Today I’d like to talk to you about a sleep disorder called narcolepsy. Narcolepsy is manifest by a symptom complex consisting of excessive daytime sleepiness, cataplexy, sleep hallucinations and sleep paralysis. All of these symptoms do not need to be present to make a diagnosis of narcolepsy, but when excessive daytime sleepiness and cataplexy are present the diagnosis can be made clinically. In the absence of cataplexy a sleep study and another type of study called a multiple sleep latency test are required to confirm the diagnosis.
So what is narcolepsy? Let’s look at the components of narcolepsy. Daytime sleepiness can be found in many disorders such as sleep apnea, periodic limb movements during sleep, shift work, it could be the result of medication or other medical disorders so daytime sleepiness by itself is not a sufficient symptom to make a diagnosis of narcolepsy.
What is cataplexy? Cataplexy is the sudden and uncontrollable loss of muscle tone that can occur either out of the blue or in response to some kind of trigger. The two most common triggers being laughter and anger. But any strong emotion, be it joy, fear, being startled, getting into an argument, even during climax during sexual activity, any strong emotion can set off this sudden loss in muscle tone. This can be manifest by the complete dropping to the ground which is the classic textbook form of cataplexy, which is rarely seen to much more subtle manifestations such as the sudden shaking of a hand while holding a coffee cup, slurring of your speech, a little blurring of your vision.
If you’re working on a computer your fingers might not move quite as well as they ordinarily move. These symptoms can last, literally, from seconds to as long as 20 to 30 minutes. Patients come out of their cataplectic episodes often feeling drained but often they will also be as wide awake as they were just prior to the episode.
Sleep hallucinations or paralysis are just as the name implies. Patients will have a hallucination seeing or hearing or smelling an object or a sound or sensation that they know isn’t there as they are falling asleep or right as they are waking from sleep. More commonly are sleep paralysis episodes where, again, as the name implies, patients are paralyzed. They’re wide awake after they’ve awakened int he morning or just as their falling asleep. They are aware of their surroundings but are completely unable to move. These episodes can last for just a few seconds or even up to 10, maybe 20 minutes and the patient will come right out of it. These are completely benign but they may be very, very frightening to the patient.
Narcolepsy is not as rare as we once thought it was. Narcolepsy is more common in males, compared to females. The peak onset of symptoms occurs in the teenage years. We have seen symptoms occur as young as 5 or 6 year old children and patients who are well into their 30’s. Patients who first present with symptoms of narcolepsy after the age of 40 must rule out other sleep disorders first before considering a diagnosis of narcolepsy. And if one takes a very, very thorough history, retrospectively, most patients will demonstrate symptoms way back into their teenage years or into their 20’s.
In children who complain of daytime sleepiness, after ruling out other causes of daytime sleepiness, narcolepsy is the diagnosis until proven otherwise. In years past, stimulants were the only medications that were available to treat narcolepsy and they only treated the symptom of excessive daytime sleepiness. Today we have many choices in the treatment of narcolepsy. To treat the symptoms of inturrupted nighttime sleep and cataplexy, we have a drug known as sodium oxybate or Xyrem.
To treat the cataplexy, tricyclic antidepressants are also still used by some physicians. To treat symptoms of daytime sleepiness we will often use drugs known as provigil, modafinil, nuvigil also known as armodafinil and older medications such as dexadrine and ritalin and adderall are also available to treat symptoms of daytime sleepiness.
I hope this video has been informative in helping you understand what narcolepsy is all about. If you have symptoms that are suggestive of narcolepsy, please visit your primary care physician or see a board certified sleep specialist at an accredited sleep center. And always remember, sleep well tonight for a better day tomorrow.
Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including narcolepsy, OSA, restless limb syndrome, insomnia, and others.
Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of narcolepsy.