Most often the person with narcolepsy is the first one in his family with the diagnosis. Up to 10% of people with narcolepsy, though, report having a close relative with the disease. Narcolepsy does not seem to be an inherited genetic disorder. What causes narcolepsy is not known.
Symptoms
The main symptoms of narcolepsy are:- Excessive daytime sleepiness – extreme exhaustion, persistent drowsiness, difficulty staying awake
- Falling asleep during the day – people with narcolepsy involuntarily fall asleep, even while doing something like talking, eating, working, or while in school. These uncontrollable “sleep attacks” can last a few seconds or several minutes.
- Cataplexy – a sudden loss of voluntary muscle control, usually triggered by sudden, strong emotions such as fear, anger, stress, or laughter. Cataplexy may appear as only a slight passing weakness, or it may be so severe that the person falls to the floor and is unable to speak, move, or keep his eyes open.
- Hallucinations – seeing a vivid, often frightening, dream may occur during falling asleep or waking up
- Sleep paralysis – a temporary inability to move or speak while falling asleep or waking up
- Automatic behavior – a person may be doing something, like writing a letter, when a sleep attack occurs. He will continue writing the letter, but not be aware of it, have no memory of it later, and his handwriting will become just a scrawl.
- Disrupted nighttime sleep
Diagnosis
Although narcolepsy can begin at any age, symptoms most often appear between the ages of 10 to 25. For some individuals, symptoms don’t appear until between ages 35 to 45, and still others don’t have symptoms until after age 50. It often takes a long time for a person to be diagnosed with narcolepsy because daytime sleepiness can result from a wide range of medical conditions, various medications, and simple lack of sleep. Cataplexy may be mistaken for seizures. Therefore, a complete physical examination and an exhaustive medical history are essential to the diagnosis.In addition, two tests are helpful in diagnosing narcolepsy. The polysomnogram (sleep study) is an overnight test that is done at a sleep disorders center. It can help eliminate other causes of the individual’s symptoms. The second test is a multiple sleep latency test (MSLT). The MSLT is performed during the day to measure a person’s tendency to fall asleep. People with narcolepsy fall asleep much faster than normal.
Treatment
Excessive daytime sleepiness and cataplexy can be controlled with medications. Provigil (modafinil) controls sleepiness. Two groups of antidepressant medications -- tricyclic antidepressants (TCAs) such as imipramine and desipramine, and serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline) -- are helpful in controlling cataplexy. Xyrem (sodium oxybate or gamma hydroxybutyrate) helps control both sleepiness and cataplexy. Due to safety concerns, the distribution of Xyrem is tightly controlled.In addition to medications, people with narcolepsy find taking 2 or 3 scheduled short naps during the day and improving their sleep at night helps reduce daytime sleepiness. Safety precautions are important because sleep attacks can occur at any time. Participating in a narcolepsy support group is also important because sleep attacks and cataplexy in public are not only embarrassing to some, but they may cause problems with work or school. The empathy and understanding that a support group provides is essential to helping the person with narcolepsy cope with his illness. Although narcolepsy is a difficult disease, it does not shorten a person’s life span.
Sources:
"Narcolepsy Fact Sheet." Disorders A - Z. 04 Mar 2009. National Institute of Neurological Disorders and Stroke. 8 May 2009.
"FAQ." Narcolepsy Network. 8 May 2009.
