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September 26, 2016 | Internal Medicine
It’s easy to blame exhaustion for your constant nodding off in the middle of conversations or important meetings. Your job’s stressful, and your inability to get a good night’s sleep is wreaking havoc on your energy levels and attention span. But what if something else is to blame for your overwhelming drowsiness during the days?
One in 3,000 Americans experience a condition called narcolepsy. This chronic brain disorder is characterized by irregular sleep-wake cycles and uncontrollable sleep episodes that come on suddenly and last a few seconds to several minutes.
Symptoms typically first appear between the ages of 7 and 25, but narcolepsy sometimes presents later in life. This “underrecognized and underdiagnosed condition” is not rare, but it is life-long. Although there is currently no cure, narcolepsy is treatable and won’t stop you from living a happy, productive life.
Most people with narcolepsy experience excessive daytime sleepiness, or EDS. This is unrelated to how much sleep they got the night before and creates a severe lack of energy and mental fogginess that interferes with normal functioning. Some people feel depressed, and others experience memory lapses or inability to concentrate.
Approximately 70 percent of people with narcolepsy experience cataplexy – a sudden, partial or total loss of muscle control. This is often triggered by a strong emotion such as laughter, fear, excitement, stress or anger.
A cataplectic attack can be a mild, barely perceptible moment of weakness such as the drooping of the eyelids or a slack jaw. A severe episode might involve extreme and complete loss of muscle tone in the arms and legs that results in a total collapse. But unlike seizure disorders, the individual is fully conscious, even during the most severe cataplectic episodes.
Less commonly, people with narcolepsy can also experience hallucinations and paralysis as they are falling asleep or waking up. Many suffer from disrupted nighttime sleep and vivid nightmares.
During narcolepsy’s involuntary and very brief “sleep attacks”, as many as 40 percent of people will continue to perform automatic behaviors such as driving or typing without interruption, although performance is impaired. In fact, “people with untreated narcoleptic symptoms are involved in automobile accidents roughly 10 times more frequently than the general population.” When they awake from these micro-sleeps, people feel refreshed for a short while until the drowsiness and fatigue return.
As many as 10 percent of individuals diagnosed with narcolepsy with cataplexy have a close relative with the same symptoms, but most cases occur in individuals with no known family history of the condition.
Researchers believe that low levels of the neurotransmitter hypocretin are often to blame. This chemical agent promotes wakefulness. In people who are lacking a sufficient number of brain cells that produce hypocretin, the cause is believed to be autoimmune in nature. “That is, the body’s immune system selectively attacks hypocretin-containing brain cells,” explains the National Institute of Neurological Disorders and Stroke.
Stress, infections, exposure to toxins and the hormonal changes experienced in puberty and menopause may play a part in contributing to the development of narcolepsy. In rare cases, traumatic injuries or tumors may be affecting the regions of the brain responsible for REM sleep.
Your internist will run a battery of specialized tests, often performed in a sleep disorders clinic, to make an official diagnosis. Although there is no cure for narcolepsy, EDS and cataplexy can be controlled in most individuals with drug therapy combined with behavioral changes.
Lifestyle modifications known to help manage narcolepsy include:
If you’re concerned about persistent daytime drowsiness that you or a loved one is experiencing, Revere Health’s Internal Medicine specialists provide health management counseling and care for a variety of diseases and conditions, including sleep disorders such as narcolepsy. We have 30 providers in four Utah locations to serve your needs.
The Live Better Team
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.