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Sleep patterns in the young and aged
Sleep patterns in the young and aged


Definition:

Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks.



Alternative Names:

Daytime sleep disorder



Causes, incidence, and risk factors:

Narcolepsy is a neurological disorder, not a mental illness. The exact cause is unknown. Genes may play a role, but it is not the only factor. Anxiety, however, does not cause narcolepsy.

The disorder may be made worse by conditions that cause insomnia such as disruption of work schedules.



Symptoms:

Persons with narcolepsy have episodes of sudden daytime sleeping ("sleep attack"), usually preceded by drowsiness . It may be difficult for a young adult to stay awake during classes or work.

The sleep attacks:

  • Last about 15 minutes each
  • May occur several times during a day
  • Usually happen after eating, but may occur at any time such as while driving, talking to someone, or during other situations where there is little movement

Sometimes, the person may have dreamlike hallucinations before sleep or during the sleep episode. The person wakes up feeling refreshed after each brief sleep episode.

Narcolepsy may also be associated temporary and sudden muscle weakness called cataplexy, that is usually brought on by strong emotions. This may involve:

  • Sudden loss of muscle tone
    • May be associated with emotional reactions such as laughter or anger
    • May be similar to seizures
  • Temporary inability to use muscles (sleep paralysis )
    • Occurs immediately upon awakening
    • Occurs at the onset of drowsiness


Signs and tests:

The doctor will perform a physical exam and order blood work to rule out conditions that can cause similar symptoms. Conditions that can cause excessive sleepiness include:

Other tests may include:

  • ECG (measures the heart's electrical activity)
  • EEG (brain activity measurements)
  • Monitoring of breathing
  • Genetic testing to look for narcolepsy gene

Tests will also include a sleep study (polysomnogram). The Multiple Sleep Latency Test (MSLT) may be used to help diagnose narcolepsy. This test measures how long it takes you to fall asleep during a daytime nap. Patients with narcolepsy fall asleep much faster.



Treatment:

There is no known cure for narcolepsy. The goal of treatment is to control symptoms.

Lifestyle adjustments and learning to cope with the emotional and other effects of the disorder may improve functioning in work and social activities. This involves:

  • Eating light or vegetarian meals during the day and avoiding heavy meals before important activities
  • Scheduling a brief nap (10 to 15 minutes) after meals, if possible
  • Planning naps to control daytime sleep and reduce the number of unplanned, sudden sleep attacks
  • Informing teachers and supervisors about the condition so those affected are not punished for being "lazy" at school or work

Prescription medications may be necessary. The stimulant drug modafinil (Provigil) is the first choice of treatment for narcolepsy. It has much less abuse potential than other stimulants. The medicine also helps maintain wakefulness. Other stimulants include dextroamphetamine (Dexedrine, DextroStat) and methylphenidate (Ritalin).

Antidepressant medications can help to reduce episodes of cataplexy, sleep paralysis, and hallucinations. Antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, and venlafaxine
  • Tricyclic antidepressants such as protriptyline clomipramine, imipramine, and desipramine

Sodium oxybate (Xyrem) is prescribed to certain patients for use at night.

If you have narcolepsy, you may have driving restrictions. Restrictions vary from state to state.



Support Groups:



Expectations (prognosis):

Narcolepsy is a chronic , life-long condition. It is not a deadly illness, but it may be dangerous if episodes occur during driving, operating machinery, or similar activities. Narcolepsy can usually be controlled with treatment. Treating other underlying sleep disorders can improve symptoms of narcolepsy.



Complications:
  • Injuries and accidents, if attacks occur during activities
  • Impairment of functioning at work
  • Impairment of social activities
  • Side effects of medications used to treat the disorder


Calling your health care provider:

Call your health care provider if symptoms of narcolepsy occur.

Call your health care provider if narcolepsy does not respond to treatment, or if other symptoms develop.



Prevention:

There is no known prevention for narcolepsy. Treatment may reduce the number of attacks. Avoid situations that aggravate the condition if you are prone to attacks of narcolepsy.



References:

Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet. 2007 Feb 10;369(9560):499-511.

Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, Aurora RN, et al. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007 Dec 1;30(12):1705-11.




Review Date: 9/9/2008
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery and Gene Therapeutics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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