The most life-threatening aspect that faces Narcoleptic patients is the symptom of Sleep Apnea – or in other words, the partial or total stoppage of breathing during sleep. Although Sleep Apnea can be divided into three categories, the one that is most commonly found is Obstructive Sleep Apnea (OSA). The other two being Central Sleep Apnea (CSA) and Mixed Sleep Apnea (a combination of both CSA and OSA).
While we sleep, a number of complicated activities go on in our brain well beyond our knowledge. While we rest, our brain does not. it keeps on sending vital signals to the muscles of our lungs instructing them to continue breathing. Central Sleep Apnea occurs when the brain stops sending those signals, thereby stopping the efforts of the muscles to take the breath. In the case of Obstructive Sleep Apnea, the brain sends the signal and the muscles receive it and try to take the breath accordingly. However, they cannot do so, as the airway gets obstructed somehow and thus hinders a steady flow of air. In the case of Mixed Sleep Apnea, it’s the combination of the two symptoms that results in the breathlessness during sleep. If the period of breathlessness lasts for more than 10 seconds, then it can be regarded as a case of Sleep Apnea.
It is noticed that the phenomenon of Sleep Apnea is generally much more common in adults than in children. This is because of the fact that in children and infant, sleep apnea is countered by an apnea alarm within the child, which awakens the child as well as their parents.
However, in the case of Narcoleptic patients, the chance of Sleep Apnea is higher than in normal people, as Narcolepsy is itself a disease that disturbs the sleeping pattern and shatters the neurological order of the patient. Naturally, a Narcoleptic patient becomes more prone to Sleep Apnea than those without the condition. In case of a healthy person, the brain can calculate whether there is excessive of carbon dioxide and a dearth of oxygen in body. Accordingly, it instructs the lungs to increase or decrease the rate of respiration. However, in case of a Narcoleptic patient, who has an already shattered nervous system there is high chance that the brain fails to do this calculation in a proper way, resulting in Sleep Apnea more frequently than in those who do not have Narcolepsy.
The repeated occurrence of Sleep Apnea every night puts increased pressure on the heart, thereby weakening it significantly. In case of a Narcoleptic patient, the pressure created on heart is almost double because of his disturbed sleeping pattern and weak nervous system. Even in normal person this extra pressure in heart will ultimately result in higher blood pressure within 4 years of the occurrence.
With Narcoleptic patients, Sleep Apnea causes acute Atrial fibrillation. It is a condition where the atrium of the heart is not in sync with the ventricle, or in other words there is no coordination between the two parts of the heart. This may result in a heart failure, commonly termed as stroke. It is also seen that all these abnormal developments can cause sudden death of the patient in their sleep, although this is not common.
Means to Diagnose:
There are mainly two methods of diagnosing Sleep Apnea. One is the Subjective method and the other is the Objective method. The Sleep Apnea can be measured in a very widely used method called – Epworth Sleepiness Scale. The patient himself can measure his intention to fall asleep on a scale of 0 to 3 and submit it to his doctor. The doctor will take action depending on the outcome of this report taking into account the various other symptoms of the patient such as:
- Sleepiness during daytime
- Performance graph since the bout of the disease
- History of accidents while driving
- Instances and frequency of falling asleep while in a meeting
- Memory loss
Another way of diagnosing Sleep apnea is Polysomnography, which is nothing more than a simple sleep study. It involves various psychological and physical parameters of a patient during his sleep. The following factors are measures during the patient’s sleep:
- Measuring the Brain wave by EEG (Electroencephalogram)
- Monitoring Eve movements by EOG (Electro-oculogram)
- Monitoring the muscular activities by EMG (Electromyogram)
- Monitoring airflow through nose and mouth
- Monitoring the movement of chest and abdomen
- Check whether the patient is snoring and if so, audio-recording the loudness of snoring
- Measurement of Oxygen level in blood
Multiple Sleep Latency Test (MSLT) is another very common way of diagnosing Sleep Apnea in a patient. Basically, this method is studying and measuring how rapidly the patient is falling asleep in a day.
The Maintenance of Wakefulness Test is another way to measure sleepiness during daytime. However, in this test, the patient is told to put extra effort to stay away during the day and this is practiced in four sessions of forty minutes each, at a 2 hour interval.
Depending upon the outcome of the above tests, patients can undergo various types of surgery, such as implantation of palates, surgery in their nose to remove any obstruction, uvulopalatopharyngoplasty, surgery to reduce the tongue, and bariatric surgery.
However, for the patients of Narcolepsy, it is advisable to opt for non-surgical methods like behavior therapy, continuous and thorough medication and different types of mental and physical exercises and usage of mask and dental appliances.
The latest medical research shows that among the patients suffering from various types of Sleep Apnea, the majority are patients with Narcolepsy. While more and more people are falling prey to Sleep Apnea, very few (almost 10%) are taking up a thorough treatment. The rest is reluctant to go to a doctor even though they are aware of the difficulty they have. This is probably out of the embarrassment that is associated with the condition. This is doing no good to those with the condition, though, and this mentality can compel them to go into social isolation and ultimately to a slow but steady health decline. Hence, it is advisable to approach a physician and take the necessary remedial measures to help regulate the condition and its symptoms.