What Is Narcolepsy?

Narcolepsy is a neurological condition that disrupts sleep and can cause excessive daytime sleepiness (EDS). Although narcolepsy is rare compared to other sleep disorders, an estimated 135,000 to 200,000 Americans have narcolepsy.

Symptoms typically begin in the teen years into the early 20’s or 30’s. The severity can range from mild to severe and can have a negative impact on school, work, social activities, and a person’s general health and well-being.

While living with narcolepsy can be challenging, finding the correct treatment can help you function at the highest possible level. This article will discuss the causes, symptoms, and treatment options for narcolepsy.

Narcolepsy is a disorder that disrupts your sleep-wake processes. The main symptom of narcolepsy is EDS resulting from the brain’s inability to regulate sleep and wakefulness.

During normal sleep, people go through stages of sleep, with the final stage being REM (rapid eye movement) sleep which occurs about an hour after falling asleep. However, REM sleep is irregular in those with narcolepsy, usually beginning minutes after they fall asleep. This happens because the brain disrupts how sleep works—this disruption results in daytime sleepiness and other narcolepsy symptoms.

Types of Narcolepsy

Per the International Classification of Sleep Disorders, Third Edition, there are two types of narcolepsy, type 1 (NT1) and type 2 (NT2).

NT1

Cataplexy, the sudden loss of muscle tone, is associated with narcolepsy type 1. However, not every patient diagnosed with NT1 experiences cataplexy. It can also be diagnosed if a person has low levels of hypocretin-1, a neurotransmitter that helps control wakefulness.

NT2

People diagnosed with NT2 have symptoms similar to those with NT1. However, they do not have low hypocretin-1 levels or cataplexy. If cataplexy or low hypocretin-1 levels occur in the future, they can be reclassified to NT1.

Symptoms of Narcolepsy

We dream and can experience muscle paralysis during REM sleep. This can explain some symptoms of narcolepsy. Some symptoms include:

- Excessive daytime sleepiness makes it hard to stay awake during the day, even if you’ve had a full night’s sleep. The lack of energy resulting from this excessive sleepiness can make it difficult to concentrate, cause lapses in memory, and can even lead to depression.

Cataplexy can lead to problems such as slurred speech all the way to a total body collapse, depending on which muscles are affected.

Hallucinations can be vivid, frightening, and can happen at any time. While they are typically visual, other senses can be involved.

Sleep paralysis prevents you from speaking or moving while trying to fall asleep or wake up. It can last from a couple of seconds to minutes.

Sleep disruptions caused by breathing problems, body movements, or vivid dreams can keep you from staying asleep.

Diagnosis

Because of its rarity and its symptoms being so similar to other conditions, narcolepsy is often misdiagnosed. Finding a doctor familiar with the condition is essential for the proper diagnosis.

Your doctor may order polysomnography (a sleep study), which is a test that monitors your brain and body activity while you sleep. A Multiple Sleep Latency Test (MSLT) may also be recommended to assess your sleepiness.

To be diagnosed with narcolepsy, you must experience EDS for no less than three months. And because NT2 has symptoms similar to other sleep disorders, your doctor must use your test results to rule out other conditions.

An NT1 diagnosis also requires low levels of hypocretin, or the patient must have symptoms of cataplexy. They must also fall asleep in a short amount of time and enter REM sleep on the multiple sleep latency test.

Treatment Options

Currently, there is no cure for NT1 or NT2. The goal of treatment is to improve the patient’s safety, reduce symptoms, and enhance their quality of life.

Often people with narcolepsy find that the disease stabilizes over time, can often improve with age, and, although rarely, symptoms may vanish spontaneously. Treatments for both types of narcolepsy are similar. However, NT2 doesn’t involve medications for cataplexy.

Non-Medical Treatments

One can incorporate many non-medical treatment options into their daily routine to help with narcolepsy. The following behavioral approaches to therapy may be beneficial.

Short naps can help people with narcolepsy feel refreshed. Making time for naps can help reduce excessive drowsiness during the day.
Establishing healthy sleep habits can help people with narcolepsy sleep better. Creating a sleep schedule, having a sleep environment free from disruptions and distractions, and limiting the use of electronic devices before bed are some healthy habits you can incorporate into your schedule.

Avoid sedatives to help with daytime symptoms. Substances such as alcohol and nicotine are sedatives that can make symptoms worse.

Eating a healthy diet is an important factor in the overall health of someone with narcolepsy, as they have a greater risk of obesity.

Exercising can not only help prevent obesity, but it can also help you sleep better.

Finding support is imperative for your emotional health. Support groups and mental health services can help reduce the risk of anxiety and depression that sometimes occurs in people with narcolepsy.

Medication

Sometimes, treatment plans may include medication as well as behavioral approaches to help someone overcome their symptoms. While medication can improve symptoms, those medications could have side effects.

Here are some medications your doctor may prescribe.

Armodafinil and modafinil are usually the first line of treatment for EDS.
Methylphenidate is an amphetamine that can lessen EDS.

Solriamfetol affects EDS similar to modafinil.

Sodium oxybate reduces cataplexy, nighttime sleep disturbances, and EDS, but it can take some time to affect EDS.

Pitolisant promotes wakefulness and has positively affected cataplexy.

Treatment of Narcolepsy in Children and Pregnant Women

Children with narcolepsy are treated similarly to adults. However, there are additional precautions taken regarding medication and the dosage. The American Academy of Pediatrics recommends a cardiovascular evaluation before starting children on stimulant medication.

There is limited information on the safety of medications used to treat narcolepsy in women who are already pregnant, trying to conceive, or breastfeeding. You should discontinue narcolepsy medications while you are pregnant, trying to get pregnant, or breastfeeding.

Let DreamZz Sleep Center Help!

Although there isn’t currently a cure for narcolepsy, by making lifestyle changes and using prescription medications, you can manage your condition and ensure the safety of yourself and those around you. In addition, ongoing research provides hope that scientists may discover more effective treatments in the future.

At DreamZz Sleep Center, our goal is to help you get control over your sleep disorders. Our fellowship-trained and Sleep Medicine board-certified physician will provide detailed information about your symptoms and offer treatment options to help you sleep better. From your initial call, we will have you scheduled for a sleep study within one to two weeks, meaning your treatment can start in less than one month.

What is Narcolepsy?