Types of Narcolepsy

Although narcolepsy without cataplexy happens often, Cataplexy almost never occurs without narcolepsy, except in the rare case that is the result of a major brain trauma.

Some drug therapy and lifestyle changes can take care of mild symptoms of narcolepsy and without cataplexy, it can be managed easily enough to maintain a normal life.

What is Cataplexy?

Cataplexy is exclusively a symptom of narcolepsy that is experienced by seventy percent of the 3 million people who suffer from narcolepsy worldwide.

Narcolepsy with cataplexy has its own biomarker. That is, there is a specific, measurable trait that is exhibited by most narcolepsy patients with the symptom of cataplexy. The peptide hypocretin-1, which is derived from the hypothalamus in patients with healthy sleep patterns and a narcoleptic without cataplexy, tends to be deficient in cataplectic. This unique feature has earned Narcolepsy with Cataplexy its own separate diagnosis from the narcolepsy without cataplexy.

Most Narcolepsy symptoms can be seen as a disassociated part of REM sleep. Cataplexy is no different. One of the things that happen during REM sleep is that the body’s muscles lose tone and go limp. Cataplexy is the same phenomenon, during wakefulness.

Hypocretin-1 plays a major role in the sleep/wake cycles of the brain. A deficiency manifests itself in the symptom of cataplexy. There is no correlation between hypocretin-1 deficiencies without cataplexy in narcolepsy, making it an unreliable test for narcolepsy without cataplexy.

Cataplexy is the uncontrollable loss of muscle tone. It can be a minor annoyance or a major event. Either way, it can be embarrassing to the person suffering from it. Cataplexy episodes are triggered by strong emotional response. Anger and robust laughter are at the top of the list.

A cataplectic episode can range from unnoticeable to a serious event.

Mild Cataplexy

When cataplexy is mild, it can go unnoticed. Perhaps the patient experiences a little clumsiness or trips. It can manifest in a single tiny muscle group, usually in the face. A droopy eyelid or momentary slackening of the jaw can be from cataplexy. Cataplexy can last as little as a few seconds, hardly giving it enough time to register as ever having happened at all.

Severe Cataplexy

Cataplexy can last for over an hour. It can affect the arms or legs. It commonly affects the neck, resulting in the head suddenly falling forward. In some cases, the entire body is affected. The result is a total collapse. The subject is awake and alert, but unable to move or communicate. It can be frightening to experience, especially when it is new.

Diagnosing Cataplexy

Diagnosing narcolepsy without cataplexy and narcolepsy with cataplexy is done much the same way. There are no simple blood tests that reveal the disorder. Even testing for a hypocretin-1 deficiency is a difficult and painful process. It requires a spinal tap to test the spinal fluids. Because of the risk involved, this kind of test is not likely to become a mainstream diagnostic tool.

Without cataplexy, narcoleptic diagnosis involves a detailed history and the use of sleep studies.

Sleep studies include the nocturnal Polysomnogram and the multiple sleep latency test (MSLT). The MSLT is the currently accepted standard in testing and data collection for the diagnosis without cataplexy of narcolepsy.

The nocturnal Polysomnogram and the MSLT are usually done together, consecutively. This way, a physician can get a complete portrait of sleep habits and REM cycles of his or her patient.

The tests are performed in a sleep clinic. The subject has a continuous electroencephalogram (EEG) while they are settled into a room in which to sleep. The EEG and visual monitoring will be used to record everything the patient experiences during a restful state.

For the nocturnal Polysomnogram, they will spend the night. For the MSLT, the next day they will have 5 scheduled naps that are 2 hours apart and will last for 20 minutes.

With the presence of moderate to severe cataplexy, diagnosis is simple, since cataplexy is a narcolepsy specific symptom, if it is present, a diagnosis of narcolepsy with cataplexy is certain to follow. If the episodes are milder, a detailed history and probably the use of journaling the symptomatic episodes may be required as there is no other way to uncover the existence of cataplexy.

Cataplexy Treatments

Without cataplexy narcoleptic symptoms can often be managed with careful lifestyle changes such as dietary guidelines, strict adherence of bedtimes and scheduled daytime naps. Often, drug therapies that include the use of stimulants and antidepressants are required.

Narcolepsy patients with cataplexy almost always need to be treated with drugs.

Behavioral and Pharmacological Treatments

Behavioral

for narcolepsy

Pharmacological:

For EDS

Pharmacological:

For cataplexy

avoid sleep deprivation

Methylphenidate

Xyrem

sodium oxybate

strategic naps

Amphetamine

Protriptyline

avoid caffeine

Modafinil

Imipramine

involve the people you associate with regularly

Selegiline

(also anti-cataplectic)

Selective serotonin reuptake inhibitors

Sodium Oxybate

The most effective drug treatment for cataplexy and EDS is gammahydroxybutyric acid (GHB). It is the only drug approved by the FDA for the treatment of cataplexy. It is sold in the USA as sodium oxybate and is produces as the drug Xyrem.

Xyrem works on the part of the brain that controls sleep cycles. At higher levels, as a very effective sedative. Promoting deep restful sleep at lower levels it is a stimulant that keeps EDS at bay.

GHB is a highly regulated substance as it is associated with illegal abuse. IT has a high rate of dependence and serious withdrawal symptoms. It induces a euphoric effect that is similar to the street drug ecstasy and it has been used to facilitate date rape. It has the ability to stimulate the human growth hormone and so it has also been abused by body builders. Overdoses of GHB can result in respiratory depression, bradycardia, seizures and death.

The most common side effects of Xyrem are:

headache
nausea and vomiting
dizziness
nasopharyngitis
somnolence
urinary incontinence

Sodium Oxybate needs careful consideration with patients that have heart concerns as it raises sodium levels in the blood.

Narcolepsy is an intrusive sleeping disorder that is currently affecting around 200,000 American people. Narcolepsy is one of medical science’s most unique sleeping disorders. Not only is Narcolepsy itself an odd and interesting disorder, it comes as a package deal with various other unique medical problems like Cataplexy, hallucinations, Automatic Behavior, and even Sleep Paralysis. Patients who have been diagnosed with the disorder should learn about all types of Narcolepsy, and undiagnosed patients who may be suffering should study Narcolepsy and its different types.

The Different Types of Narcolepsy

Technically, there are not different types of Narcolepsy. Unlike other sleep disorders like Sleep Apnea, there is not a central and an obstructive classification. Narcolepsy is the same in all patients who suffer from its symptoms. The disorder is defined as the uncontrollable urge to sleep at inappropriate times during the day; this is absolutely true in all patients with Narcolepsy, so technically, there is one medically recognized type of the disorder.

More often than not, however, most Narcolepsy patients experience at least one or more complicated disorders in addition to their Narcolepsy. The majority of narcoleptics also suffer from one of the following four complications: Cataplexy, Hypnagogic Hallucinations, Automatic Behavior, and Sleep Paralysis.

Narcolepsy with Cataplexy

Only three million people in the entire world suffer from some type/degree of Narcolepsy. Out of those three million people, only two percent also suffer from Cataplexy. Cataplexy is thought to be unique to Narcolepsy patients, and is often one of the disorder’s primary identifiers; it is often associated with other Narcolepsy symptoms like Sleep Paralysis and hallucinations.

Cataplexy is defined as the sudden loss of muscle tone and strength coupled with severe daytime sleepiness. The sudden loss of muscle strength can be mild or severe. In mild Cataplexy episodes, there may only be a small portion of muscle on the body that becomes paralyzed. In opposition, severe episodes of Cataplexy can leave the entire body unable to move or speak for several minutes at a time. These sudden changes in muscle tone are often triggered by the patient’s witnessing of a strong emotional response.

Laughter, crying, and shouting are some of the most common triggers in people with this type of Narcolepsy.

Cataplexy is extremely dangerous, and is one the leading causes for accidents, especially automobile accidents. Because Narcolepsy patients are unable to determine when an episode of Cataplexy will occur, there Cataplexy victims often live in constant fear of witnessing a trigger and embarrassing themselves in public.

Narcolepsy with Hallucinations

Unlike the rare Cataplexy, this type of Narcolepsy is extremely common. Patients who suffer from Narcolepsy are at a high risk for experiencing Hypnagogic Hallucinations; in fact, hallucinations are one of the disorder’s most commonly recognizable symptoms. Where Cataplexy is only present in two percent of all Narcolepsy patients across the world, as many as fifty percent of all narcoleptics are thought to suffer from Hypnagogic Hallucinations.

There are two main types of hallucinations: Hypnagogic Hallucinations and Hypnopompic Hallucinations. Hypnagogic Hallucinations occur during the transitional period that takes place when the brain is shifting from a place of wakefulness to one of sleep. Hypnopompic Hallucinations, on the other hand, are the opposite; these hallucinations occur when the body is shifting from a place of sleep to one of wakefulness. Hypnagogic Hallucinations are seen in this type of Narcolepsy, and can be extremely vivid.

Patients who also suffer from Hypnagogic Hallucinations experience intense dream-like visions when they are falling asleep. Many Hypnagogic Hallucinations incorporate various images that actually present in the sleeper’s environment into vivid hallucinations. These hallucinations can involve the manipulation of the patient’s vision, hearing, sense of touch, sense of balance, and even their ability to move. Many Narcolepsy patients who suffer from the hallucinations describe them as bizarre, and even frightening. Because the hallucinations are so realistic, patients become afraid of them; many patients even fear the hallucinations as a sign of mental instability.

Narcolepsy with Automatic Behavior

One of the most interesting, and consequently dangerous, types of Narcolepsy includes symptoms of Automatic Behavior. Often confused with sleep walking, Automatic Behavior refers to the continuation of an activity that was taking place while before falling asleep after falling asleep. In many cases, Automatic Behavior occurs when patients with this type of Narcolepsy attempt to fight off sleepiness in an effort to complete an activity. For example, patients who suffer from this type of Narcolepsy may suddenly fall asleep while washing the dishes. Instead of dropping the plate they were holding when they suddenly fell asleep, patients with Automatic behavior continue washing the plate as if they remained awake.

Although Narcolepsy patients with Automatic Behavior continue performing the activity while unconscious, they have absolutely no memory of the even upon wakening; the event is out of conscious control. Unconscious periods of continued behavior can last anywhere from a few short seconds to as long as half an hour. Patients who experience this unique disorder often wake up in strange places disoriented and frightened. Automatic Behavior becomes a serious and dangerous problem when it occurs during dangerous activities like driving or cooking.

Automatic Behavior, also called automatism, is not unique to Narcolepsy types. It is a common symptom of many different psychiatric and neurological disorders. Schizophrenia and Fugue are common psychiatric disorders that are associated with Automatic behavior.

Narcolepsy with Sleep Paralysis

Although it is possible to see symptoms of Sleep Paralysis in patients plagued with disorders other than Narcolepsy, Sleep Paralysis is most commonly associated with this form of Narcolepsy. In addition to Cataplexy and hallucinations, Sleep Paralysis, which can also be called Isolated Sleep Paralysis, completes the trio of famous Narcolepsy identifiers (in addition to daytime sleepiness, of course).

Narcoleptics who suffer from Sleep Paralysis experience periods on paralysis, either when going to sleep or upon wakening. During an attack of Sleep Paralysis, the victim is completely unable to move voluntarily, and must wait for the attack to pass. Although Sleep Paralysis is passing, and not physically harmful, it can still be terrifying and stressful to try and deal with on top of Narcolepsy’s other problems and complications.

While most Narcolepsy cases contain varying levels of each of these four symptoms, every patient’s case it unique. In most cases, one symptom is more prevalent than the others.

Does Cataplexy without Narcolepsy happen?

What is Cataplexy?

Diagnosing Cataplexy

Cataplexy Treatments

Behavioral and Pharmacological Treatments

Sodium Oxybate