Narcolepsy

• Excessive Daytime Sleepiness (EDS)
  All individuals with narcolepsy have EDS which is characterized by persistent sleepiness, regardless of how much sleep an individual gets at night. Theses episodes are characterized by an overwhelming sense of sleepiness that comes on quickly or without warning (“sleep attacks”). People with narcolepsy also suffer from decreased alertness and difficulty concentrating or fully functioning throughout the day.
• Cataplexy
  Cataplexy is the sudden loss of muscle tone while awake. This symptom can cause several physical changes, from slurred speech to complete weakness of most muscles. Cataplexy may last for a few minutes in some patients. Not everyone with narcolepsy experiences cataplexy.
• Sleep paralysis
  The temporary inability to move or speak while falling asleep or upon waking up. Episodes are usually brief, lasting a few seconds to a few minutes.
• Hallucinations
  Vivid images that may occur upon falling asleep or waking.
• Fragmented Sleep and Insomnia
  The inability to have a complete sleep cycle or the inability to fall asleep.
• Automatic Behaviors During Narcolepsy Episodes
  An individual may fall asleep while participating in an activity (talking, eating, etc.) and will continue to perform that task while asleep. They cannot recall their actions, and their performance is almost always impaired.

Diagnosis is made by a combination of clinical examinations, medical history details, sleep journaling, and physical exams. The physical exams include a sleep study or polysomnogram (PSG) and a multiple sleep latency test (MLST). During the PSG the patient is monitored over night and their sleep habits and brain waves are noted. The MLST takes place the next day where the patient is asked to take 5 short naps 2 hours apart. If an individual falls asleep within 8 minutes on average over 5 naps and have REM sleep start within 15 minutes for at least 2 out of the 5 naps, then a positive diagnosis for narcolepsy can be made.

Narcolepsy is a lifelong problem. Symptoms may partially improve over time, but they will never fully disappear. Although there is currently no cure for narcolepsy, some of the symptoms can be treated with medicines and lifestyle changes. Lifestyle changes include taking short naps at times when you feel the most sleepy, maintaining a regular sleep schedule, avoiding caffeine and alcohol before bedtime, avoiding smoking (especially at night), exercising daily, avoiding large meals right before bedtime, and relaxing before bedtime. Medications used to treat excessive daytime sleepiness and sometimes cataplexy include stimulants, CNS depressants, a dopamine and norepinephrine reuptake inhibitor, and a selective histamine H3-receptor antagonist/inverse agonist.