Narcolepsy

Published August 8, 2020, 10:35 PM

by Dr. Jose Pujalte Jr.

IF SYMPTOMS PERSIST

“How blessed are some people, whose lives have no fears, no dreads, to whom sleep is a blessing that comes nightly,and brings nothing but sweet dreams.” Abraham Stoker (1847 – 1912), Irish author. “Dracula” (1897)

Chances are your doctor has given you a strong pain-killer or muscle relaxer when you most needed it. Say you banged up your knee really bad or the back pain’s been three weeks and the over-the-counter meds are next to useless. Pain pills are then leveled-up to weak opioids and yes – there is finally relief. But did you read the fine print? For example, tramadol which is a popular and widely-used analgesic “may cause effects such as somnolence and dizziness and therefore may impair the reactions of drivers and machine operators” (product insert warning). It appears that the trade-off for hours free of pain can be daytime sleepiness, if not nausea, headache, or vomiting.

Narcolepsy. Now imagine being sleepy for most of the day but without the medication and that it’s been going on since your teens. The Cleveland Clinic website defines narcolepsy as a nervous system disorder “that affects the brain’s ability to control sleep and wakefulness.” A brain chemical called hypocretin has been implicated. Hypocretin is essential in regulating the sleep/wake cycle and the critical dream phase of sleep or REM (rapid eye movement). Low hypocretin leads to too much sleepiness and even “dreaming sleep” can occur in periods of wakefulness.

Type I – is narcolepsy with sudden muscle weakness called cataplexy and low levels of hypocretin

Type II – is narcolepsy without cataplexy and with normal hypocretin levels.

Other Signs and Symptoms. Aside from EDS (Excessive Daytime Sleepiness) and cataplexy, narcolepsy may also present with the following:

  • Sleep paralysis –the person upon falling asleep or waking up is unable to move or speak but it will only last for seconds to minutes.
  • Disrupted nighttime sleep – occurring several times.
  • Automatic behavior – falling asleep while performing tasks such as talking, driving, or even eating without awareness or memory of the occurrence but observed by others.
  • Hallucinations  – hypnagogic hallucinations occur on falling asleep while the hypnopompic type is experienced upon waking; these are vivid auditory or visual illusions.

Diagnosis. An initial doctor’s visit will lead to a sleep clinic. MayoClinic.com recommends seeing a sleep specialist because of the need to sort through a sleep history and records, and analyses by polysomnography and a multiple sleep latency test. In the former, the electrical activity of the brain, heart, and muscles are monitored. In the latter, daytime sleep is measured. Usually, a person with narcolepsy falls asleep easily and goes into REM immediately.

Treatment. There is no cure for narcolepsy. However, there are medications to manage it and keep life productive. The first-line drugs are stimulants (modafinil, armodafinil) that counteract daytime sleepiness. SNRIs or Selective Serotonin Reuptake Inhibitors (fluoxetine, venlafaxine) are given to combat catapalexy, hallucinations, and sleep paralysis. Anti-depressants and sodium oxybate may also be used for cataplexy, with the latter preferred to improve nighttime sleep. It can take up to 10 years to recognize narcolepsy. Wake up from that wretched life.

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