Sleep is closely regulated by the brain. Narcolepsy is a disorder of the nerves in which the brain is not able to regulate the sleep cycle. In essence, the body does not know when to sleep or wake up. The two main characteristics of narcolepsy are extreme daytime sleepiness and cataplexy or lose of muscle tone.
To understand narcolepsy, it is important to understand the cycle of normal sleep. The first stage of sleep is light and progressively gets deeper with time. The two stages of sleep, light and deep, are also referred to as Non Rapid Eye Movement (non-REM) and REM.
After sleeping for about 2 hours the brain enters the REM stage which is the zone where dreams occur. In normal sleep, a person alternates between the non-REM and REM zones throughout the night. Please note the normal sleep starts in non-REM.
In narcolepsy, the person almost immediately goes to the REM; the non-REM stage is too short or non existent. In essence, they dream immediately after sleep. Muscles and other parts of the body in REM (dreams) are either paralyzed or under complete control of the dream. This explains why the person with narcolepsy loses muscle control and often hallucinates.
Contrary to popular belief, a person with narcolepsy does not sleep more normal people. The person sleeps the normal 6 to 8 hours. However, they are not able to control when to sleep or not sleep.
Narcolepsy does not discriminate between the two genders. The first sign of narcolepsy is usually seen in the early decade of life but remain hidden until they are fully developed. Typically, many people who have narcolepsy are diagnosed late.
Narcolepsy does not have a known cause. However, there are genes that shared by all narcoleptics. They have defectes in the gene that releases chemical that control the sleep-wake cycle. Studies have also shown a strong association between narcolepsy and deficiency of the chemical hypocretin. It is also possibly caused by defects in the part of the brain that controls REM sleep.
The Tetrad Symptoms of Narcolepsy
There are four main symptoms that are seen in all narcolepsy patients:
- Excessive Daytime sleepiness: it can be so severe and sudden the person sleeps when eating, driving, or when talking to a friend.
- Cataplexy: loss of muscle tone and is initiated by strong emotions such as laughing, anger or happiness in dream.
- Hallucinations: just before sleeping they hallucinate about thing or events that are around them.
- Sleep paralysis: inability to move or speak just before sleeping or after waking up.
Seeing that narcolepsycauses excessive daytime sleepiness, any events or factors that could lead to sleep should be avoided. These include taking heavy meals and drinking alcohol. Person with narcolepsy can easily be depressed because this condition is not understood by many people. In fact, some people may refer to it as laziness. As such, narcoleptic have a higher than normal chances of being depressed. Therefore, counseling is very important these people.
Medically the condition is treated with stimulants to increase alertness. Most of the tetrad symptoms are cleared by using antidepressants. Daytime sleepiness is treated using sodium oxybate which induces deep sleep such that the patient does not feel drowsy during the day