Narcolepsy: Why It Happens

Introduction

The first and foremost question that crops up while going through this topic is what is Narcolepsy?  In short, Narcolepsy is a neurological disorder that causes extreme weakness of body muscles resulting in sleepiness throughout the odd hours of the day-even in the midst of a hectic work.
The specialty of this particular decease is that it has nothing to do with any psychological problem and hence, it’s seen that the patient’s social awareness and their ability to respond – as well as their auditory capacity – remain more or less unaffected.

Mild Narcolepsy Symptoms

The primary way to identify a Narcolepsy patient is through the occurrence of Cataplexy, which is a sudden muscle fatigue resulting in strong emotional outburst. Though there are exceptions, it is generally true that up to 70% of Narcolepsy patients also suffer from Cataplexy.

Apart from Cataplexy, the main characteristic of a Narcolepsy patient is falling asleep or feeling drowsy all through the day, even after a sound sleep in the night.
It’s quite common that a patient with Narcolepsy falls asleep in trains and buses, thereby missing the stops. They often fall asleep even while driving their cars, resulting in fatal accidents. There have been instances when a patient has fallen asleep in a dentist’s chamber and have to be shaken awake by the dentist. The more these things occur, the more the patient goes into a social cocoon, withdrawing themselves from the social activities and hence needing immediate medical attention.

This phenomenon is regarded as Excessive Daytime Sleepiness (EDS). Almost 90% of the Narcolepsy patients suffer from this disorder. Other common symptoms are hypnagogic hallucinations. Almost 30% of patients are recorded to suffer from this particular symptom. This particular symptom is attributed to certain dreamy visions those a patient witnesses at the moment of falling asleep. Though one school of thought tends to give certain super-natural angles to this phenomenon, extensive research has shown the exact reason behind this is othing more than a hypnagogic hallucination.

Narcolepsy sufferers also often complain of acute disturbance of sleep during night; some secondary symptoms such as blurred or double vision and dropping eyelids are also very common. Another very common symptom, present in almost 25% of Narcolepsy cases is a condition called Sleep Paralysis. A patient with this particular symptom cannot talk or even move when they are falling asleep or awaking from sleep. This may last anywhere from few seconds to as many as several minutes.
Though in general, Narcolepsy patients have sound sleep at night, there have been certain cases, where a patient has prolonged period of sleeplessness during night, with increased heart rate, occurrence of hot flashes and at certain instances acute alertness for hardly any reason. It’s also often seen that the Narcolepsy patients fall asleep faster than normal, and may get up after hearing an almost inaudible noise.

While a normal person takes about one and a half hour of sleep on an average to see dreams, a Narcolepsy patient can see dreams instantly. As a result of this Rapid Eye Movement (REM) is also a unique feature of a Narcolepsy patient during sleep.  At times this REM can be extremely rapid and abnormal.

The most important phenomenon about Narcolepsy is that except for daytime sleepiness, the other symptoms do not affect the patient to a large extent. Hence, those patients who do not have daytime sleepiness may not seek much medical help, thus hindering a conclusive diagnosis.

It can be mentioned that the symptoms of Narcolepsy may remain hidden for many years. In fact, there are cases where Narcolepsy has been diagnosed after as many as ten years of suffering from the symptoms of the condition. Almost 50% of the adult Narcolepsy patients coming for diagnosis have recorded to have been affected by the disease between 15 and 30 years of age.

Conclusion

In spite of extensive research being conducted all over the world, the exact cause of this particular disease is yet to be recognized. One school of thought claims that Narcolepsy is related to a genetic disorder that exists in the history of a family. It’s believed that up to 10% of all Narcolepsy patients had someone else in their families with the condition.

Another school of thought states that Narcolepsy is an autoimmune disease. In these cases, the immune system of the human body produces cytokines more that what is needed for the human body. This affects the immunity system of the body resulting in a series of disorders of various kinds. In this train of thought, researchers believe that the Narcolepsy condition itself may attack those cells which contain brain peptide hypocretin (orexin). This results in certain deficiencies those are the major factors responsible for this disease.

One striking phenomenon that is generally noticed in patients with Narcolepsy is that they contain very low levels of Hypocretin in their body. Though we do not know what exactly causes the damage of the Hypocretin cells, it may be the result of an infection.

Some say that the exact reason of this disease can be a particular type of infection that affects the genetic order. Certain hormonal changes at different stages of life, the environment of the patient, the stress of day-to-day life can also be responsible. A recent study has come out with startling results, though. Almost all the patients of Narcolepsy are recorded to carry HLA-DR15 and HLA-DQ6 gene. Hence, it can be said these gene are more susceptible to Narcolepsy than the others. With research in genetics reaching newer heights and gene mapping already in vogue, we can expect the disease to be eradicated sooner than later.

Narcolepsy in Children: What Every Parent Needs to Know

What are the Symptoms of Narcolepsy in Children?

Most of the symptoms that are present in adult Narcolepsy patients are seen in children with Narcolepsy. The big four symptoms, most commonly used to identify narcoleptic patients are the same four symptoms that adults look for.

The BIG FOUR

  • Daytime Sleepiness: Narcoleptic children are always tired during the day, even if they slept a healthy amount the night before. Children with Narcolepsy fall asleep many times throughout the day and experience a hard time staying awake.
  • Cataplexy: Like in narcoleptic adults, Cataplexy is a very rare development that accompanies the disorder. It is just as possible for narcoleptic children to develop Cataplexy as it is for older patiyou’rents, but it is much more dangerous in small children. Most young children need constant supervision to ensure their safety. Children with Cataplexy need much more physical attention and cautionary care than other children. Children with Cataplexy are often seen as despondent or depressed. Strong emotional responses like laughter could cause them to suddenly fall into a Cataplexy episode, so they are scared to encounter the emotional response.
  • Sleep Paralysis: Children with Narcolepsy often experience periods of paralysis when falling asleep and/or waking up. For a short period of time, ranging from a few seconds to a few moments, the child experiencing sleep paralysis has no control over their ability to move their body, speak, or even move their eyes. The child is completely aware the entire time, but unable to function.
  • Hypnagogic Hallucinations: Hypnagogic Hallucinations in narcoleptic children are often misdiagnosed as simple “bad dreams” or night terrors. If your child is experiencing habitual, vividly overwhelming dreams, you may want to look deeper at the root of the problem.

Other Symptoms of Narcolepsy in Children:

Children with Narcolepsy may also exhibit other physical symptoms of their disorder. In fact, hyperactivity and lack of focus are two of the most commonly identified symptoms of Narcolepsy in children.

  • Problems Falling Asleep
  • Sudden Deep Sleep
  • Excessive Day Sleep
  • Disrupted Sleeping Patterns
  • Automatic Behavior
  • Memory Loss
  • Lack of Concentration
  • Falling Grades
  • Substance Abuse
  • Low Motivation
  • Mood Swings
  • Difficulty Keeping up with Peers

How is Narcolepsy in Children Diagnosed?

Children who may be suffering from Narcolepsy are diagnosed in the same fashion as adults. After a thorough physical examination of the child, a thorough record of personal and family medical history will be taken. If a diagnosis cannot be reached, the child may be referred to a sleep clinic where they will be suggested to participate in a sleep study- most commonly the polysomnogram and the Multiple Sleep Latency Test.

How Can you Treat Children and Narcolepsy?

  • Medication: Prescription medications are often given to treat the effects of Narcolepsy in children. Antidepressants and hyperactivity medications like Adderall and Ritalin are most common.
  • Behavior Modification:
  • Follow an extremely strict sleeping schedule- Wake up and fall asleep at the same times everyday.
  1. Before bed, do relaxing activities with your child; read them a book or give them a bath. Do the same activity before bed every night to instill a sense of routine and composure in your child.
  2. Change, or rearrange medications under the supervision of a medical professional.
  3. Avoid dangerous activities like swimming, coking, driving, or playing unsupervised. Activities that require a certain level of risk involved are only recommended for the times of day when a young child or adolescent feels most alert.
  4. Encourage your child to increase their physical activity during the day. Exercise will help your child’s brain regulate sleeping patterns, as well as keep the immune system healthy and powerful.
  5. Keep your child away from tasks they may find boring or too repetitive. An interested child is an alert child.
  6. Eat healthy meals with your child at a scheduled time. Meals should consist of well balanced, small portions of food and should be eaten more frequently throughout the day.
  • Napping Schedule: If your child is suffering from Narcolepsy, try your best to help them get an adequate amount of sleep every night; this means including a sleeping schedule that accommodates the suggested amount of sleep for the age group of your child. Deciding whether or not a narcoleptic child is safe to nap during the day can be tricky. Generally, it is recommended that parents let narcoleptic children take one to two short naps during the day, but no more than absolutely needed.

Tips for Caring for Children with Narcolepsy

  • Narcolepsy is a scary and overwhelming disease for all age groups who struggle with it. Many adult narcoleptics feel a sense of shame and embarrassment surrounding the oddity of their disorder. Imagine how that embarrassment must feel to a young child who just found out that they’re different from everyone else. It’s going to be a long, winding, and sometimes painful road for your child when it comes to managing and accepting their disorder.
  • As a parent, your job is to be there for children whenever they need it. Be an open book; if your child has questions about their medical condition, tell them the truth. Help your child know that they are still beautiful and normal even though they have a disorder that sets them apart. You are going to be their biggest support system while they struggle to deal with the complications of childhood Narcolepsy.
  • Help your child follow all of the treatment suggestions given by your doctor. If your child was prescribed medication, make sure that they take it accordingly and responsibly. If your doctor places any dietary or physical restrictions on your child, help them stick to the commitment.
  • Education and conversation is the key to making a young child with Narcolepsy, or any other uncommon disorder, feel comfortable. If your child, or the child of someone close to you, has recently been diagnosed with an uncommon disorder, make sure that you make the effort to educate the people around you on the subject. Help them understand the symptoms and causes of Narcolepsy in children.
  • Plan for a future that includes a child with Narcolepsy. Evaluate how this development will affect your home, work, education, and family. Start planning for the necessary changes that must occur to accommodate a child with Narcolepsy early so that you will be well-prepared for situations yet to come.
  • Let your family, friends, colleagues, and school administrators know about your child’s condition as soon as possible; this way, all the necessary modifications that need to be made to suit your child’s special needs will be in place prior to your arrival. If you fail to point out your child’s unique medical and physical needs, they may gain a false reputation of laziness or unintelligence.
  • Look for support in the community. Narcolepsy is not a common disorder, but you’d be surprised to see how much support is right around the corner. Look for support groups in town, and in surrounding locations, that are geared towards assisting children with debilitating disorders like Narcolepsy or Cataplexy.
  • If you have trouble finding a support group locally, ask your doctor or medical care provider. In some cases, your medical professional may not be to knowledgeable about sleep disorders and testing. When they are unable to point you in the right direction, try your local universities and libraries.
  • When looking for support locally fails, hop on the internet and see what you can find near you.

The Difficulties in Diagnosing Narcolepsy

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.

Estufs

Asparagus WebArt