April 19, 2018 | It’s one thing to fall asleep watching television in a comfortable chair, but imagine falling asleep while having a conversation or even driving an automobile. These are very possible for someone with narcolepsy, a neurological disorder that causes a person to have difficulty staying awake. Despite the perception that people with narcolepsy are perpetually sleepy, they do not typically sleep more than the average person. Narcolepsy is considered a “state boundary” control abnormality. In other words, narcolepsy patients sleep a normal amount but cannot control the timing of their sleep. Narcolepsy affects both males and females equally.  The symptoms often start in childhood, adolescence, or young adulthood but they can occur at any time in life.  It is estimated that anywhere from 135,000 to 200,000 people in the United States have narcolepsy.  However, since this condition often goes undiagnosed, the number may be higher.

April 19, 2018 | Most people with narcolepsy have low levels of hypocretin, a neurotransmitter normally present in the hypothalamus region of the brain that helps promote wakefulness and regulates REM sleep. What causes narcolepsy remains a mystery although a combination of factors may play a role in causing a lack of hypocretin. Up to 10 percent of people who have narcolepsy report having a relative who has the same symptoms. Infections and brain injuries caused by conditions such as brain tumors, strokes, or trauma can also lead to lack of hypocretin. In some people, there are fewer of the cells that make the neurotransmitter due to an autoimmune reaction. Such a reaction occurs when the body’s immune system mistakenly attacks the body’s cells healthy tissues. Some research suggests that environmental toxins may play a role in triggering narcolepsy. These toxins may include heavy metals, pesticides and weed killers, and secondhand smoke.

April 19, 2018 | Narcolepsy is a lifelong problem. The symptoms can partially improve over time, but they will never disappear completely.  The most obvious symptom is excessive daytime sleepiness, or EDS. EDS is characterized by persistent sleepiness, regardless of how much sleep an individual gets at night. Cataplexy, a sudden loss of muscle tone while a person is awake, is another symptom. In about 10 percent of cases of narcolepsy, cataplexy is the first symptom to appear and can be misdiagnosed as a seizure disorder. Attacks may be mild and involve only a momentary sense of minor weakness in a limited number of muscles, such as a slight drooping of the eyelids. The most severe attacks result in a total body collapse during which individuals are unable to move, speak, or keep their eyes open.  But even during the most severe episodes, people remain fully conscious, a characteristic that distinguishes cataplexy from fainting or seizure disorders.

April 19, 2018 | There is no cure for the sleep disorder known as narcolepsy.  A doctor may prescribe stimulants to increase daytime alertness in a patient, while several different antidepressant medicines can be used to treat the sudden loss of muscle tone, hallucinations or sleep paralysis that affect some people. Drug therapy should be supplemented by behavioral strategies. For example, many people with narcolepsy take short, regularly scheduled naps at times when they tend to feel sleepiest. Improving the quality of nighttime sleep can combat excessive daytime sleepiness and help relieve persistent feelings of fatigue. Among the most important measures people with narcolepsy can take to enhance their sleep quality are maintaining a regular sleeping and eating schedule, and avoiding alcohol and caffeine-containing beverages before bedtime. Regular exercise is also recommended, but not within 3 hours of bedtime.

April 19, 2018 | People with narcolepsy can do virtually anything anyone else can do, but they have to take precautions when undertaking certain aspects of life. Driving, for example, can be dangerous but with special attention, it’s not impossible. A person with narcolepsy should always take their medications as prescribed if they plan to drive, and they should plan to drive when they are least likely to have a sleep attack or any other symptoms that could lead to an accident. The Americans with Disabilities Act protects the employment rights of people who have disabilities, including narcolepsy. The ADA requires employers to reasonably accommodate the needs of their workers with disabilities. For workers with narcolepsy, this may include allowing short naps during the workday, adjusting work schedules around sleepy periods and alterations to the workspace or job duties. Workers must tell their employer that they have narcolepsy to get these accommodations.