Narcolepsy, when sleep is a curse.

Imagine that you wake up and find yourself asleep at school, work, or even while driving, even though you had enough sleep at night and had a nap during the day, and it is repeated when you wake up and feel very drowsy and unable to resist your desire to sleep. In this case, you most likely suffer from Narcolepsy.

What is Narcolepsy?

Narcolepsy is a rare chronic brain disorder. It is characterized by excessive sleepiness during the day and in places that are not suitable for sleeping, like at work or while driving, despite getting enough sleep during the night.¹

When do symptoms appear?

Narcolepsy is a disease that affects all ages in both sexes, especially young people between the ages of 15 and 25. Its symptoms usually begin in the early teenage years. Its prevalence varies between geographical regions, as it affects the Japanese more often, whereas it spreads at smaller rates in the United States and Europe at a rate of 1 out of 2,000 people.²

What causes narcolepsy?

The exact causes of the problem have not been precisely determined yet, but there are several factors contributing to its cause, of which are:

1. Selective loss of neurons containing the neurotransmitter orexin (Hypocretin) in the lateral hypothalamus which is attributable to an immunological cause. Orexin is a neurotransmitter that regulates sleep and body balance, as well as emotions and behavior. It is also a stimulant of serotonin and dopamine. When this neurotransmitter is lost, a defect in the regulation of sleep and wakefulness occurs, and the person becomes drowsy and numb.⁴
2. Hormonal changes that occur during puberty, menopause, or due to psychological stress.¹
3. Head injuries or strokes.¹

Symptoms of Narcolepsy

1. Sudden paralysis during wakefulness, in which sudden weakness or paralysis occurs in muscles such as the neck or lower jaw.
   These reasons make speech unclear and may cause the patient to fall to the ground as if they’re unconscious, but in reality, they are fully conscious. This condition is called “cataplexy”. Temporary loss of muscle control in response to positive emotions, such as laughter or meeting an unexpected friend, or negative emotions such as anger.
2. Sleep paralysis: a temporary inability to move or speak when waking up or falling asleep.¹
3. Rapid eye movement (REM) Sleep Behavior Disorder: it is a disorder in which unpleasant dreams are accompanied by involuntary movements such as loud sounds and violent movements of the arms and legs.⁴
4. In children, it may be accompanied by a sudden increase in weight of 5 to 15  kilograms in just a few months.²

Patients also feel rested when waking up or when taking a nap, but after a few hours, they begin to feel drowsy, like how a healthy person feels if they stayed up all night.

What is the pharmacological and non-pharmacological treatment?

So far, there is no definitive treatment for this disease, and the currently available treatment methods are not fully effective for all symptoms. Physiotherapy usually begins when the patient is between 10 and 20 years old. For pharmacological treatment, neither the European Medical Agency nor FDA approved a large number of drugs used for treating this disorder. The use of these drugs is limited to the recommendations of experts; among these drugs are Modafinil – Armodafinil – Pitolisant.

For Non-pharmacological treatment: Behavioral therapies play an essential role in managing and controlling the disorder. Emotional support also plays an important role in improving the patient’s condition.³

If you have Narcolepsy symptoms or you notice them in someone you know, do not hesitate to make them aware of the need to visit the doctor. And if you notice that one of your relatives is suffering from it, do not hesitate to provide them with psychological and emotional support, as it can be a reason to improve their condition.

Also read:

• Interstitial Cystitis (IC)
• Polycystic Ovary Syndrome (PCOS)

References:

[1] MOH

[2] Pubmed

[3] Springer

[4] Statpearls