Narcolepsy is a chronic neurological disorder characterized by excessive sleepiness presenting after puberty.
- Cataplexy - momentary weakness sometimes noted in periods of high emotion
- Sleep Paralysis - a sensation of paralysis felt by patients when just waking-up or just falling asleep
- Hypnagogic Hallucinations - vivid life-like dreams at sleep onset or when awakening
The development of narcolepsy appears to involve both environmental and genetic factors. There is a strong genetic link to genes synthesizing the hypocretin neurotransmitter (HLA-DR2 and HLA-DQ1). It is postulated that an autoimmune process may result in the death or depletion of hypocretin producing cells resulting in the symptoms of narcolepsy.
The diagnosis of narcolepsy is made by polysomnography and multiple sleep latency tests (nap studies). The overnight sleep study is usually normal. The abnormality of excessive daytime sleepiness shows-up on the subsequent nap studies. Characteristically, patients with narcolepsy fall asleep quickly (in less than five minutes on average) when given a chance to nap on four or five occasions separated by a period of two hours between naps. Once asleep, patients may enter REM sleep early (within 15 minutes of falling asleep). Patients without narcolepsy normally do not enter REM sleep until 7 0-120 minutes into sleep. If a patient enters REM sleep on two or more occasions over a period of five naps, the likelihood that the patient has narcolepsy is increased.
Several common medications can confound the nap study results including anti-depressants, anti-anxiety medications, and sedating medications. The patient’s physician may need to counsel the patient whether or not to hold these medications prior to a nap study.
The treatment of the excessive sleepiness symptom with narcolepsy includes ensuring sufficient nighttime sleep, providing a short nap during the day, and stimulant medications. Common stimulant medications prescribed include modafinil (Provigil), methylphenidate (e.g. Ritalin, Concerta, Metadate), Adderall, and Dexedrine.
The symptoms of cataplexy and sleep paralysis can be treated with a tricyclic antidepressant (TCA) (e.g. protryptiline, imipramine) or selective serotonin reuptake inhibitor (SSRI) (e.g. Prozac). For TCA or SSRI failures, sodium oxybate (i.e. Xyrem) has been found to be effective.
To learn more or make an appointment, call 734-712-2276.