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  Narcolepsy

Narcolepsy is extreme day time sleepiness, even after a normal night’s sleep. EDS, or Excessive Daytime Sleepiness is when a person is drowsy and falls asleep without warning. These periods of sleeping happen several times a day, for various lengths of time. Nighttime sleep may be normal or with restless periods of awakening.

Narcolepsy
Narcolepsy


A typical sleeper experiences phases of sleep that begin with NREM (non-rapid eye-movement) where no dreaming occurs and leads to REM sleep, in which most of remembered dreaming may occur. The brain of a person with narcolepsy slips right into REM sleep without the usual phase of NREM sleep. The side effects are that nighttime sleep does not include much deep restful sleep, so the brain tries to make up during the day time – causing EDS – Excessive Daytime Sleepiness. Narcolepsy patients quickly fall into a deep sleep with or without warning. Narcolepsy patients wake up and are disoriented, having experienced vivid dreams – which can occur even when they are asleep for only a matter of seconds.

Symptoms:
There are four standard symptoms of narcolepsy with may or may not occur in all patients:

Hypnagogic Hallucinations: Hypnagogic is the state of drowsiness immediately before sleep. Vivid, frightening dreamlike hallucinations occur during this stage.

Automatic behavior: This is sleepwalking. A person will continue to function normally, though actually they are asleep. Activities, such as talking, walking, performing housework will occur with no recollection. This behavior occurs in 40% of narcoleptic patients.

Sleep paralysis: This is a temporary inability to move or talk when waking up. It is scary, but not dangerous and may last up to a few minutes.

Cataplexy: This is a sudden los of muscle function. Cataplexy episodes may last from a few seconds to several minutes and the patient remains conscious throughout the episode. The loss of muscle function may include sagging facial muscles, a slight weakness in the neck or knees or a complete body collapse similar to fainting. Cataplexy episodes might be triggered by sudden emotional responses such as laughter, surprise, fear or anger.

Causes:

There is no known cause of narcolepsy. There are conditions that indicate an increased risk of having narcolepsy.

One strong genetic link has been found in an area of Chromosome 6 that is known as the HLA complex. Certain variations of the HLA complex have been observed in patients with narcolepsy, though having the variation does not mean that a person will have narcolepsy.

The variations in the HLA complex are believed to increase the auto-immune response to neurons in the brain, which produce proteins called hypocretin and orexin. These proteins control appetite and sleep patterns. Individuals with narcolepsy have a decreased number of these protein producing neurons in their brains.

The relationship of narcolepsy to the neural control of normal sleep is not completely understood. Though evidence of variations of HLA complex has been noted, inheritance factors have remained undiscovered.

Population:
Estimates of narcolepsy in the general population are as follows:

Worldwide: as many as three million people

United States: as many as two hundred thousand, though less than fifty thousand are diagnosed. It has been estimated to be 1 in 1,000.

Narcolepsy shares the same prevalence as Multiple Sclerosis and Parkinson’s disease, but is often mistaken for depression, epilepsy or medication side effects.

Narcolepsy occurs in men and women, with symptoms first occurring during adolescents. Eight to twelve percent of people with narcolepsy also have a close relative with narcolepsy – indicating some possibility of inheritance. Narcolepsy in susceptible teenagers is a complicated because normal teenagers already experience excessive daytime sleepiness due to increased educational and social pressures. The average of time between onset and diagnosis is 15 years. Excessive daytime sleepiness from narcolepsy causes cognitive, educational, social, psychological and occupational complications. Cognitive impairment may be only an impression due to the excessive daytime sleeping.

Narcolepsy is more common in men than women. There is are limited treatment options. The severity of narcolepsy varies from slightly noticeable to debilitating leading it to be under diagnosed.

Diagnosis
When the four standard symptoms of Narcolepsy (Cataplexy, automatic behavior, hypnagogic hallucinations, and sleep paralysis) are present, diagnosis is uncomplicated. Diagnosis is more difficult when only a few of the symptoms are present or sudden sleep episodes are rare.

There are two tests used to diagnose narcolepsy. They are the polysomnogram and the multiple sleep latency test. The tests are performed at a sleep center by a sleep specialist. Most major medical centers have sleep centers. Individuals with narcolepsy will enter REM sleep early an awake often during the night. A polysomnogram is a continuous recording of brain waves during sleep, including various muscle and nerve functions.

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