Sleep Related Topics

Sleep and Wellness
Sleep Apnea
Snoring Is Not Funny
Not Enough Sleep
Restless Legs Syndrome (RLS)
What Is Parasomnia?
Sleep and Children
Sleep Hygiene
Sleep Study Procedure (PSG)
CPAP Titration
Actual Sleep Study


This is an interesting disorder that has gone through major changes, especially in the last few years in diagnosing and treating and finding the causation for this illness.  Before recent discoveries many different hypotheses were entertained, and the medical literature is full of these different opinions if somebody would like to spend time searching this entity.

The fact is narcolepsy is a brain disorder.  Around 1999, it was discovered by two different groups that the chemical labeled hypocretin/orexin is not properly and adequately produced from few thousand cells that exist in the posterior part of our hypothalamic region.  Insufficient or lack of this hormone unfortunately can have a disabling effect on the patient.  There are four cardinal symptoms that most of the sleep centers try to look for and ask the patient.

  1. Excessive daytime sleepiness.  This is a common complaint and symptoms can be caused by a variety of different disorders, but in patients with narcolepsy, it has a unique pattern to it.  The patients fall asleep in many undesirable conditions such as during conversation, eating, driving, visiting friends, family, and attending religious ceremonies.  The time from the wakefulness to sleepiness is usually less than five minutes and in most of our patients this phenomenon occurs less than 30 seconds.  The naps that the patient takes during the daytime sleepiness is refreshing and a 15 to 20 minute nap can make the patient functional.  Lack of this diagnosis and proper treatment can have a major effect on a patient’s socioeconomic functions such as loss of job, motor vehicle accidents, and others.
  2. Cataplexy.  This probably is one of the symptoms that we have found the hardest to obtain from the patient.  Cataplexy means loss of muscle tone while the patient is awake.  This can vary from one extreme, which is complete loss of tone or falling to the floor with a brief weakness of the knees, or slight loss of muscle tone in neck muscle.  Most of the patients have adapted to this phenomenon over years and consider this as a normal process and do not easily volunteer this information to their physicians.  A major clue that helps patients to realize this phenomenon in the event of emotional stimulation such as laughter, anger, and surprise.  This process gets triggered and patients may feel that they have lost control of their muscles in some fashion.  Having these symptoms increases the chance of narcolepsy more than 90% on patients.
  3. Sleep paralysis.  Sleep paralysis is a brief period of muscle paralysis when the patient is falling asleep or waking up from the sleep.  This can occur in normal individuals and also can occur in the patients with narcolepsy.  This can be a frightening experience and not everybody with sleep paralysis needs to seek sleep consultation, but if it is associated with other symptoms, sleep consultation is a must.
  4. Hallucinations.  The hallucinations in patients with narcolepsy usually occur when the patient is trying to fall asleep.  The patient can have visual and/or auditory hallucinations.  Most of the patients with this disorder are not forthcoming and disclosing these symptoms in the fear of the stigma attached with a possible mental disorder.  In reality these symptoms have nothing to do with mental illness and it is part of the four major symptoms of narcolepsy.  The patient should feel free to talk about this with a sleep specialist.  In our centers we have seen patients who unfortunately have been diagnosed with mental disorders that latter on turned out to have narcolepsy.  Diagnosis of narcolepsy usually is accomplished by a sleep specialist with a good history taking and sleep study followed with daytime evaluation measuring the patient’s excessive sleepiness, which is called multiple sleep latency test (MSLT).  During this test, every two hours the patients are given 20 minutes to measure their sleepiness.

There are other tips that help in the diagnosis of the narcolepsy and the latest one that is not available in most of the centers is obtaining spinal fluid through a lumbar puncture and measuring the amount of chemical hypocretin/orexin.

There have been major changes in treatment of patients with narcolepsy in the last 10 years and proper diagnosis and treatment will improve the quality of the life and the patient’s productivity.

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