What is Narcolepsy? Causes, Symptoms, and Treatment

Narcolepsy is a sleep disorder which is characterised by sleep attacks due to loss of muscle control but there are some ways to manage the symptoms with a stop to excessive daytime sleepiness, tiredness and regain control of your life. The people with narcolepsy may feel tired and sleep even after waking up throughout the day. Narcolepsy can interfere with social, psychological, cognitive function and the social activities, it is left untreated and undiagnosed. It is a lifelong problem but it doesn't usually worsen as the person ages and it affects both males and females equally and their symptoms may often start from childhood, adolescents ( 7 - 25 years), but it can occur anytime in life. The NINDs which is a component of National Institute of Health along with other National Institutes and centres through grants to medical institutions across the country.

What is Narcolepsy?

Narcolepsy is a neurological disorder which affects the brain ability to control the sleep- wake cycle and the disruption may cause excessive sleepiness, which is the primary symptom in narcolepsy so it is difficult for the people dealing with narcolepsy to stay awake for a long time. It may go through with a pattern of stages in narcolepsy, which includes a rapid eye movement (REM) sleep occuring in the final stage, usually an hour after falling asleep. 

Symptoms of Narcolepsy

The common symptoms of narcolepsy are Cataplexy and excessive daytime sleep which is often connected with the emotional state, these symptoms you may tend to exhibit when you will experience intense emotions, sadness, laughter,  shock, surprise etc. 

The following symptoms can vary from one person to another and the common symptoms include :

• Excessive Daytime Sleepiness / Tiredness: The people dealing with narcolepsy can't sleep without giving you any such update or warning and it will happen at any place or any time. Generally people get sleepy when they are getting bored or during any kind of work. And it is a very risky kind of symptom which can cause you to fall asleep while travelling or walking in a stretch suddenly. 
• Hallucinations: Some people who are dealing with narcolepsy may experience visual or auditory sensation while falling asleep or upon awakening and this is also a major symptom in narcolepsy. 
• Nighttime Wakefulness: These symptoms majorly happen in narcolepsy which means you may have a period of wakefulness at night with elevated heart rate, anxiety or intense alertness.
• Changes in Rapid Eye Movement Sleep (REM): Some people in narcolepsy will sleep when they are dreaming some things and they get REM sleep within 60 to 90 mins of sleep.
• Automatic Behaviour: Some people try to avoid sleep which may trigger automatic behaviours that occur when a person is unaware. 
• Cataplexy: Cataplexy only occurs in people with NT1 and an episode of cataplexy occurs in response to sudden emotions such as sadness, laughter, surprise, excitement etc and it is a sudden loss of muscle control. 
  

Types of Narcolepsy

Narcolepsy mainly has two types:- 

• Narcolepsy Type- 1: People who are dealing with narcolepsy around 20% of people have Type -1 , which also includes cataplexy. This can be more serious and mild which may fall you down to the ground. The people who are dealing with Type-1 Narcolepsy may experience excessive daytime sleepiness along with cataplexy. 
• Narcolepsy Type- 2: Around 80% of people dealing with Narcolepsy Type-2 which doesn't involve cataplexy and it's very hard to diagnose than Narcolepsy Type-1 and people dealing with Type-2 Narcolepsy may experience excessive daytime sleepiness but don't have cataplexy and they also have a normal hypocretin level.
   

Causes of Narcolepsy

The main cause of narcolepsy is a lack of hypocretin which is also known as Orexin. Hypocretin is a chemical in the brain that activates arousal and regulates sleep discovered by scientists. Generally , Narcolepsy has fewer HCRT cells, the neurons that secrete hypocretin, which may count for their tendency to fall asleep. The Scientists are working on developing treatment to reduce Narcolepsy Symptoms in humans to supplement hypocretin levels. 

Risk Factors in Narcolepsy

Risk factors may include various age factors, narcolepsy typically starts with age between 10 Years to 30 Years and it is 20 to 40 times higher if you have a close family member who has narcolepsy. Narcolepsy can also occur after severe trauma to areas of the brain which regulates wakefulness and REM sleep and Brain tumours may also cause narcolepsy. 

Diagnosis of Narcolepsy

Some people dealing with Narcolepsy can often be either mis-or-undiagnosed and people should wait to consult the doctor because the most common symptom of Narcolepsy is excessive Daytime Sleepiness which could be indicative of many other conditions as well. Narcolepsy symptoms are often falsely attributed to other sleep chronic sleep disorders or medical conditions which may includes depression or epilepsy.

Tests for Narcolepsy

• Polysomnogram (PSG) : The PSG Test is performed and done in a Sleep Disorder Clinic or a Sleep Lab and the test will be for overnight measurements that take constant measurements while you're sleeping to detect the problems in your sleep.
• Multiple sleep latency test (MSLT) : The MSLT Test for a Sleep Disorder is specially done in a clinic or in a laboratory and it will done during the day time to measure the tendency to fall asleep and detect whether some elements of REM sleep happen at unusual times during the day and you will need to take 4 to 5 short naps usually 2 hours apart. 
• Lumbar puncture :The Lumbar Puncture is also called a spinal tap in a hospital or outpatient facility and the doctor or nurse uses a needle to remove a small amount of spinal fluid from your back area and the fluid is going to send for tested to check the levels of hypocretin and low level of hypocretin will cause Narcolepsy. 

Narcolepsy in Children

Narcolepsy in children affects the child's brain and their ability to regulate their sleep cycle and the sleep wake cycle is your child's internal clock that will manage when they should be asleep or awake. 

Following  are two types of Narcolepsy in Children;

• Narcolepsy in Children Type-1 / Narcolepsy with Cataplexy: In this case, a child may experience daytime sleepiness and cataplexy (Sudden weakness), hypocretin low levels and it can also cause rapid weight gain in children. 
• Narcolepsy in Children Type-2 / Narcolepsy without Cataplexy: The child may experience Excessive daytime sleepiness, tiredness but they won't have cataplexy and it doesn't affect hypocretin levels in children. 

Treatment of Narcolepsy

The cure for Narcolepsy doesn't exist and a combination of treatment can help control the symptoms and help you to continue your daily life activities with activeness and treatment that works best and it varies from specific symptoms, which include a combination of counselling, medication etc.

1. Medication: Following medication that helps in treating Narcolepsy.

• Sodium oxybate: Sodium Oxybate also know as gamma hydroxybutyrate Or GHB, Sodium Oxybate is FDA approved to treat the people with narcolepsy and it helps to reduce the symptoms of excessive daytime sleepiness and cataplexy and if you are taking this medication are advised to limit your salt in diet intake. 
• Antidepressants: Narcolepsy may also be relieved with the use of certain types of antidepressants and this may help with cataplexy, hallucinations , sleep paralysis and other symptoms. The medication may be used off-label for Narcolepsy treatment and they have not been approved by FDA.

2. Cognitive Behavioural Therapy (CBT): This treatment CBT or you can say talk therapy , this therapy usually connects between your thoughts, emotions, actions and reactions and it is also used to treat various conditions which may include depression and PTSD.

3. Other Treatment for Narcolepsy: Following are the lifestyle changes that may help the people dealing with narcolepsy, this may change your symptoms :

• Start doing Exercise daily without breaking the consistency. 
• Start Taking short naps during the day time. 
• Stick with a regular sleep schedule. 
• Don't smoke, drink caffeine, and consume alcohol. 
• Try to avoid eating large meals at bedtime. 
• At night time try to be relaxed and free from all the work.

Conclusion

In conclusion, narcolepsy generally gets stable over time and in some of the cases the symptoms may improve with time so it affects many different areas in your lifestyle. Sometime people dealing with narcolepsy have many common symptoms which may include Daytime sleepiness, tiredness and cataplexy. You should wait for some duration of time and If you are experiencing these symptoms of stress, anxiety you may consult your family doctor or therapist for further treatment.