of the disorder is this fast movement into REM sleep.

The MSLT provides additional diagnostic data by measuring the speed at which a patient falls asleep and the speed at which they enter REM sleep, also used in conjunction with other tests to prove the existence of narcolepsy.

Blood Tests

Blood tests would help to exclude other disorders that resemble the narcolepsy causes. As an example, Thyroid disorders and sleep apnea also have excessive daytime sleepiness as one of their symptoms, and this is why it is a good idea to diagnose this condition. Blood tests are used to rule out these conditions, such as narcolepsy.

Many narcolepsy patients have a low level of hypocretin, which is a neurotransmitter that controls wakefulness. Though cerebrospinal fluid examination is more conclusive, blood analysis may at times point to an aberration of hypocretins, indicating narcolepsy.

Blood tests cannot be used to diagnose narcolepsy, but they can offer helpful insight, allowing physicians to eliminate any other diagnosis and arrive at the correct diagnosis.

Clinical History

A comprehensive clinical history should be provided in the diagnosis of narcolepsy. Based on the symptoms, particularly excessive daytime sleepiness, the doctor will enquire about the onset, frequency, and impact of narcolepsy symptoms. Knowledge of the onset of these symptoms might help with the diagnosis.

The family history is essential. In some families, narcolepsy is a familial disorder; therefore, a history of the disorder develops in individuals who have close family members who have the disorder, making the person more likely to be diagnosed with the disease. This fact is pivotal to the physician.

The physician will also determine the daily life impact of the symptoms. In case excessive sleepiness during the day is creating serious problems, it serves as an additional argument in favor of the diagnosis of narcolepsy and allows for estimating the most effective narcolepsy treatment variation.

Narcolepsy Treatment

Currently, there is no cure for narcolepsy, although there are a number of narcolepsy treatments that can be utilized to control the symptoms and also enhance the quality of life. Narcolepsy treatment is aimed at reducing the sense of sleepiness in the day, eliminating the sudden attacks of sleepiness, and other symptoms like cataplexy.

Medication for Narcolepsy

To treat the symptoms of this ailment, medication for narcolepsy becomes instrumental. The following classes of drugs are often used to treat people with narcolepsy:

• Stimulants: This is the initial kind of drug that is carried out in treating excessive wakefulness. One of the drugs used to make a person feel alert is known as modafinil (Provigil) and armodafinil (Nuvigil).
• Antidepressants: Tricyclic antidepressants and selective serotonin-norepinephrine reuptake inhibitors (SNRI) are used as treatment agents of cataplexy and other mood disorders associated with narcolepsy.
• Sodium Oxybate: It is a medication to alleviate excessive daytime sleepiness and cataplexy. It is also proven to enhance the quality of sleep and reduce sleep attacks.
• Methylphenidate: Methylphenidate is a medication of the stimulant type of medication employed to help in the management of attention deficit hyperactivity disorder (ADHD), treat sleepiness, and enhance concentration.

Lifestyle Adjustments

Narcolepsy medication can be used with lifestyle modification for narcolepsy treatment. These include:

• Routine sleeping time: There are cases when it may be a good idea to maintain a regular bedtime and a regular wake-up time.
• Short daytime naps: Daytime naps might be one of the solutions to excessive sleepiness.

• Diet and exercise: The proper diet and physical activity could help to improve the general well-being and also potentially alleviate some of the symptoms of narcolepsy.
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• Trigger avoidance: It has also been observed that there are patients who are more susceptible to attacks of the disorder caused by a given situation or emotion, particularly cataplexy. This disorder is responsive to the prevention and detection of these triggers.
  
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Cognitive Behavioral Therapy (CBT)

Compared to the drugs used in narcolepsy, Cognitive Behavioral Therapy (CBT) may be applied to rectify the mental aspect of the disease. This cognitive behavioral therapy can be used in patients who continuously experience the drowsy feeling, sleep attacks, and others.

• Narcolepsy Patients Support: Narcolepsy is not a convenient disease to cope with, and every patient may face severe emotional and social problems. The support group plays a vital role in supporting individuals to cope with the disease and its effects on their lives.
• Support Groups: There are support groups for narcoleptics in which people can discuss their experiences and give each other advice to feel like they are part of a community. Find these sorts of groups locally at health associations or on the internet. They can be important in terms of help to the growing number of people who are seeking advice and information about others living simultaneously with similar problems.
• Counseling and Therapy: Narcolepsy may make someone psychologically or emotionally affected, and this can be undone by the means of psychological counseling. Coping skills may be acquired when you are affected by a long-term condition, which in this case is narcolepsy, using methods that will allow you to manage stress, anxiety, and depression.
• Family Support: Narcoleptic patients should also have the support of their close friends and their families. The family should be taught the management of the disorder and increase their understanding of the symptoms, and provide moral and practical support.

Conclusion

Narcolepsy is a complicated disorder that lacks a clear understanding; however, when narcolepsy is detected at an early stage and adequately controlled, the condition can be controlled, and the patients are able to live normally. The awareness of the symptoms and their possible causes of appearance, and the attempts to compute what type of treatment should be conducted, are one of the key components of narcolepsy treatment.

There is hope among the sufferers of this disorder through available and current researches, which produce the best drugs and support systems. Drugs, psychological support, and lifestyle change can assist all narcoleptics in managing their lives and living more joyful.