People have been known to fall asleep in interesting places such as the bus, the train, at school, and even at work. However, for some people this is part of a serious and chronic disorder called narcolepsy. Narcolepsy occurs throughout the world, and in the United States, 200,000 Americans are estimated to have the disorder although only about 50,000 are diagnosed. This is because narcolepsy may be confused with depression or epilepsy. Both men and women are equally likely to have narcolepsy, and symptoms usually begin between the ages of 10 and 20.
Symptoms of narcolepsy include problems with sleep during the evening and daytime. During the evening, sleep is disrupted by the lack of NREM sleep which can lead to insomnia in some cases. Problems during the day are called excessive daytime sleepiness (EDS) which is characterized as extreme sleepiness during the day, often called sleep attacks, that compels people to take a nap. If a person attempts to fight these sleep attacks, their ability to do work usually decreases and often these attacks occur during inappropriate times such as at work/school or driving. Another major symptom of narcolepsy is cataplexy. Cataplexy is the sudden loss of muscle control which is triggered by intense emotions or vigorous activities such as sports. Cataplexy can range from a slight weakness to total collapse, and can last for several minutes. This is related to sleep because it is a similar condition that occurs naturally in REM sleep. Because people with narcolepsy often shift from wakeful states to states of REM without NREM stages, other symptoms include sleep paralysis (the inability to move upon waking), hypnagogic hallucinations (dream-like hallucination while waking up), and automatic behavior (performing tasks while sleeping only to wake up and have no memory of these behaviors).
The causes of narcolepsy are linked to the lack of a specific chemical in the brain called hypocretin, which is a chemical that helps with alertness and is produced in the hypothalamus of the brain. There are theories that state that this is possibly due to the body's immune system attacking cells that produce hypocretin, which would make narcolepsy an autoimmune disorder. Narcolepsy is also linked with families so the cause may also be genetic. In order to be diagnosed with narcolepsy, doctors may ask patients to take certain surveys and tests. The Epworth Sleepiness Scale, used to determine sleep deprivation and other sleep disorders as well, is often the first diagnostic test administered. Once sleep deprivation is established, doctors go on to do sleep studies, including polysomnogram (PSG). A polysomnogram measures EEG activity (brain waves), heart rate, eye movements, leg muscle activity, and chest and stomach movement during a normal night of sleep.
Treatment for narcolepsy includes both medications and lifestyle changes. In order to increase daytime alertness, patients may take Modafinil, Methylphenidate, Amphetamines, and other medications. In order to treat cataplexy, patients may be given gamma hydroxyl butyrate, although antidepressants have been used in the past to treat cataplexy. Lifestyle changes usually include developing healthier sleep habits at night such as avoiding distractions before bedtime, not taking caffeine before bed time, and doing something relaxing beforehand. During the day, people with narcolepsy are recommended to safeguard their homes and avoid being alone if they feel that a sleep attack is likely to happen.
Narcolepsy is a misunderstood disorder and often joked about, but for sufferers this is a serious disorder that leads to a great amount of stress in life. People with narcolepsy often have difficulty retaining jobs and performing daily tasks, and with a possibility of 150,000 in the United States alone that are undiagnosed, these people are unaware that their problems may be caused by this disorder. Further education of narcolepsy will help increase not only awareness for the general public but also awareness for people undiagnosed with narcolepsy.
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