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Narcolepsy by Jenna Hollenstein, MS, RD

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Definition

Narcolepsy is a disorder of the nervous system. It results in frequent, involuntary, episodes of sleep during the day. Sleep attacks can occur while you drive, talk, or work.

Causes

The cause is unknown. It is thought to have a genetic link. There is increasing evidence that it may be an autoimmune disorder. In this type of disorder the body’s own immune system attacks a part of the brain.

Risk Factors

A risk factor is having family members with narcolepsy.

Symptoms

Symptoms usually start during the teenage years. Onset may range from 5-50 years old. Symptoms may worsen with aging. They may improve in women after menopause .

Symptoms include:

Excessive daytime sleepiness
Daytime involuntary sleep attacks
Unrefreshing sleep
Sudden loss of muscle tone without loss of consciousness (cataplexy)
Temporary paralysis while awakening
Frightening mental images that appear as one falls asleep
Memory problems
Symptoms may be triggered by:
- A monotonous environment
- A warm environment
- Eating a large meal
- Strong emotions

Brainstem—Area of Brain Related to Alertness

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. If narcolepsy is suspected, you may be referred to a specialist in sleep disorders.

Tests may include:

Multiple sleep latency test (MSLT)—measures the onset of rapid eye movement sleep, which occurs earlier than normal in narcolepsy
General sleep lab study—often done the night before an MSLT; helps to rule out other causes of daytime sleepiness by monitoring:
- Brain waves
- Eye movements
- Muscle activity
- Respiration
- Heart beat
- Blood oxygen levels
- Total nighttime sleep
- Amount of nighttime REM sleep
- Time of onset of REM sleep
- Degree of daytime sleepiness

Treatment

Treatment may include:

Stimulant medicines that increase levels of daytime alertness, such as:
- Methylphenidate
- Dextroamphetamine
- Methamphetamine
- Modafinil
- Armodafinil
- Gamma-hydroxybutyrate (GHB)—for excessive daytime sleepiness and cataplexy, such as sodium oxybate
Antidepressants—to help treat many symptoms of narcolepsy (eg, cataplexy, hallucinations, sleep paralysis)

Other treatment options include:

Planned short naps throughout the day
Counseling to cope with issues of self esteem
Wearing a medical alert bracelet or pendant

Prevention

There are no guidelines for preventing narcolepsy. But, you can try to prevent symptoms by:

Exercising on a regular basis
Getting adequate sleep at night

RESOURCES:

Narcolepsy Network http://www.narcolepsynetwork.org/
National Sleep Foundation http://www.sleepfoundation.org/

CANADIAN RESOURCES:

Better Sleep Council of Canada http://www.bettersleep.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Bhat A, El Sohl AA. Management of narcolepsy. Expert Opin Pharmacotherapy . 2008;9(10):1721-1733.
Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet . 2007;369:499-511.
Feldman NT. Narcolepsy. Southern Medical Journal . 2003;96:277-282.
Narcolepsy fact sheet. National Heart, Lung, and Blood Institute. National Institutes of Health website. Available at: http://www.ninds.nih.gov/disorders/narcolepsy/detail_narcolepsy.htm . Updated October 2009. Accessed February 8, 2010.
Narcolepsy: new understanding of irresistible sleep. Mayo Clinic Proceedings . 2001.

Last reviewed September 2011 by J. Thomas Megerian, MD, PhD, FAAP

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