Narcolepsy

Narcolepsy is one of the most under diagnosed illnesses that medicine of the twenty first century deals with. It is estimated that only one quarter of those actually suffering from this disorder have been properly diagnosed and treated. This leaves approximately 120,000 sleepy people who have been misdiagnosed and improperly treated or undiagnosed completely. For these people, the impact on their lives is considerable and at times completely disabling or fatal (auto accidents account for the majority of the fatalities). With the advent of modern sleep monitoring techniques and recent developments in genetics this number should drop significantly. Although no cure for narcolepsy has been found, recent advances in medications allow most people to lead normal or nearly normal lives.

Narcolepsy can be defined as uncontrollable attacks of REM (Rapid Eye Movement) Sleep also called dream or paradoxical sleep during what is considered daytime or "normal" waking hours. Between these episodes the person feels sleepy on a continual basis unrelated to the amount or type of nighttime sleep.

Excessive daytime sleepiness is just one of the symptoms of narcolepsy. There are three other symptoms that are closely associated with narcolepsy and are known as the ancillary symptoms. These include cataplexy, which is the sudden loss of muscle strength usually brought on by a strong emotional stimulus e.g. laughter, anger, and fright. Sleep Paralysis is the sensation that all of your muscles are paralyzed and occurs in the transition into or out of sleep. Many "normal" people experience a feeling of free falling generally after a full night's sleep and occurs when waking up out of the last REM period (dream state) of the night. Sleep paralysis becomes pathologic when it occurs at sleep onset rather than sleep offset.

The third associated symptom is called Hypnagogic and Hypnopompic Hallucinations. Hypnagogic hallucinations are vivid still image mental pictures that occur when one first falls asleep and hypnopompic hallucinations are similar vivid frozen motion mental imagery at the point of awakening.

Narcoleptic patients can have one, two or all three of the associated symptoms and sometimes there will be no other symptom, other than the daytime sleepiness. Most patients with narcolepsy start off with the daytime sleep attacks and then go on to develop the ancillary symptoms later on. The ancillary symptoms however such as cataplexy can be as troubling to the patient as the primary symptom of sleep attacks. Treatment of the sleep attacks and cataplexy for the most part require different medications. Other symptoms of narcolepsy include:

•Automatic behavior - performance of routine tasks while in a twilight sleep state for which the person has no memory "upon awakening".

•Disturbed nighttime sleep.

•Poor concentration abilities.

•Poor short-term memory.

•Short temper and mood swings.

•Social isolation.

•Depression.

Narcolepsy typically starts during a person's teenage years and for this reason many patients are labeled; slow, unmotivated, daydreamers, drug users, or ADD (Attention Deficit Disorder) sufferers.

The exact cause is not known but narcolepsy appears to be a disorder of that part of the central nervous system that controls sleep and wakefulness. An almost identical syndrome occurs in dogs and a very recent discovery has identified a mutant gene that codes for a specific neurotransmitter receptor. This is very exciting because it may allow medical science to modify the gene so that the correct receptor is made and "cure" the condition. The ancillary symptoms: cataplexy, sleep paralysis and hypnagogic hallucinations can be thought of as REM (rapid eye movement) intrusion into wakefulness. During REM sleep all muscles of the body become paralyzed and dreaming occurs. In narcoleptics however this behavior is not confined to sleep during the night but occurs periodically throughout the day causing all the signs and symptoms described above. Narcolepsy is not caused by psychiatric or psychological or emotional problems.