Narcolepsy: The Sleep-Cycle Disruptor
The Disorder that Distorts Healthy Sleep Cycles
Narcolepsy is a less common sleep disorder than insomnia or sleep apnea. But it is not as rare as you may think. This sleep disorder affects approximately 1 in 2,000 people. It is a disorder that causes dysfunction with the body’s sleep-wake cycles and significant alterations to normal REM sleep. The result of this disturbance to normal sleep architecture is number of sleep-related symptoms that are disrupting and often debilitating. Without medical treatment, narcolepsy can have adverse effects on physical and mental health, and can substantially limit the scope and range of a person’s daily activities.
Narcolepsy often presents itself for the first time in adolescents and young adults between the ages 15-25. However, it can occur in older adults and, rarely, in younger children. The causes of it are not fully understood. There appears to be a genetic component to the sleep disorder, but not all, or even most, cases of narcolepsy can be traced to genetic connections. Scientists have linked narcolepsy to deficiencies of hypocretin, neurotransmitter that plays an important role in the brain’s regulation of sleep and wakefulness.
There remains a misconception that people with this disorder sleep excessively. This is not true. People who suffer from it don’t sleep constantly or in most cases to excess. Rather, they often have great difficulty sleeping, and may have trouble controlling their sleep.
Excessive daytime sleepiness. Nearly everyone with narcolepsy experiences extreme fatigue and tiredness during their waking days. In people with narcolepsy, this tiredness is usually not relieved by sleeping. Naps may improve alertness and energy levels temporarily, but sleepiness returns relatively quickly. This pervasive, often intense sleepiness can significantly interfere with a person’s ability to function during the day.
Sleep attacks. Sleep attacks are overwhelming, irresistible urges to sleep. They often come on suddenly, and can occur anywhere at any time of day. Along with the extreme daytime tiredness that accompanies the disorder, sleep attacks can make certain activities, such as driving, dangerous for people with narcolepsy. Not all patients suffer sleep attacks, but many do.
Fragmented sleep. Many people with narcolepsy have significant trouble staying asleep throughout the night. They may wake up frequently and have difficulty returning to sleep. This lack of sleep contributes to the pervasive tiredness they experience during the day.
Hallucinations. With this sleep disorder, people may experience disturbing visions adjacent to sleep, either while falling asleep or when awakening. These visions are often intense and frightening: people may see a dark and looming figure hovering over them, or feel a foreboding presence in their room. Sometimes hallucinations involve the body feeling out of control, such as falling or flying uncontrollably through the air. Narcolepsy-related sleep hallucinations are extremely vivid, and can trigger deep emotions of fear and dread.
Sleep paralysis. This is a highly disconcerting, often frightening symptom that occurs in some people with narcolepsy. Waking from sleep, a person finds his or her immobilized, unable to speak or move. Sleep paralysis can also happen while falling asleep. Episodes of sleep paralysis may last a few seconds, or as long as a minute or more.
Both hallucinations and sleep paralysis are parasomnias that are not exclusive to narcolepsy. Not all people with narcolepsy experience these symptoms—and not everyone who experiences sleep paralysis or hallucinations around sleep has narcolepsy. Indeed, many of the symptoms of narcolepsy also belong to other sleep disorders, such as sleep apnea or REM sleep behavior disorder.
Cataplexy. Some people with narcolepsy also suffer cataplexy—a sudden loss of muscle tone—while others do not. The effects of cataplexy involve sudden, temporary episodes muscle impairment or paralysis. This can include slurred speech, weakness in limbs, or difficulty holding up one’s head. More severe cataplexy may involve loss in one’s ability to move arms or legs, or physical collapse. Cataplexy is triggered in response to intense emotions: fear, excitement, joy, anger, surprise, or even laughter.
Treating the Problem
Narcolepsy is often managed and its symptoms improved with a combination of medication and lifestyle adjustments, along with strong adherence to a sleep routine.
Stimulant medication may be prescribed to alleviate daytime tiredness and help diminish sleep attacks. SSRI medications, used to treat depression, may also be prescribed to help with these symptoms, along with the symptoms of hallucinations and sleep paralysis. There is also medication that can be used to treat cataplexy, for those patients with narcolepsy who suffer from it.
A strong, consistent sleep routine is critical for people with narcolepsy. This includes waking and going to bed at the same times, every day. If naps are needed to help with daily functioning and overall sleep goals, they are used on a schedule. Exercise can be very helpful for people with this sleep disorder. It is important for people with narcolepsy to avoid habits that interfere with healthy sleep and the maintenance of a sleep routine. Alcohol, nicotine, drugs should be avoided, and caffeine may need to be limited or avoided as well.
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