Narcolepsy 1

Running Head: Narcolepsy: Description and treatments

Margarete Chubbuck

June 9, 2011

Narcolepsy: Description and treatments

Psy 381

Narcolepsy 2

According to the DSM, narcolepsy is a sleep disorder defined as a dyssominia where

individuals suffer from repeated sleep attacks in which they are unable to resist falling asleep

at sudden moments of the day. The diagnostic characteristics of this disorder include, “A.

Irresistible attacks of refreshing sleep that occur daily over at least 3 months. B. The presence

of one or both of the following: (1) cataplexy (i.e., brief episodes of sudden bilateral loss of

muscle tone, most often in association with intense emotion) (2) recurrent intrusions of

elements of rapid eye movement (REM) sleep into the transition between sleep and

wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep

paralysis at the beginning or end of sleep episodes” (behavenet.com). Narcoleptic people have

an offset sleep pattern, according to helpguide.org, narcoleptics have unique sleep cycles.

They enter the REM, or dream, phase of sleep right after falling asleep, whereas most people

take about 90 minutes to enter the REM phase. Narcoleptics experience the REM

characteristics of sleep, this duration of sleep includes vivid dreams and muscle paralysis at

the beginning stage whenever a persona falls asleep. The last characteristic of someone with

narcolepsy is if, the sleep attacks are not a cause of medication or any other substance abuse

situation (behavenet.com, Clinical capsule). The characteristic that surprised me while looking

at these criteria was that narcolepsy is associated with intense emotion (i.e. sadness, happiness,

laughter, etc). There are two different types of hallucinations that occur during a sleep attack

and people with narcolepsy experience vivid, frightening, visual or auditory sensations when

falling asleep or waking up from the sleep attack (helpguide.org). Hypnopomic hallucinations

are dream-like hallucinations that are not as vivid as hypnagogic hallucinations which feel

very real and occur at sleep onset, these hallucinations only occur during the REM stage of

sleep (behavenet.com). Narcolepsy is basically a sleep disorder where people fall asleep at any

Narcolepsy 3

moment during the day, usually during a time of intense emotion; the sleep is a restful sleep

and is usually referred to as a “nap”. Sometimes when people have these sleep attacks the

person is still active, according to helpguide.org, this is called micro-sleep and is a very brief

sleep during which people will continue to function in everyday activities and then they will

not be able to recall any of the activities.

The proposed causations of narcolepsy are considered to be chemical imbalances in the

brain that cause people to fall asleep suddenly. People with narcolepsy are lacking in

hypocrtion which is a chemical in the brain that regulates sleep, narcolepsy is a cause of

chemical imbalance in the brain. Hcrt cells are lacking in narcoleptics which inhibits the

ability to fully control alertness and tendency of falling asleep (helpguide.org). There is

currently no cure for this sleep disorder but scientists are still working on a way to manage

narcolepsy. Scientists do believe that this disorder is genetic and maybe that environmental

factors affect the chemicals in the brain, for example a virus that affects the brain functions.

Narcolepsy is a hard disorder to diagnose it can also be easily misdiagnosed because

people wait so long to consult a doctor because they do not think it is a very serious disorder.

Narcolepsy doesn’t pertain to a certain ethnic group or sex, it is a chemical imbalance in the

brain, and/or genetic. This disorder is diagnosed in about 1 out of every 2000 Americans but

because this disorder is so hard to diagnose there might be a larger population of people with

narcolepsy that isn’t recorded. There are not very many symptoms of narcolepsy; sometimes

the only symptom is excessive daytime sleepiness, which is a symptom that can be included in

other disorders. “Additionally, narcolepsy symptoms are often falsely attributed to other sleep

disorders or medical conditions (such as depression or epilepsy)” (helpguide.org), the only

unique symptom of narcolepsy is cataplexy which affects muscle functioning. People live with

Narcolepsy 4

this disorder for decades before consulting a doctor because there is only one unique symptom

in narcolepsy. In order to diagnose narcolepsy the patient has to give the doctor his/her

symptoms and then test are conducted to see if the disorder is truly narcolepsy. According to

helpguide.org the four tests that are conducted are, “Epworth Sleepiness Scale, which is a

general sleep questionnaire, nocturnal polysomnogram, overnight test that measures the

electrical activity of your brain and heart, and the movement of your muscles and eyes,

multiple sleep latency test (MSLT), a test measures how long it takes for you to fall asleep

during the day, and spinal fluid analysis which analyzes the lack of hypocretin in the

cerebrospinal fluid may be a marker for narcolepsy”. A new way to test for narcolepsy is

examining the spinal fluid of the patient. There are plenty of different tests to run to analyze

someone who thinks they might have narcolepsy, but since there is only one unique

characteristic of this disorder it is very difficult for an individual to even come to the

conclusion that they might have the disorder and consult a doctor for further testing of the

disorder.

Because there is no cure for narcolepsy there are combinations of treatments that can

control the symptoms of this disorder. To treat narcolepsy attacks combinations of counseling,

medication, and behavioral changes have to take place (helpguide.org), some behaviors that

can be changed might be eating habits and getting patients on a special diet to possibly

balance out the chemical imbalance in the brain. Another possible behavior change that could

be considered might be to change your environment and surround yourself with more peaceful

settings during the day so your emotions don’t get so high and erratic, this might establish a

sense of control for your brain.

Narcolepsy 5

Recent studies show that even when narcolepsy is treated there is still no cure for the

disorder, when given medications patients sleep tendency improved. In a recent study 18

narcolepsy patients were given sodium oxybate, “The following significant effects were

observed: improved subjective sleepiness (12/13), cataplexy (13/13; median number of attacks

from 20 to 1/month), hallucinations (8/10) and sleep paralysis (8/8); increase in mean sleep

latency on the Maintenance of Wakefulness Test (from 5.5 to 17.4 min) and sleep/rest

efficiency on actigraphy (from 61 to 76%); decrease in Epworth Sleepiness Scale score (from

18 to 14), sleep onset REM periods on the Multiple Sleep Latency Test (from 3.6 to 2.4) and

errors in the Steer-Clear Test (from 11 to 2%). Five patients discontinued SO because of

insufficient compliance (n = 2), lack of efficiency (n = 1) and side effects (n = 1)” (Poryazova,

2011). This study shows that patients that were given medication for narcolepsy had improved

sleep habits and were maintaining positive sleep habits.

Because narcolepsy does not occur in a specific culture or ethnic group there is no way

to mistake it when looking for it cross-culturally , if the patients have the symptoms of this

disorder this might be a good sign that they have narcolepsy.

While conducting my research on narcolepsy I have come to the conclusion that this

disorder is in fact genetic and could be cause from a chemical imbalance in the brain, a way

that this imbalance could be triggered is by environmental factors such as a virus that can

disturb the chemicals in the brain and affect sleep habits. There is no cure for narcolepsy but it

can be maintained by the use of medication, counseling, and behavioral changes that can put

sleep patterns back on the right track. Changes in environment can also help control

narcoleptic tendencies by putting these people in environments that help the brain stay focused

and try to regain the chemical that is lacking. This disorder is very hard to diagnose and the

Narcolepsy 6

only way doctors will know if a patient has this disorder is if the patient brings out the

symptoms in discussion, the only unique characteristic of narcolepsy is cataplexy and occurs

in about 70 percent of patients, this is when muscles freeze up and it is almost like a

paralyzing experience.

Narcolepsy 7

References:

http://www.behavenet.com Clinical capsule. DSM-IV-TR, Narcolepsy criteria. Retrieved June

9, 2011.

http://www.helpguide.org/life/narcolepsy_symptom_causes_treatments.htm Narcolepsy:Narcoleptic symptoms, causes, treatment, and medication. Retrieved June 2, 2011.

Poryazova, R. Tartarotti, S. Khatami, R. Baumann, C. R. Valko, P. Kallweit, U. Werth, E. Bassetti, C. L. Sodium Oxybate in Narcolepsy with Cataplexy: Zurich Sleep Center Experience. Retrieved from, European Neurology, 2011, Vol. 65 Issue 3, p175-182.

Narcolepsy 8