Narcolepsy is a sleep disorder that affects up to 1 in 2,000 people. However, it is not included in the category of “rare diseases”. It is sometimes misdiagnosed as another sleep problem because it has some common symptoms: tiredness, fatigue, weakness. Untreated narcolepsy can lead not only to problems in the personal and professional spheres, but also to threaten life: a person can suddenly fall asleep while driving or while cooking. Therefore, at the first suspicion of it, you need to make an appointment with a doctor by phone +7 (499) 519–32-56 and a detailed diagnosis of the body.
What are the main symptoms of narcolepsy?
Sudden and uncontrolled falling asleep is one of the main symptoms of this disease. Her other symptoms:
constant feeling of tiredness
fatigue and desire to fall asleep even in the middle of the working day,
night sleep disturbance
sudden loss of muscle tone
Narcolepsy is defined as a neurological condition in which the brain’s ability to regulate sleep and wake cycles is impaired. People with this disorder often have trouble sleeping both at night and during the day, as different stages of sleep occur at inappropriate times. People with narcolepsy may fall asleep uncontrollably while working, driving, cooking, and even laughing, talking, and having sex. “Sleep attacks” usually do not last long — a few seconds or minutes, but sometimes they can drag on for up to several hours.
What types of disease exist?
Doctors classify two types of narcolepsy. In the first case, patients have a low level of hypocretin (orexin), a substance of the brain, which was discovered only in the early 2000s. It plays a key role in maintaining wakefulness, helping regulate circadian rhythms and the body’s energy balance. In the first type of narcolepsy, people experience such characteristic symptoms as sudden numbness and loss of muscle strength (cataplexy), which may even cause the patient to fall while remaining fully conscious.
Type II narcolepsy, a milder form of the disease, is not characterized by severe hypocretin deficiency and cataplexy attacks. Sometimes the second type, due to lack of treatment, gradually develops into the first. That is why a timely appointment with a doctor and a correct diagnosis are needed. Both types of narcolepsy are classified as autoimmune diseases.
The exact reason for the decrease in the level of hypocretin in the body is still unknown. It is speculated that this may be due to a misguided attack by the immune system. People are not born with narcolepsy, but rather may or may not have a genetic predisposition to develop the disease. For those who have the prerequisites for it, at some point the usual work of the immune system is disrupted: in the process of fighting the flu or another infection, it starts by mistake to attack neurons that produce hypocretin.
When is a doctor’s appointment required?
Unexpected and unexplained “sleep attacks”, excessive daytime sleepiness, hallucinations, and sleep paralysis are all signs of serious problems in the body that require an appointment with a doctor. Because people with narcolepsy have disrupted circadian rhythms, the most common problem is restless sleep at night. But the main symptom that is observed in every patient with narcolepsy is excessive daytime sleepiness.
Additionally, REM sleep may occur at the wrong time. During this stage, dreams occur, and the person’s body is naturally immobilized so that the person does not harm himself by experiencing events in a dream. In people with narcolepsy, the REM phase is poorly controlled by the brain and the boundaries between sleep and wakefulness are blurred, leading to very vivid dreams and sleep paralysis while awake.
How do doctors diagnose the disease?
To make a diagnosis, doctors carefully analyze the symptoms, conduct a medical examination of the patient, taking into account a complete history, including family diseases. This information is needed to accurately evaluate the results of two types of diagnostic tests:
Latency sleep test (MSLT).
In the first study, the doctor asks the patient to spend the night in the hospital to monitor and record body functions such as brain activity, heart rate, blood pressure, and eye movements. This test helps to observe the phases of rapid and non-rapid eye movement during sleep to determine the quality of sleep.
The latency sleep test is performed during the day after the test of the first type of study. It includes a series of five scheduled naps throughout the day during which patients will be under medical supervision. It will determine how quickly a person falls asleep and goes into different phases of sleep, in particular, in REM. It can sometimes take up to 10 years after the onset of symptoms before a diagnosis is made.
Because the symptoms of narcolepsy can resemble those of other conditions (apnea, depression, or seizure disorder), delayed or inaccurate diagnosis is common.
What types of treatment are available?
There is currently no single cure for narcolepsy. But doctors have found that a combination of certain medications and lifestyle adjustments can be very effective in treating the condition. Sometimes the patient is prescribed antidepressants, drugs for ADHD and psychostimulants. In Western countries, such drugs for narcolepsy as modafinil and methylphenidate are common, which are not registered in Russia. They are designed to reduce daytime sleepiness. And antidepressants are recommended to control cataplexy.
But an important condition for treatment is a change in lifestyle and behavior, including the correct sleep pattern (going to bed at the same time and sleeping for at least seven hours), playing sports, reducing caffeine and alcohol in the evening. The doctor may advise the patient to take small breaks for daytime sleep or rest to reduce drowsiness and increase energy.
In the future, research scientists may lead to the artificial production of hypocretin to control its deficiency in the brain. Doctors continue to look for ways to prevent the destruction of this neurotransmitter in those who are genetically susceptible to narcolepsy.