Understanding Narcolepsy (Sleep Attacks)

Narcolepsy is one of the causes of Excessive Daytime Sleepiness. It is a sleep disorder characterized by overwhelming daytime drowsiness and sleep attacks, causing the patient to fall asleep in the most inopportune moments, e.g., while eating or during a meeting. It affects either sex equally and usually starts in the puberty years.

Symptoms

Excessive Daytime Sleepiness (EDS) is the most important and usually first symptom. It presents as frequent drowsiness and inability to stay awake during the day even after getting enough night time sleep. The condition is troublesome and occasionally results in embarrassing situations. Cataplexy is a loss of muscle control triggered by intense emotions such as laughter, anger, joy, or due to strenuous exercises.

It is less common than EDS, and can cause a range of physical changes from slurred speech to total physical collapse, lasting for a few seconds to a few minutes. Sleep Paralysis refers to episodes when the patient is unable to talk or move for brief periods on falling asleep or waking up. Hypnogogic Hallucinatons are very vivid and scary dreams and sounds which the patient experience when falling asleep.

As the patient may be semi-awake when beginning to dream, he experienced dreams as reality, and these may be particularly vivid and frightening. Automatic behavior occurs when familiar routines or boring tasks are performed with no recollection or memory of them later on. Sleep paralysis and hypnogogic hallucinations can occur in people without Narcolepsy.

Diagnosis

To diagnose Narcolepsy, the patient first undergoes a medical history and physical examination. This is followed by a Polysomnogram (PSG) and a Multiple Sleep Latency Test (MSLT). A Polysomnogram measures the various body function during sleep, including:

• Nasal airflow

• Respiratory effort

• Blood oxygen level

• Snoring

• Heart rate and rhythm (ECG)

• Electrical activity in the brain (EEG)

• Eye and muscle movements

The Multiple Sleep Latency Test is performed in the day to assess how easily the patient falls asleep and also the type of sleep pattern produced. It records the brain waves, heart rate, muscle activity and eye movements. No blood test is involved in the diagnosis of Narcolepsy.

Treatment

Narcolepsy cannot be cured but the symptoms can be greatly improved through medications and lifestyle modifications. The main aim is to maintain alertness and control some of the lesser occurring symptoms if they happen.

Stimulants to help patient stay awake or alert, and antidepressants which help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis may be used on its own or in combination to manage the symptoms.

Drug treatment is only one way of treating narcolepsy. Taking short naps and following a good sleep hygiene program are also helpful, and may suffice for people who lead slow paced lives.

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