Narcolepsy

What is narcolepsy?

Narcolepsy is a neurological disorder that affects the brain’s ability to regulate your sleeping and waking cycles. The condition is somewhat rare -- affecting an estimated 200,000 or so people in the U.S . Narcolepsy can happen at any point during your life, but most often, the first signs and symptoms show up in childhood, adolescence or young adulthood. There are two basic types of narcolepsy:

• Type 1 narcolepsy: People with this type of narcolepsy also suffer from cataplexy . A person with this condition experiences partial or total loss of muscle control often brought on by a strong emotional reaction (like laughter, fear, stress or anger).
• Type 2 narcolepsy: This less severe version of the condition does not include cataplexy.

What are the symptoms of narcolepsy?

The number one symptom for people with either type of narcolepsy is excessive daytime sleepiness. You may feel exceptionally sleepy regardless of how much sleep you got during the night. This can lead to an overwhelming desire to sleep, and sometimes cause you to involuntarily fall asleep while doing everyday activities like eating, talking or driving. Other symptoms of narcolepsy include:

• Cataplexy: People with Type 1 narcolepsy will experience sudden bouts of muscle weakness called cataplexy. It can be mild -- causing only one symptom, such as a momentarily droopy eyelid -- or, in more severe cases, a person may lose all muscle control and fully collapse. Cataplexy is often mistaken for a seizure, but unlike seizure, there is no loss of consciousness.
• Sleep paralysis: It’s not uncommon for people with narcolepsy to be temporarily unable to move or speak while falling asleep or waking up.
• Hallucinations: People with narcolepsy may have dream-like hallucinations (seeing or hearing things that aren’t real) during periods of sleep paralysis.
• Disrupted sleep: People with narcolepsy often have vivid dreams, involuntary leg movements, acting out dreams and other issues that prevent them from getting a full and restful night’s sleep.
• Insomnia: Despite excessive tiredness during the day, people with narcolepsy often have difficulty falling asleep at night.

What causes narcolepsy?

The causes of narcolepsy aren’t completely understood. It most likely has to do with a lack of the brain chemical (hypocretin) that controls sleep/wake schedules and regulates REM sleep (the period of sleep when dreams usually occur). People with type 1 narcolepsy (with cataplexy) have very low levels of hypocretin.

How is narcolepsy diagnosed?

In addition to performing an exam and taking a complete health history, your doctor will likely recommend one or both of the following tests in order to make a definitive diagnosis of narcolepsy.

• Sleep lab study: For this test, you will spend the night at one of our sleep lab locations . Our technicians will connect you to devices that measure your breathing, brain and muscle activity and eye movements. This test can help determine how quickly you enter into REM sleep. People with narcolepsy go into the REM stage much faster than others.
• Multiple sleep latency test (MSLT): This is also known as a “nap test” because it is done to measure daytime sleepiness, ability to fall asleep and how quickly you enter into REM sleep. This test can also be performed in one of the Henry Ford sleep labs.

How is narcolepsy treated?

There is currently no cure for narcolepsy, but at Henry Ford Sleep Disorders and Research Center, our doctors will work with you to find the most effective treatments. The right treatment can help reduce daytime sleepiness and cataplexy and improve your overall quality of life. Possible treatment options include:

Medications

• Modafinil: This central nervous system stimulant is less addictive than other stimulants and can help minimize daytime sleepiness.
• Amphetamines: These can also be used to minimize sleepiness and improve alertness. But they should be taken cautiously because of side effects (like irritability and heart rhythm disturbances) and the potential for addiction or abuse.
• Sodium oxybate: This strong sedative is taken at night to improve overnight sleep and help reduce daytime sleepiness and cataplexy.
• Antidepressants: Some antidepressant medications can help reduce cataplexy.

Lifestyle changes

• Napping: Try to schedule short naps during the day at times when sleepiness tends to peak.
• Sticking to a regular sleep schedule: Keeping consistent bed times and wake-up times will help you sleep better.
• Getting daily exercise: Being physically active gives you more energy during the day and helps you sleep better at night.
• Avoid alcohol before bed: Drinking can increase nighttime sleep disruptions.
• Avoid heavy, high carbohydrate meals: Eating a big meal that’s high in carbohydrates can exacerbate daytime sleepiness and disrupt nighttime sleep.