Challenges and Practices in Narcolepsy Diagnosis

December 5, 2011 By Leave a Comment

Even though disease, Narcolepsy can be identified positively through physical observation, physicians are still misdiagnosing patients. Misdiagnosis happens especially when dealing with those that have psychological problems.  Clinical evidence suggest that tests on a patient’s cerebrospinal fluids (CSF) can nearly confirm Narcolepsy, as 90% of Narcoleptics tested in studies have shown to have no hypocretin-1 in their CSF.

Often doctors will rely on symptom reporting by patients, questionnaires, testing sleep latencies in patients, and monitoring a patient as he/she sleeps and may not test the patient’s CSF before starting therapy.  Doctors can however be firm in their diagnosis by observing the presence of nearly all Narcolepsy symptoms together in a patient.  The confirmation of cataplexy, for example confirms a patient has Narcolepsy, as it is unique to Narcolepsy.

Diagnosis and treatment of Narcolepsy is somewhat standardized but methods and drugs vary from patient to patient most of the time.  Upon diagnosis doctors usually choose to prescribe two frontline medications (modafinil, sodium oxybate).  Both of these drugs are habit forming and sodium oxybate can be very dangerous.  For this reason the process of diagnosis may take some time because the doctor wants to be sure of his diagnosis before prescribing it.

Most patients do not receive their Narcolepsy diagnosis until ten to fifteen years after the first symptoms start appearing. For a doctor to make a correct narcolepsy diagnosis they must take into consideration the patient’s family and medical history. This includes the medications the patient is taking and any even what the person eats regularly. Diagnosing narcolepsy becomes easy when the patient exhibits all major narcolepsy symptoms listed below:

  1. Excessive daytime sleepiness (EDS) and an urge to take frequent naps during the day. These daytime naps must happen every day for six months at least in order for it to be considered as solid basis for narcolepsy diagnosis. Diagnosing narcolepsy is common in young adults and adolescents; bringing the problem to their attention when they suddenly fall asleep at school or at work. Sometimes, patients also experience insomnia but the majority of time a narcoleptic will have no issue falling asleep and entering almost directly into REM sleep.

  2. Cataplexy or sudden muscle weakness and loss of muscle control and tone, causing the patient to stop motor activity.

  3. Visual or auditory hypnagogic hallucinations that occur right before falling asleep.

  4. The inability to move upon awakening, or sleep paralysis.

However, narcolepsy diagnosis that’s based solely on symptoms can be problematic for several reasons. One reason is that some patients that receive a Narcolepsy diagnosis often seek medical advice for just one symptom (frequently hypnagogic hallucinations or sleep paralysis) which could be caused by other similar disorders; epilepsy in particular. Another reason for the difficulty in the diagnosis of narcolepsy is that the symptoms do not always become apparent to anyone for several years. This is true for the patient himself and even to a skilled observer. In certain cases, a patient is required to consult specialists in the field, or get treated and monitored at a sleep disorder clinic for a more effective treatment for Narcolepsy and to confirm that a patient does indeed have Narcolepsy.

Questionnaires for Diagnosing Narcolepsy

The Epworth Sleepiness Scale is one of the questionnaires for sleeping habits that a doctor can administer to get a more reliable narcolepsy diagnosis. The ESS makes use of simple questions in measuring excessive sleepiness; differentiating it from the normal sleepiness we usually feel in the daytime. See figure 02-01a for the test.

Figure 02-01a: The Epworth Sleepiness Scale

*Note this test varies slightly with different results analysis.

  

Situations

 Chance of Dozing0-none1-slight chance2-moderate chance3-high chance
Sitting and reading Indicate score (0-3)
Sitting inactively in public places Indicate score (0-3)
As a car passenger for one whole hour without any breaks Indicate score (0-3)
Watching television Indicate score (0-3)
Sitting and talking to someone Indicate score (0-3)
Sitting quietly after lunch (without alcohol) Indicate score (0-3)
In a car stuck for a few minutes in traffic Indicate score (0-3)
Lying down for an afternoon rest when circumstances allow Indicate score (0-3)
Show Results 1 – 6: Getting enough sleep7 – 8: Tends to be sleepy but is average9 – 15: Very sleepy and must seek medical adviceOver 16: Dangerously sleepy

Multiple Sleep Latency Tests

MSLT or multiple sleep latency tests can also help in making an accurate Narcolepsy diagnosis. The MSLT makes use of a device that can measure the time a patient takes to fall completely asleep during the day while lying inside a quiet room. Patients are asked to take 4-5 scheduled naps that are 2 hours apart. People with healthy sleeping habits usually fall asleep in 10-20 minutes. However, patients with a diagnosis of Narcolepsy show a significantly shorter time duration; approximately less than eight minutes, when moving from wakefulness to sleep. At least two of these naps are REM sleeps; the sleep state associated with dreaming. Still, the test has its limitations. There is no clear definition which abnormal results are proven to be basis for diagnosing narcolepsy. The Epworth Sleepiness Scale might be more precise in identifying narcolepsy from regular daytime sleepiness.

Polysomnography

Polysomnography is a study of an overnight sleep that can prove valuable in determining the major cause of sleepiness. A patient, without changing any of his daily habits, goes to the sleep centre two hours before bedtime. Various devices are used to monitor the patient while he sleeps:

  1. The ECG or electrocardiogram monitors the patient’s heart
  2. The EEG or electroencephalogram monitors the brain’s electrical activity
  3. The Electrooculogram monitors the eye movements
  4. The Electromyogram monitors muscle movements

With these instruments, doctors can record a patient’s condition, and monitor activity as their patients pass, or fail passing, through the stages of sleep. Neuroimaging methods can also be used in studying or confirming physiological sleep theories and discovering new relevant information about neurobiological aspects of the human sleep, memory and dreams. A few studies in neuroimaging focus on subjects suffering from narcolepsy and other sleep disorders.

Narcolepsy Diagnosis and Narcolepsy Treatments are carefully adapting with new findings.  Newer drugs are replacing older ones and doctors are diagnosing patients with better confidence. With proper diagnosis Narcolepsy symptoms can be treated quickly and nearly all signs and symptoms of the neurological disorder can be substantially reduced.

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Narcolepsy Blood Test & Other Useful Facts

December 4, 2011 By 1 Comment

What is Narcolepsy?

Narcolepsy is a health conditions wherein a person feels sleepy throughout the day. Sleep disorders can result from any of three basic reasons. These are:

  1. Insufficient or poor sleep: An ideal example of this is the people suffering from sleep apnea. This problem can be sorted out if the patient’s sleep-related breathing issues are taken care of.

  2. Weakened Brain System: This is also one of the reasons that can keep any person awake. A perfect example of this is Narcolepsy. In this situation, an individual feels very sleepy throughout the day even after having a good sleep at night.

  3. A mixed condition: The condition of Narcolepsy usually develops in a person in his or her earlier childhood or teen years and eventually, with growing age and weight, it takes the form of sleep apnea, adding to the existing problems of the condition.

It is important to note that if a person is suffering from both the critical conditions and the treatment is applied on only one such as sleep apnea and not on the other, it can lead to disastrous results.

Treating sleep apnea may improve the health conditions of the patient but cannot eradicate the problem from its root. Cardiac and stroke related dangers can be alleviated but the untreated narcolepsy will make them fall asleep anyway, paving way for other complications. There can be more than one reason and symptom to any kind of sleep disorder. Hence, it’s essential to offer proper and wholesome treatment to the patient.

As mentioned earlier, Narcolepsy causes brain-related sleepiness in a person. In addition, it is also associated with REM sleep disorders. REM or Rapid Eye Movement sleep disorder in a person occurs immediately after he or she falls asleep. This disorder can be caused by hypnopompic hallucinations and hypnagogic. The hypnopompic hallucinations and hypnagogic is the occurrence of the fragments of dreams before or after the sleep. Another cause of REM sleep can be sleep paralysis or a situation where a person finds himself or herself unable to call out or even move his or her body while sleeping or waking up. Cataplexy as well as dreaming during short sleep can also cause REM sleep disorders. Cataplexy is a medical condition under which the patient feels weakness in his muscles due to any kind of emotional impact, such as laughter. Patients suffering from cataplexy typically always also have Narcolepsy, but patients having Narcolepsy might not always experience cataplexy.

Who can suffer From Narcolepsy?

Both males and females can suffer from Narcolepsy. The main symptom of this disease is sleepiness, which usually takes place in latter part of the childhood, teen years or beginning of 20s. Narcolepsy can also develop in the individuals who are 30 years of age, but, this is very rare.

Symptoms of Narcolepsy

The symptoms of narcolepsy are falling asleep at a frequent rate, hyperactive behavioural pattern, and even other conditions such as Cataplexy.

Causes of Narcolepsy:

This disease is caused if the chemical “neurotransmitters” is found to be missing in the brain cells. Neurotransmitters controls and supervises the communication link between different brain cells and nerve.

Some members in a family can be genetically prone to developing Narcolepsy. However, this is not considered to be a purely genetic ailment in people. Narcolepsy may sometime result from excessive stress, but, as with the instances of genetic causes, this is not strictly a psychological disorder.

How to diagnose Narcolepsy

In order to diagnose Narcolepsy, some careful steps need to be taken. The patient’s history should be carefully observed. His or her sleeping habits should be closely monitored, and a multiple sleep latency test should be conducted. Other than this, the cataplexy disorder should also be taken into consideration.

Is a Narcolepsy blood test helpful?

Narcolepsy cannot be conclusively diagnosed by blood test. However, there are some medical practitioners that believe that blood test can help diagnose this medical condition in a patient. They think that individuals suffering from Narcolepsy have specific HLA types. HLA types are genetically ascertained signs on white blood cells that help in finding out tissue compatibility-for instance, to check an individual’s willingness to donate a kidney to the one whose system may not accept the kidney that has been transplanted. HLA types are determined by a blood test. However, these tests cannot be used for diagnosing narcolepsy because of two reasons: 1) the test will be in negative for the patients who are suffering from narcolepsy as well as cataplexy, and 2) about 25% of the people have same HLA types that are related to Narcolepsy.

How to cure Narcolepsy?

Narcolepsy can be treated if proper medication as well as a bit of common sense is applied. A Narcoleptic patient cannot be treated solely on the basis of medication. The treatment should be designed according to each individual case in concern. In this process, it is important to remove all the aggravating elements that can cause the symptoms to grow more serious, and cause the suggested medications to become less useful.

To elucidate it further, the practitioner cannot recommend a diabetic to do anything whatever he or she feels like because insulin shots are being given. Prescribing medication also means that the patient should be given a proper diet chart and counselled as and when required. This is applicable in case of all types of ailments including Narcolepsy.

Also, the medical practitioner who is treating the individual with Narcolepsy symptoms should possess experience and expertise in handling these types of cases. Physicians should inform the patient about the things or conditions that can pose further risks to his or her health. Not only this, it’s the duty of the practitioner to educate his patient about the ways to handle this disorder with a positive attitude.

Some of the medications that can be prescribed to a Narcoleptic patient are sodium oxybate (Xyrem) and antidepressants. Sodium oxybate (Xyrem) taken at night. All these are stimulating agents. Since these medications may contain some side-effects, physician should prescribe them with utmost care to any individual based on his or her medical records, symptoms, and more.

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Hypocretin Deficiency: Narcolepsy with Cataplexy

November 9, 2011 By Leave a Comment

Narcolepsy without cataplexy and narcolepsy with cataplexy are two different classifications in international diagnosis.

While there is little known about the cause of narcolepsy, over the past few decades scientists have made huge leaps in the understanding of cataplexy.

Evidence of a Deficiency in Hypocretin-1 in patients with cataplexy has given Narcolepsy with cataplexy its very own biomarker. During clinical testing of the cerebrospinal fluid (CSF), nearly all narcolepsy patients with cataplexy had a severe deficiency of the protein hypocretin-1which is normally located in the hypothalamus.  The reason for this deficiency is unknown, but there is speculation that it may be an autoimmune dysfunction. Cataplexy is also sometimes referred to as a hypocretin deficiency syndrome.

Narcolepsy without Cataplexy

The diagnosis of narcolepsy sleep disorder can be a difficult one to confirm.  There are no physical tests.  No genetic testing, no blood tests.

Doctors will take a complete history and use clinical testing like the multiple sleep latency test or MSLT, and perform a nocturnal Polysomnogram to determine the existence of narcolepsy or its symptoms.

During the nocturnal Polysomnogram, the patient is placed in a comfortable room and monitored all night to determine the cause of symptoms like insomnia and EDS. An electroencephalogram or EEG is used as well as video monitoring to record body functions and sleep patterns and activity.  Some pertinent data that is recorded would be breathing, including the existence of apnea. Pulse and blood pressure, Snoring, sleep talking and restlessness.  The onset and duration of REM sleep is carefully recorded.

The MSLT is done the day after the nocturnal Polysomnogram.  The patient will stay at the clinic the rest of the day and have 5 naps during their stay.  The naps are done in the same relaxing setting as the nocturnal Polysomnogram. An EEG is used again, as well as video surveillance to monitor and record the time it takes the subject to fall asleep, or if the onset of REM sleep is accomplished. These factors are standard to diagnose narcolepsy.

Narcolepsy alone can be difficult to live with.  Falling asleep at inappropriate times wreaks havoc on patients’ lives.  School, work and relationships become impossible to maintain and patients sometimes then succumb to depression and reduced sense of self-worth.

With carefully planned lifestyle changes such as tight bedtime routine, strict diet and scheduled daytime naps, patients with mild narcolepsy symptoms can sometimes beat the disease. However, when symptoms are more severe, the lifestyle changes are still utilized, but drug therapy is added to round out the treatment.

Drug treatment for narcolepsy includes stimulants such as Provigil or Nuvigil are used to combat Excessive Daytime Sleepiness or EDS. These drugs help the narcoleptic stay awake during the day. Many people with narcolepsy need stimulants to function at an acceptable level in their daily lives and to live successful and prosperous lives.

Narcolepsy Therapies

Behavioral

Pharmaceutical

for EDS

Pharmaceutical

for Cataplexy
>Carefully controlled night time sleep Methylphenidate sodium oxybate, GHB
Scheduled daytime naps Amphetamine Protriptyline
smaller, lighter, more frequent meals Modafinil Imipramine
Involvement of friends, family and associates Selegiline (also anti-cataplectic) Cloniipramine

Narcolepsy with Cataplexy

Patients who have the condition: narcolepsy with cataplexy, also suffer the same EDS symptoms as narcolepsy without cataplexy.  However, they have the added stress of the symptom of cataplexy.

Cataplexy is a bizarre and rare phenomenon that affects over two million patients with narcolepsy. When a patient experiences cataplexy, they lose muscle tone and function, suddenly and without warning.

These episodes can be so slight they go unnoticed.  Perhaps the patient will feel clumsy for a moment.  Or an eyelid may droop or the cheek may go slack. It may last for as little as a few seconds. Hardly enough time to register the change.

A cataplexy episode can also be more severe. In the event of a severe episode, a person can lose all muscle control in his or her body and a total collapse is experienced.

Cataplexy can cause psychological trauma, particularly after the first episode or when it strikes in children because the collapse is experienced while completely awake and alert.  The inability to move or respond to their environment is particularly terrifying for many patients.

What Causes Narcolepsy?

No one knows what causes narcolepsy without cataplexy. There is some speculation that it is genetic, but there is insufficient evidence as it rarely runs in families. Recently, some evidence has come to light that it may be an autoimmune function, like cataplexy. There must be much more research done to confirm this and even longer before a suitable diagnosis and treatment can be formulated on the autoimmune basis.

Sodium Oxybate- Xyrem

Xyrem is the brand name for the drug sodium oxybate.  The chemical is gammahydroxybutyric acid or GHB.  GHB is the most effective treatment of cataplexy. It has the disorder covered on both ends of the spectrum.  GHB is paradoxical in its behavior in the body. It is both an extremely effective sedative and a potent stimulant. In high doses, it interacts with the GAGA system; it has a sedative effect and inhibits the release of dopamine in the brain.  At a lower dose, it works as a stimulant.  It stimulates the brain to produce dopamine and glutamate.

GHB has been successfully used to treat several disorders, such as depression and insomnia for years in other countries.  In the US, however, it is only approved by the FDA for the treatment of Cataplexy. It does not affect the deficiency of hypocretin, but the symptoms of cataplexy are greatly improved.

GHB is associated with tremendous amounts of negativity. In high doses, it is a highly effective sedative.  It has been called the “date rape drug” for its most infamous criminal use. It is sometimes abused as a street drug, as in moderate amounts, it causes euphoria.  On the street, it’s referred to by several names, including as “liquid ecstasy.”  It has been abused by body builders as well. In small amounts it stimulates the production of the human growth hormone.  It is addictive and abrupt cessation can cause terrible withdrawal symptoms.

Antidepressants for Cataplexy

Even though the FDA has not approved them for this use, several antidepressants are being used to manage the symptoms of cataplexy.  There needs to be a lot more research done into the effectiveness of antidepressants for cataplexy.

Tricyclic antidepressants have shown a lot of promise in the treatment of narcolepsy and its symptoms.  Unfortunately, there are a whole host of frightening side effects that are common to tricyclic antidepressants.  Although they were a popular treatment in the past, they are not used very often anymore.

Although less proven, the selective serotonin reuptake inhibitors, or SSRIs, like Prozac, Paxil and Zoloft are commonly used to treat these symptoms.  Their effectiveness is the subject for debate among doctors and scientists until proven one way or another.

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Narcolepsy Causes- The Unanswered Question

November 8, 2011 By Leave a Comment

Narcolepsy is a chronic sleep disorder that disrupts the lives an estimated three million people throughout the world. This can be a dangerous disease for those who suffer from this illness, as well as those around them, as people with narcolepsy cause accidents inadvertently, by falling asleep at the most inopportune of moments. Scientists have hypothesized on the exact causes of narcolepsy, but ultimately the root cause of narcolepsy remains a mystery that is still being studied.

This leaves the question: What causes narcolepsy?

It is widely believed by doctors of neurology and scientists that narcolepsy is caused by several different factors. One of which is genetics, although this has never been proven, as narcolepsy is rare among relatives. Another theory, which is more solid than the genetics theory, is environmental factors combined with emotional stimuli. This is especially true when looking at narcolepsy with cataplexy.  The following is a list of factors that are known triggers for cataplectic attacks:

  • Laughter
  • Anger
  • Hysterical laughter (More severe than laughter alone.)
  • Stressful situations
  • Poor sleep habits (Not having scheduled nap times or having insomnia.)
  • Poor diet

Another extremely common occurrence is that narcolepsy is misdiagnosed or left completely undiagnosed. E.D.S. or excessive daytime sleepiness is usually the most common symptom a person with narcolepsy suffers, so it is often ignored or thought of as some other problem. In fact, the only truly unique symptom in narcoleptic patients is cataplexy. Cataplexy is the sudden loss of muscle control, which can cause falls and serious injury. This often takes years to diagnose correctly and is often misdiagnosed as epilepsy and depression.

Effects of Narcolepsy on a Person’s Life

Narcolepsy, especially when left untreated or misdiagnosed, can have dire consequences on a person’s life. Ridicule and embarrassment, as well as the risk of injury due to accidents, both to self and others, can weigh heavy on the mind of a person suffering from this ailment. Although it is not thought of as a mental disorder in and of itself, narcolepsy can lead to severe depression in those struggling with its symptoms.

Dangerous activities include:

  • Driving and operating machinery
  • Working a general labor job
  • Cooking and food preparation
  • All forms of sports and exercise

Other aspects of a person’s life than can become disrupted are:

  • Social and professional relationships
  • Mental health due to anxiety and depression
  • Personal relationships, such as marriage, can suffer due to lowered sex drive
  • Memory and attention may suffer due to sudden sleep attacks

Diagnosing Narcolepsy Correctly

People that suspect that they may have narcolepsy should keep a journal and write down all narcolepsy symptoms they experience such as daytime sleep attacks. When making a doctor visit, this journal should be taken and given to the doctor. This information, combined with the extensive testing and the questionnaire provided by doctors, can give a person years of happiness that they would otherwise miss due to the symptoms of narcolepsy.

The tests performed to help diagnose narcolepsy are as follows:

  • E.S.S. or Epworth Sleepiness Scale. This is a questionnaire designed to pin point the symptoms of narcolepsy.
  • Nocturnal Polysomnogram. This is a study that is done overnight to measure the electrical activity of a person’s brain and heart, as well as the movement of the muscles and the eyes.
  • M.S.L.T. or Multiple Sleep Latency Test. This test helps to measure the time it takes a person to fall asleep during the day.
  • Spinal Fluid Analysis. This is a newer test that is done to help diagnose narcolepsy, in which the cerebrospinal fluid is tested for the chemical hypocretin. A lack of this chemical is a red flag for narcolepsy.

What is the Cause of Narcolepsy?

Scientists discovered, after years of research, that patients with narcolepsy have one common factor. They all lack a chemical that is found in the brain called hypocretin. Hypocretin sometimes called orexin, controls a person’s sleeping and waking functions. Without it people fall asleep when they should be fully awake. The neurons that secrete hypocretin are found in lower quantities in narcolepsy patients, which cause the lack of this important chemical.

Self Help Treatment of Narcolepsy

There are many ways a person suffering from narcolepsy can keep sleep attacks to a minimum. First, scheduling naps throughout the day can help one to have control on when he or she falls asleep. Next, the avoidance of drugs, alcohol and caffeine is important, as these can interfere with sleep when it’s needed. It should also be mentioned that some over the counter medications should be avoided, due to the drowsiness they can cause. Another good self-help idea is for a person to involve everyone he or she knows. Telling employers, co-workers, friends and family about this medical situation can save one from much ridicule and embarrassment. Finally, and most importantly, a person who suffers from narcolepsy should always wear a medical bracelet or necklace to alert everyone in case a situation may arise.

Medications, Diagnosis and Treatment

Common medications used to treat this condition include sodium oxybate, antidepressants and stimulants. First, sodium oxybate is a strong drug used in the treatment of patients with cataplexy. Commonly referred to as “the date rape drug”, sodium oxybate is considered safe when used as prescribed to treat narcolepsy, as it reduces sleep attacks and cataplexy, while helping the patient gain needful sleep. Next, antidepressants are used to help lessen the effects of cataplexy, sleep paralysis and hallucinations. Fluoxetine (Prozac) and Sertraline (Zoloft) are the two most commonly used antidepressants used to help treat narcolepsy. Finally, there is the ever popular mainstay of the medical fight against narcolepsy, stimulants. Stimulants increase a narcoleptic person’s awareness and wakefulness. It should be noted that people with a history of psychiatric issues should avoid taking stimulants, due to the increased risk of suicidal thoughts, mania, hallucinations and anxiety.

Medical researchers have been trying to formulate a drug to synthesize hypocretin in a clinical setting. This could help people with a diagnosis of narcolepsy to have less sleep attacks. Combined with an effort to change lifestyles and sleep habits, this synthetic hypocretin drug could in fact wipe out narcolepsy and its causes.

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Falling Asleep All the Time Could Mean Narcolepsy

October 28, 2011 By Leave a Comment

It might feel like sleeping all the time, but narcoleptics do not sleep more than people with healthy sleep cycles. The nighttime sleep cycle is interrupted from insomnia, sleep apnea or another sleep disorder.  The result is the need to make up for it during daytime hours.

Clinical features

The diagnosis of narcolepsy depends on the existence of several symptoms. Narcoleptics suffer from EDS, seventy percent also suffer from cataplexy and a smaller portion has regular episodes of sleep paralysis with or without hallucinations. It is exceedingly rare for any one patient with narcolepsy to suffer from all of these symptoms.  Often, one or more are present.

  • EDS

The defining symptom of narcolepsy is Excessive Daytime Sleepiness (EDS) it is just what it sounds like.  The feeling is of being very sleepy during the day, followed by sleep attacks.  It is not exhaustion.  It is not just tired.  The desire to sleep is so strong it becomes need, uncontrollable need to sleep. The narcoleptic does not fall asleep all the time because he or she is lazy, but because it is unstoppable.

  • Cataplexy

The diagnosis of narcolepsy with cataplexy is separate from narcolepsy without cataplexy.  Narcolepsy with cataplexy has its own biomarker.  There is a noticeable deficiency in the protein hypocretin-1 in the hypothalamus in most patients with narcolepsy with cataplexy.  This deficiency brings the possibility of an autoimmune dysfunction as the cause of this symptom. This is good news as it gives scientists another angle from which to search for treatments.

Patients with narcolepsy with cataplexy condition, suffer from falling asleep all the time like patients without cataplexy, but they also have episodes where their muscles lose tone and they lose the ability to control them. The experience can be as slight as the drooping of an eyelid and as extreme as total collapse and can last from a few seconds to over an hour.  Unlike narcolepsy, with this symptom, the patient is completely alert and awake.

Narcolepsy symptoms like the loss of muscle control experienced in cataplexy may only leave you with your hands falling asleep all the time.

  • Sleep Paralysis

Sleep paralysis is experienced by a large portion of the population once or twice in a lifetime.  Narcoleptics that have sleep paralysis have these episodes frequently.  The sensation is a lot like cataplexy in that the patient is alert but has no control over their body.  It does not however, depend on the deficiency of hypocretin.  Instead, sleep paralysis is experienced in the twilight between wake and sleep. This symptom is often accompanied by hallucinations.

  • Hallucinations

In normal REM sleep, the body loses tone and dreams. Narcolepsy patients sometimes experience this while waking or falling asleep.

Hallucinations experienced when a patient is falling asleep are called hypnogogic hallucinations.  When hallucinations are experienced between the REM cycles and coming fully awake it is called hypnopompic hallucinations.

These hallucinations are often surreal and dark and they can sometimes be mistaken for something supernatural like an out of body experience or possession.

Misdiagnosis

There are several diseases that share overlapping symptoms with narcolepsy.  As a result, getting the correct diagnosis and treatment can be a tricky task.  Many psychiatric illnesses can look like narcolepsy. Patients with major depressive disorder (MDD), bipolar disorder, and psychotic disorders often display narcolepsy like symptoms. . Mood disorders are often accompanied by insomnia. When a Patient’s in the depressed phase of bipolar disorder or has MMD, they could have EDS on top of the fatigue that is common to the disease.

The easiest psychiatric disorder to mistake for narcolepsy is schizophrenia.  The commonalities between the two make it very easy to misdiagnose.  Both narcolepsy and schizophrenia usually start during adolescence or early adulthood. Schizophrenia patients can have insomnia and hallucinations are found in both cases. Misdiagnosing these two diseases means that the patient is getting inappropriate treatments. Narcolepsy patients would find the sedative effects of many antipsychotics only worsen their EDS a. Schizophrenics would likewise find that stimulants have adverse effects on their disorder.

On top of the psychiatric diseases that can lead to misdiagnosis, there are several neurology based disorders that can initially look like narcolepsy. The cataplexy and sleep attacks can have the appearance of a seizure. Two more neurological disorders that share commonalities with narcolepsy are Parkinson’s disease and Alzheimer’s disease.

Diagnostic Tools

There are no sure ways to test for narcolepsy.  There is no known genetic testing and no blood tests that show the presence of the disease. Diagnosis of narcolepsy is dependent on observation and detailed histories. In the absence of a physical test, the Multiple Sleep Latency Test or MSLT is the accepted standard of testing for testing sleep drive and excessive sleepiness. The doctor will probably order a nocturnal Polysomnogram where the patient will be hooked up to an electroencephalogram (EEG) the night before the MSLT to collect data on breathing, heart rate, waking and sleep activity as well as snoring, apnea, sleep talking or other physical activities while sleeping that may explain the presence of EDS.

The test is preformed the next day in the same clinical setting during the rest of the day.  There are 5 scheduled naps that last for 20 minutes, every 2 hours. The room where the patient is to nap is made as comfortable and sleep inducing as possible.  Stimulation is avoided, the temperature and noise level is kept at a perfect setting and then the patient is left to try to sleep.

The purpose of the MSLT is to determine the presence or absence of REM sleep during the first 15 minutes of the nap. Taking an average of 8 minutes or less to fall asleep over the total 5 naps and experiencing REM sleep during at least 2 of them, is the current criteria for a diagnosis of narcolepsy.

If you find yourself thinking “I fall asleep all time” then you should talk to your doctor.  A local sleep clinic can provide you with literature and advise you which specialists are available.

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Sleep Paralysis Hallucinations- A General Guide

October 28, 2011 By Leave a Comment

Sleep paralysis is often a symptom of narcolepsy, but having sleep paralysis doesn’t mean a person also has narcolepsy. During episodes of sleep paralysis, people often suffer from a sleep paralysis hallucination. This means that narcolepsy hallucinations and sleep paralysis are linked, making this a frightening situation for people who experience this ailment.

Sleep Paralysis and Hallucinations Defined

Sleep paralysis is when a person’s brain disconnects from their body during the time when they are falling asleep or when they are starting to wake up. The person remains aware of their surroundings, but is unable to speak or move, making this a truly scary situation. Hallucinations are surreal, yet very compelling in nature. When a person has a hallucination, they will see and hear things that are not really there. When narcolepsy, hallucinations and sleep paralysis are combined, a person can go through a great deal of suffering.

Sleep Paralysis and Narcolepsy Hallucinations

When a person has narcolepsy they suffer most commonly from E.D.S or excessive daytime sleepiness, causing them to have trouble staying awake during daytime hours. If left untreated, the person could suffer from insomnia during nighttime hours. When he or she is finally so tired that there are no other options but sleep, his or her body shuts down. During this period of sleep, sleep paralysis can occur with ensuing hallucinations. The periods of paralysis and hallucinations can cause the person not to want to go to sleep which can start a mania. Then, the cycle repeats itself perpetually, until the person finally has no choice but to act by seeking medical treatment.

Causes of Sleep Paralysis Hallucinations

Many different factors play a role when a person suffers from narcolepsy and sleep paralysis hallucinations. The following is a list of factors that are commonly thought of as triggers that cause these attacks.

  • Stressful situations.
  • Jet lag.
  • A change in sleep patterns.
  • Anxiety
  • Other sleep disorders.

Hallucinations are said to occur when the neural transmissions in the brain experience errors during the period of R.E.M. or rapid eye movement sleep. These hallucinations are said to be linked to sleep apnea, which is another sleep type of sleep disorder.

Symptoms of Sleep Paralysis Hallucinations

The symptoms of sleep paralysis hallucinations are very haunting in nature, People often say that the experience is extremely vivid, which can be truly frightening. These symptoms include:

  • The feeling of being watched.
  • Demonic beings or evil spirits being present in the room.
  • The feeling of being weighted down, especially on the chest.
  • Strange noises, such as voices, footsteps, heavy breathing and guttural sounds.
  • The feeling of being suffocated.
  • Horrific images.
  • The feeling of being weightless or levitating.

These symptoms often cause a sense of dread in people who suffer from them, especially when falling asleep. For this reason alone, medical treatment should be sought to lessen the strain that these symptoms place on people. It should be noted that sleep paralysis is not considered by doctors to be dangerous.

Other complaints

A couple of other general complaints made by people who suffer from sleep paralysis hallucinations are:

  • The inability to move the arms and legs.
  • The inability to speak.
  • The feeling of being exhausted when the episode has ended.

Methods of Coping with Sleep Paralysis Hallucinations

People suffering the symptoms of narcolepsy and sleep paralysis hallucinations can take comfort in that fact that there are numerous ways to cope with this illness. The following is a list of well-known methods used to deal with these symptoms.

  • Be completely relaxed when trying to fall asleep.
  • Overexertion or complete exhaustion of the body should be avoided at all cost.
  • Eat a well-balanced, healthy diet.
  • Avoid caffeine, alcohol, drugs, and medications that cause drowsiness.
  • Try to stick to a solid sleep schedule, incorporating naps during the day.
  • Keep a journal to record episodes of sleep paralysis and hallucinations.
  • Sleep in a dark room with good air flow and little or no noise.
  • Try some light reading before bed time.
  • Breathing deeply and stretching can eliminate anxiety, which is suspected to be a cause of sleep paralysis hallucinations.
  • Repeat breathing deeply a try to relax when and episode occurs.
  • Remember that sleep paralysis hallucinations are just a medical phenomenon.

Medications Used to Treat Narcolepsy

There are several drugs that are used to treat narcolepsy on a regular basis. The most common being Sertraline (Zoloft) and Fluoxetine (Prozac), which both fall into the antidepressants category. Next, there are stimulants, which are a mainstay drug for treating narcolepsy, but should be avoided by patients who have a history of mental health issues, especially suicidal ideology. Finally, there is sodium oxybate.

Antidepressants are usually prescribed to help alleviate the symptoms of cataplexy. Cataplexy is when a person suddenly and without warning loses control of their muscles. This usually results in a fall and sometimes results in physical injury.

Sodium oxybate is prescribed to treat severe cataplexy. This drug is most commonly referred to as a date rape pill, due the relaxing sleep it induces. When taken at bedtime, it helps a person to sleep more soundly, thus reducing daytime narcoleptic attacks.

Stimulants are prescribed to help patients who have been diagnosed with narcolepsy so they can stay awake during the day. This drug stimulates the central nervous system, which promotes wakefulness and alertness. Older versions of stimulants are said to be addictive and have many side effects.

The True Story of a Sleep Paralysis Hallucination

Michael, age 22 from Indiana, said in a recent interview:

“When I first started experiencing sleep paralysis and hallucinations, I didn’t have any idea that such a disease existed. I don’t remember there being a great deal of stress in my life, other than working. One night as I was going to sleep I felt very dreamy, almost like I was floating, but I could see the room from where I was lying. I tried to ask my girlfriend what was happening, but I was unable to speak. I kept hearing this low, growling sound, kind of like demons in the room. Then I saw a shadowy figure, which look like Death himself. He walked through the door, came over to me, and he reached out and started choking me. I was unable to fight or get away and at this point I was trying to scream, because I was terrified by what was happening. I woke up a little while later and felt drained, both mentally and physically.”

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All You Need to Know About the Effects Of Narcolepsy

October 27, 2011 By Leave a Comment

Narcolepsy is a sleep disorder that causes people to fall asleep during moments when they should be attentive. This chronic sleep disorder can strike any time, day or night, and knows no age, color, sex or class. Sometimes the diagnosis of narcolepsy is difficult, due to the lack of medical history. Narcolepsy effects are wide and varying, depending on how sever the condition has become.

Understanding what Narcolepsy is

Narcolepsy is a neurological disorder that has not been completely diagnosed by physicians, and sometimes is even misdiagnosed. Narcolepsy has been classified as a hypersomnia disorder that affects surprisingly more men than women and shows normally between the ages of 10 and 25. There is a reported one per one thousand people that has narcolepsy, there could be even more people in the world with narcolepsy but the diagnosis is still a little dodgy.

Narcolepsy symptoms and effects

There are many different symptoms that come along with narcolepsy, and how they affect daily life.

  • extreme day sleepiness
  • muscle weakness
  • sleep paralysis

These are just a few symptoms of narcolepsy some of the effects that narcolepsy brings about are

  • falling asleep at random times
  • losing time and not knowing what you did during those missing hours
  • stress
  • depression
  • lack of interest in school or a job

Most people with narcolepsy are categorized as being lazy, unmotivated, pessimistic, and a general pain to be around, because they seem to lack the motivation to complete simple tasks because of fatigue, and a genuine need to sleep at random times. Narcolepsy effect many different aspects of life and with certain life style changes can become very manageable. With the effect of narcolepsy being better diagnosed and the signs closer observed, the diagnosis has become more accurate.

Diagnosing the Effect of Narcolepsy

There are many different ways to diagnosing narcolepsy

  • a sleep study
  • blood test
  • an evaluation by a physician

With these many different ways to diagnose narcolepsy and its effect doctors have become more effective at performing a multiple sleep latency test so that if there is more than one patient with narcolepsy the condition can then have a diagnosis and treatment. If the disease is classified as insomnia because narcolepsy does have certain characteristics, then a sleep latency test should be performed to tell if the diagnosis is correct or not. With the advances that have been made in this field of study, the medication and changes that have greatly improved a chance at a seemingly normal life has been greatly increased.

When the first signs of narcolepsy hit a physician can help explain the process and what is happening in the body. Do not be afraid to talk about what is happening with the body and the changes that have been made.

What to look out for and discuss with a physician

  • daytime sleepiness
  • sleep paralysis
  • night terrors
  • emotional triggers such as laughing, crying, becoming stressed, or even sexual activities

These are just a few examples of the symptoms of narcolepsy, but there still are a great many more than just those few listed, but if the symptoms continue for more than 3 nights a week for over 3 months at a time then that is a sure sign that narcolepsy is a factor in life.

Coping with narcolepsy

  • Stay away from cigarettes
  • no alcohol
  • stay stress free
  • exercise
  • eat healthy foods

With these minor changes in life the brain begins to cope with narcolepsy and all of the problems that can arise from the disorder. Medication also helps with the diverse effects that the disease has the continuous need to sleep, the paralysis, and even the lack of motivation.

Medication for Narcolepsy

  • Adderall- this drug is primarily given to people with ADHD but in the case of having Adderall prescribed for narcolepsy the drug works by changing the amount of certain natural substances in the brain.

  • Ritalin- this drug is also used for ADHD and ADD but with narcolepsy it activates impulse control and hyperactivity.

  • Provigil- improves wakefulness

  • Methylin- with this drug there is a caution label that specifically says that if there is any substance abuse, emotional problems, or alcoholism, do not take this drug because the drug may not work or it could become very addictive and cause mental health issues.

Just like any other drug there will always be side effects but for the most part the medication that is prescribed for narcolepsy has been a great help and works with little to no problem from the patient with side effects. The tests that are performed to find what medicine and how the dosage should be can be a long process but if every sign, symptom, and reaction to the medication is reported back to a physician then the medications dosage and type can be changed as according to the patients preference.

With every new medication that is being created and tested on patients with anywhere from mild narcolepsy to advanced narcolepsy the medical environment is coming closer and closer to finding a permanent solution to the problem of narcolepsy. Also with each new drug comes a clearer understanding how the brain feels the need to constantly shut its self-off and rest.

The brain does not have a clinical diagnosis as to why it spontaneously shuts down, but when a doctor can completely understand what is going on in the human brain, and why the patient will want to constantly daytime sleep, the human race will have a way change the effects on narcolepsy.

Some of the tests that are preformed to see in narcolepsy are a factor and not something else is urology, or a urine sample to see how the chemical balance is working in the patient’s body. Every case of narcolepsy is different just like the patient and needs to be handled with care and precision by the family physician or a physician that specializes in narcolepsy cases. So if signs are being pointed out that there might be a chance that narcolepsy is a problem consult a physician and have the tests ran to be properly diagnosed.

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Narcolepsy Tests Used for Diagnosis

October 27, 2011 By Leave a Comment

There are two classifications for narcolepsy in international diagnosis: Narcolepsy with cataplexy and narcolepsy without cataplexy.  Both of these disorders share the primary narcolepsy symptom: Excessive Daytime Sleepiness (EDS).  This is the symptom that defines narcolepsy. It is this symptom that narcolepsy testing is looking for.

Excessive Daytime Sleepiness

Excessive Daytime Sleepiness (EDS) is exactly what it sounds like.  The patient experiences not just being tired or the feeling of exhaustion, but the desire to sleep that is so strong it becomes need.  People with EDS often find themselves falling asleep at inappropriate times. There is little sympathy for a student that falls asleep during a lecture or an employee that sleeps on the job. These episodes can cause embarrassment for patients and lead to complications like depression and self-medication with illegal stimulants.

Cataplexy

Cataplexy is suffered by approximately seventy percent of narcolepsy patients. Cataplexy is the experience of sudden and uncontrollable loss of muscle tone. When a person experiences cataplexy, they lose control of muscle function.

This can be so slight that it is not noticed, lasting for a few short seconds an example of a simple cataplexy episode would be the momentary drooping eyelid.  It most commonly affects the face, around the eyes or the slackening of the jaw.  It can also be a very serious event.  A severe cataplexy episode can leave a patient completely collapsed with no control for a period that can last for over an hour.

It is believed in scientific circles that cataplexy is a form of REM function.  During REM sleep, muscles lose tone and go slack.  The biggest difference between normal REM sleep and Cataplexy is that the person who is experiencing it is completely alert. Being awake and unable to move can be a terrifying experience, especially the first time it is experienced.

Other Common Narcolepsy Symptoms

Although less common than EDS or cataplexy, there are two other symptoms that are associated with narcolepsy.  Sleep paralysis and hallucinations occur often enough in narcolepsy patients to merit notice.

  • Sleep Paralysis Although they are not related, the behavior of sleep paralysis and cataplexy are similar. Sleep paralysis is experienced in the twilight between wake and sleep.  Like cataplexy, it is believed to be a displaced part of REM sleep.  The subject experiences paralysis during this time, but they have not lost consciousness.  This can be as frightening as cataplexy, especially since it is often associated with hallucinations.

  • Hallucinations are a common symptom of narcolepsy. They occur either with or independent of other symptoms. Again, these waking dreams, these hallucinations are believed to be displaced aspects of REM sleep.  They can be dark and sinister and when experienced during sleep paralysis, they have historically been mistaken for possessions or out of body experiences.

Sleep paralysis and hallucinations are not exclusively narcolepsy symptoms, neither are they experienced by every narcolepsy patient.  In fact, it is exceedingly rare that any one patient would have all of these symptoms.

Testing

Using the Nocturnal Polysomnogram and Multiple Sleep Latency Test, narcolepsy is determined by the sleep cycles and the details they give.

Nocturnal Polysomnogram

First, the patient spends the night at the sleep center. They are monitored through the night for abnormal patterns, snoring, or apnea- anything that may explain the excessive daytime sleepiness that the patient experiences are carefully recorded.

During the test, an electroencephalogram or EEG monitors the patients and coupled with video surveillance an accurate record of nocturnal behavior is made. Some of the things that will be determined are how long it takes the patient to fall asleep and the onsets and duration of REM sleep is also recorded. This is a very important factor in determining the diagnosis of narcolepsy.

Multiple Sleep Latency Test

The next day, the patient stays at the clinic.  The MSLT is done during this time.  For this narcolepsy test, the patient spends the day at the clinic and during their stay; they will have five, 20 minute, scheduled naps that are set two hours apart throughout the day. During the naps, the patient is settled into a comfortable room that is made as sedate and sleeps inducing as possible.  During this time, the time it takes to fall asleep and the presence or absence of REM sleep are carefully scrutinized as it is by these things that the doctor will decide if the patient suffers from narcolepsy.

An event that is uncommon in normal sleepers but often happens with narcolepsy patients is SOREM or Sleep Onset REM. The diagnosis of narcolepsy takes several recorded events.  First is that it should take an average of eight minutes for the subject to fall asleep on average through the five naps.  Then there needs to be either two occurrences of SOREM or even one occurrence of REM at any point within the 20 minute naps.

Even though it is the accepted standard, some experts criticize the MSLT as a diagnostic tool for narcolepsy as there are several other sleep disorders such as sleep apnea, shift work Sleep disorder, and periodic limb movement disorder, that can cause multiple SOREMS on a MSLT.  However, with a lack of a better standard for testing, narcolepsy is diagnosed by history, Nocturnal Polysomnogram and the Multiple Sleep Latency Test.

The Role of Hypocretin in Cataplexy

Narcolepsy with the symptom of cataplexy earned itself its own diagnosis because it has its very own bio-marker.  The protein hypocretin-1 is found in the hypothalamus.  In patients with the diagnosis of Narcolepsy with cataplexy, over 90% had a significant reduction in the levels of hypocretin-1.  This deficiency is an important discovery into the cause, treatment and possible the future cures for narcolepsy with cataplexy.

Approximately 20-40% of non-cataplectic, narcolepsy patients show a low level of hypocretin-1. So it is not a good indicator of narcolepsy in general and the presence of the deficiency in cataplectic indicates a separate pathology for the two.

Testing for hypocretin-1 deficiency is a difficult process that involves removing some of the spinal fluid.  Because this procedure is both painful and potentially dangerous, it is not a common diagnostic tool. This kind of testing is left for laboratory work and scientific studies.

Medical Histories

Perhaps the most used and most reliable testing for narcolepsy and the only one widely used for cataplexy is a detailed medical history.  Often a doctor will have a patient journal to record symptoms and episodes.  Family and personal medical histories are carefully compiled and scrutinized as well.

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Narcolepsy Blood Test: What is it?

September 11, 2011 By 1 Comment

What is Narcolepsy?

Narcolepsy is a health conditions wherein a person feels sleepy throughout the day. Sleep disorders can result from any of three basic reasons. These are:

  1. Insufficient or poor sleep: An ideal example of this is the people suffering from sleep apnea. This problem can be sorted out if the patient’s sleep-related breathing issues are taken care of.
  2.  Weakened Brain System: This is also one of the reasons that can keep any person awake. A perfect example of this is Narcolepsy. In this situation, an individual feels very sleepy throughout the day even after having a good sleep at night.
  3. A mixed condition: The condition of Narcolepsy usually develops in a person in his or her earlier childhood or teen years and eventually, with growing age and weight, it takes the form of sleep apnea, adding to the existing problems of the condition.

It is important to note that if a person is suffering from both the critical conditions and the treatment is applied on only one such as sleep apnea and not on the other, it can lead to disastrous results.

Treating sleep apnea may improve the health conditions of the patient but cannot eradicate the problem from its root. Cardiac and stroke related dangers can be alleviated but the untreated narcolepsy will make them fall asleep anyway, paving way for other complications. There can be more than one reason and symptom to any kind of sleep disorder. Hence, it’s essential to offer proper and wholesome treatment to the patient.

As mentioned earlier, Narcolepsy causes brain-related sleepiness in a person. In addition, it is also associated with REM sleep disorders. REM or Rapid Eye Movement sleep disorder in a person occurs immediately after he or she falls asleep. This disorder can be caused by hypnopompic hallucinations and hypnagogic. The hypnopompic hallucinations and hypnagogic is the occurrence of the fragments of dreams before or after the sleep. Another cause of REM sleep can be sleep paralysis or a situation where a person finds himself or herself unable to call out or even move his or her body while sleeping or waking up. Cataplexy as well as dreaming during short sleep can also cause REM sleep disorders. Cataplexy is a medical condition under which the patient feels weakness in his muscles due to any kind of emotional impact, such as laughter.
Patients suffering from cataplexy typically always also have Narcolepsy, but patients having Narcolepsy might not always experience cataplexy.

Who can suffer From Narcolepsy?

Both males and females can suffer from Narcolepsy. The main symptom of this disease is sleepiness, which usually takes place in latter part of the childhood, teen years or beginning of 20s. Narcolepsy can also develop in the individuals who are 30 years of age, but, this is very rare.

Symptoms of Narcolepsy

The symptoms of narcolepsy are falling asleep at a frequent rate, hyperactive behavioural pattern, and even other conditions such as Cataplexy.

Causes of Narcolepsy:

This disease is caused if the chemical “neurotransmitters” is found to be missing in the brain cells. Neurotransmitters controls and supervises the communication link between different brain cells and nerve.
Some members in a family can be genetically prone to developing Narcolepsy. However, this is not considered to be a purely genetic ailment in people. Narcolepsy may sometime result from excessive stress, but, as with the instances of genetic causes, this is not strictly a psychological disorder.

How to diagnose Narcolepsy

In order to diagnose Narcolepsy, some careful steps need to be taken. The patient’s history should be carefully observed. His or her sleeping habits should be closely monitored, and a multiple sleep latency test should be conducted. Other than this, the cataplexy disorder should also be taken into consideration.

Is a Narcolepsy blood test helpful?

Narcolepsy cannot be conclusively diagnosed by blood test. However, there are some medical practitioners that believe that blood test can help diagnose this medical condition in a patient. They think that individuals suffering from Narcolepsy have specific HLA types. HLA types are genetically ascertained signs on white blood cells that help in finding out tissue compatibility-for instance, to check an individual’s willingness to donate a kidney to the one whose system may not accept the kidney that has been transplanted. HLA types are determined by a blood test. However, these tests cannot be used for diagnosing narcolepsy because of two reasons:  1) the test will be in negative for the patients who are suffering from narcolepsy as well as cataplexy, and 2) about 25% of the people have same HLA types that are related to Narcolepsy.

How to cure Narcolepsy?

Narcolepsy can be treated if proper medication as well as a bit of common sense is applied. A Narcoleptic patient cannot be treated solely on the basis of medication. The treatment should be designed according to each individual case in concern. In this process, it is important to remove all the aggravating elements that can cause the symptoms to grow more serious, and cause the suggested medications to become less useful.

To elucidate it further, the practitioner cannot recommend a diabetic to do anything whatever he or she feels like because insulin shots are being given. Prescribing medication also means that the patient should be given a proper diet chart and counselled as and when required. This is applicable in case of all types of ailments including Narcolepsy.

Also, the medical practitioner who is treating the individual with Narcolepsy symptoms should possess experience and expertise in handling these types of cases. Physicians should inform the patient about the things or conditions that can pose further risks to his or her health. Not only this, it’s the duty of the practitioner to educate his patient about the ways to handle this disorder with a positive attitude.

Some of the medications that can be prescribed to a Narcoleptic patient are sodium oxybate (Xyrem) and antidepressants. Sodium oxybate (Xyrem) taken at night. All these are stimulating agents. Since these medications may contain some side-effects, physician should prescribe them with utmost care to any individual based on his or her medical records, symptoms, and more.

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The Difficulties in Diagnosing Narcolepsy

September 9, 2011 By Leave a Comment

Many symptoms of Narcolepsy mimic the symptoms of other common medical disorders, especially sleep disorders. Symptoms like daytime sleepiness and moodiness are common, and often go untreated because they are unrecognized. Many patients who experience the problems do not seek medical treatment; they brush the problem under the rug making diagnosing Narcolepsy very difficult. Many medical professionals also misdiagnose Narcolepsy with other sleeping disorders, depression, and even epilepsy. Because Cataplexy is the only symptom really unique to Narcolepsy, it is often its only identifier.

If a medical professional diagnoses you with Narcolepsy, or other common sleeping disorders, they are likely to refer you to a sleep specialist for further testing. Sleep clinics and sleep labs are equipped with the facilities and technology needed to evaluate the specific constrictions that accompany your individual Narcolepsy case. Sleep tests are also recommended to many patients who experience symptoms of other sleeping disorders; they can are a great tool for separating the identifying symptoms of many different disorders.

Narcolepsy Testing

Not all hospitals are equipped with sleep labs, so you may have to do a little hunting. Many universities have medical campuses that house the necessary facilities. If the university closest to you does not have a sleep clinic, they should be able to point you in the right direction. Choosing a sleep lab for your Narcolepsy testing should be a delicate, well-researched venture. Choose your sleep specialist like you would you psychiatrist; it must be someone that you can trust and are comfortable with because you will be sharing a lot of personal information.

Polysomnogram

The most commonly administered Narcolepsy test used to diagnose and understand the sleeping disorder is the polysomnogram. The polysomnogram is a rather routine test and is also used to test patients with other sleep disorders like Sleep Apnea and Parasomnia. The polysomnogram is an overnight sleep study; the patient sleeps at the facility under the care and supervision of a trained medical professional.

The patient is attached to machine through electrodes and wires. The electrodes are placed on various parts of the sleeper’s body are able to pick up electrical energy from the sleeper and send the information to a machine where the activity is analyzed and interpreted into data that the test administrator records. Brain activity, eye movement, heart rhythm, breathing patterns, oxygen level changes, and even physical movements of the body can all be interpreted and recorded during sleep through a polysomnogram. Because patients with Narcolepsy enter the REM stage of sleep almost immediately upon falling asleep, the polysomnogram is a useful tool for identifying this symptom.

Multiple Sleep Latency Test

Second to the polysomnogram, the Multiple Sleep Latency test is the second most common of all Narcolepsy tests for patients who are experiencing symptoms and signs of the debilitating disorder. This test, also performed in a sleep lab under medical guidance, is used to measure the amount of time that lapses between attempting to fall asleep and actually falling asleep; Multiple Sleep Latency Testing can identify the first physical changes in the body that occur when actual sleep takes place. Like the polysomnogram, this test is often used to diagnose an array of other sleeping disorders, but the MSLT is especially effective at measured the effectiveness of current treatment methods in previously diagnosed patients.

In most cases, Multiple Sleep Latency Tests are performed the day following a polysomnogram test. Performing the test the following day allows you sleep professional to gain a more complete and accurate understanding of your unique symptoms and habits. The test is many hours long, and within this period of time, the patient is given periodic segments of twenty minutes in which he is prompted to nap. If they fall asleep, they are awakened after twenty minutes by the test administrator; if they fall asleep during their scheduled waking time, the test administrator will also wake them. The different changes and reactions that take place in the body upon falling asleep and awakening are recorded for further analysis.

Maintenance of Wakefulness Test

The third most common form of sleep testing used to identify the symptoms of Narcolepsy is the Maintenance of Wakefulness Test. Like the name of the test suggests, this sleep study is used to record a patient’s ability to stay awake. Narcoleptic patients are able to use this test specifically to identify the severity of their sleep attacks, and whether or not they could be a danger to themselves or others. The Maintenance of Wakefulness Test is similar to the Multiple Sleep Latency test in that it is usually administered the day after a polysomnogram and is many hours long.

During the test, the patient is asked to try their best to maintain wakefulness; this way, the administrators are able to tell how well her body is able to stay awake naturally and without any outside influences that might alter the results. If and when a patient falls asleep, the test administrator will wake them up after ninety seconds. The test consists of periodic sessions throughout the day, and if the sleeper does not fall asleep within the first forty minutes of each session, the session will discontinue.

The Maintenance of Wakefulness Test is pretty boring. In most cases, the test is performed in a modest, quiet room that is commonly set up to look something like a hotel room. The test will probably commence a few hours after waking up from the polysomnogram. There are no sounds or distractions in the room; it is meant to be free of any outside influences that may disrupt the patient’s natural ability to stay awake. The patient is placed in a bed sitting upright comfortably (most facilities will offer pillows for the patient’s comfort).

Hypocretin Test

Some Narcolepsy patients, or prospective Narcolepsy patients, are recommended for Hypocretin testing. The fluid that encompasses the spinal cord is called Hypocretin, and testing the levels of Hypocretin around the spinal cord can help doctor’s diagnose Narcolepsy in more difficult cases.

Hypocretin testing takes place through a spinal tap. During a spinal tap, the doctor inserts a needle into the lower back of the patient. The needle reaches the Hypocretin around the spinal cord and is able to retain some of the fluid found there. The fluid is extracted and used for Hypocretin level testing. It is an uncomfortable procedure, and is usually a last resort for patients who may be suffering from Narcolepsy.

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