Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your daily routine.

Narcolepsy is a chronic condition for which there's no cure. However, medications and lifestyle changes can help you manage the symptoms.

Symptoms

• Excessive daytime sleepiness- People with narcolepsy fall asleep without warning, anywhere, anytime.
• Sudden loss of muscle tone- This condition, called cataplexy, can cause a number of physical changes, from slurred speech to complete weakness of most muscles, and may last for a few seconds to a few minutes.
• Sleep paralysis- People with narcolepsy often experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief — lasting one or two minutes — but can be frightening.
• Hallucination- These hallucinations are called hypnagogic hallucinations if occurring as you fall asleep and hypnopompic hallucinations if occurring upon waking.

Diagnosis

Your doctor may make a preliminary diagnosis of narcolepsy based on your excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). After an initial diagnosis, your doctor may refer you to a sleep specialist for more evaluation.

Formal diagnosis may require staying overnight at a sleep center, like the Torrance Memorial Sleep Disorders Center, where you undergo an in-depth analysis of your sleep by a team of specialists.

Treatment

There is no cure for narcolepsy, but medications and lifestyle modifications can help you manage the symptoms.

Medication

Medications for narcolepsy include:

• Stimulants- Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day.
• Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)- Doctors often prescribe these medications, which suppress REM (rapid eye movement)sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis.
• Tricyclic antidepressants- These older antidepressants are effective for cataplexy
• Sodium oxybate (Xyrem)- This medication is highly effective for cataplexy. Sodium oxybate helps to improve nighttime sleep, which is often poor in narcolepsy. In high doses it may also help control daytime sleepiness. It must be taken in two doses, one at bedtime and one up to four hours later.

Lifestyle Modifications

Lifestyle modifications are important in managing the symptoms of narcolepsy. You may benefit from these steps:

• Stick to a schedule- Go to sleep and wake up at the same time every day, including weekends.
• Take naps- Schedule short naps at regular intervals during the day. Naps of 20 minutes at strategic times during the day may be refreshing and reduce sleepiness for one to three hours. Some people may need longer naps.
• Avoid nicotine and alcohol- Using these substances, especially at night, can worsen your signs and symptoms.
• Get regular exercise- Moderate, regular exercise at least four to five hours before bedtime may help you feel more awake during the day and sleep better at night.