Narcolepsy is a neurological disorder that results from your brain’s inability to regulate
your sleep wake cycle.
Two of the classic symptoms are excessive daytime sleepiness and cataplexy.
What is cataplexy?
Cataplexy is the loss of muscle tone that is triggered by strong emotions such as laughing
or anger.
The muscle tone loss can be very dramatic such as collapsing to the floor.
Or it can be very subtle such as a slight facial droop.
When we talked about the sleep cycle, we talked about how a normal cycle goes from
light to deep sleep then to REM.
With narcolepsy, people have REM sleep intrude into their wakefulness.
So they can be awake and talking and suddenly become overwhelmingly sleepy.
When they fall asleep, they immediately go into dreaming.
On the surface it can seem as if people with narcolepsy are sleep deprived.
But they typically are not.
They usually get an adequate amount of sleep but they can’t control the timing of their
sleep.
What are some other signs of narcolepsy?
Hypnogogic hallucinations – This is a weird experience that happens at sleep onset.
You can see bizarre and vivid images as you are transitioning from being awake to being
asleep.
Another sign of narcolepsy is sleep paralysis and it usually occurs with the hallucinations.
Because your body is normally paralyzed when you dream, and this is called REM atonia,
people with narcolepsy can get sleep paralysis at odd times of the day when they fall asleep.
The paralysis usually lasts a few seconds to a few minutes.
Because the paralysis and hallucinations occur at the same time, it makes the whole experience
of falling asleep very creepy.
People without narcolepsy can experience hypnogogic or hypnopompic hallucinations as well.
Hypnopompic hallucinations occur during the transition from sleep to waking up.
It can be accompanied by significant sleep inertia and even confusion.
You may have seen someone close to you wake up confused and talking without making sense
for a few minutes until they fully wake up.
If you ask them about the nonsensical stuff they were talking about, they probably won’t
remember what they said. Or the content of what they said. They may remember speaking.
Let me tell you about a few other freaky experiences you can have with sleep paralysis.
Sometimes you can feel as though there is a presence in the room with you, feel chest
pressure as if someone is inhabiting your body or have the sensation of floating above
your body.
Like an out of body experience.
It’s been thought that these experiences may be responsible for some people’s believing
they have been inhabited by an alien.
Other symptoms of narcolepsy include choppy sleep, nightmares and leg jerking.
How is narcolepsy diagnosed?
Your doctor may suspect narcolepsy from your symptoms, but it’s definitively diagnosed
from a sleep study.
A couple of the tests performed would be a polysomnogram and the multiple sleep latency
test .
The polysomnogram measures your muscle activity, breathing and brain activity.
The Sleep latency test measures your time to fall asleep.
A normal sleep latency is 15-20 minutes. Thirty minutes max.
Narcolepsy is diagnosed with a sleep latency of less than 8 minutes and the presence of
2 sleep onset REM periods.
With narcolepsy you must show on testing two instances when you go straight from awake
to REM.
The treatment for narcolepsy is basically managing the symptoms to make people
more functional because the inability to control your sleep timing can be very debilitating.
These people can fall asleep while sitting at a red light.
So the treatment involves medication plus behavioral strategies.
The gold standard treatment is a medication called Xyrem or sodium oxybate.
This medication treats the daytime sleepiness and the cataplexy.
Sodium oxybate is related to the drug GHB – gamma hydroxyl butyrate also known on
the street as liquid ecstasy.
Don't get scared. GHB is illegal, sodium oxybate is not.
If you still have daytime sleepiness with the Xyrem, your doctor may add a stimulant
such as Provigil and nuvigil are designed to help people with narcolepsy be more alert.
Sometimes antidepressants are used to treat the cataplexy, hypnagogic hallucinations and
sleep paralysis.
As for behavioral interventions, we usually recommend people take at least three scheduled
10-15minute naps during the day to help with the sleepiness.
It also may help prevent the sleepy episode from occurring by beating it to the punch
with a scheduled nap.
This way you are sleeping on your terms and not having it creep up on you while you are
at a traffic light.
So that’s narcolepsy.
This usually develops in late adolescence to early adulthood.
It can go undectected in many people for years, but if you are just now at age 50 having trouble
staying awake during meetings, it’s probably not narcolepsy.
In the next lecture we will discuss Movement Disorders that interfere with your sleep.