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Staying awake shouldn't be a struggle
Narcolepsy is a disease of the central nervous system due to the deficiency of a protein called hypocretin which is important in controlling the timing, expression and occurrence of components of normal sleep. When hypocretin is deficient, components of rapid-eye movement sleep will suddenly occur during waking hours.
Symptoms of narcolepsy include:
- Excessive Daytime Sleepiness which occurs in the form of sudden irresistible sleep attacks, continual disabling drowsiness, and microsleeps which are brief intrusions of sleep into wakefulness which can make driving hazardous. Uncontrollable sleep can be perceived as sloth or laziness and affect work performance and personal relationships.
- Catalepsy is the sudden loss of voluntary muscle control brought about by severe fatigue, stress, and commonly, laughter, anger or fear. Loss of muscle tone can be as obvious as total body collapse or as subtle as buckling of the knees or sagging of the jaw and facial muscles. Episodes can be momentary or last as long as a half hour, after which there is complete recovery. Episodes are unexpected, and often embarrassing and can create life threatening situations.
- Sleep Paralysis is the spontaneous and unexpected inability to move that can occur in the period of time that exists while falling asleep and waking up. These episodes resolve spontaneously without side effects.
- Hypnagogic Hallucinations also occur during the drowsy periods that intervene as we fall asleep and arise out of sleep. They can be visual and sometimes auditory. They represent dream fragments that persist out of sleep into wakefulness.
All of these phenomena represent the actual intrusion of sleep components into wakefulness. They do not represent psychological problems.
Narcolepsy is a permanent disease. At this time, treatment is aimed only at symptom control and not direct treatment of the disease itself. Stimulants such as Ritalin and Dexedrine and the vigilance promoting drug Provigil are used to promote wakefulness. Serotonin reuptake inhibitors are used to control catalepsy and the other symptoms of narcolepsy.
Adjustments to lifestyle include:
- have regular sleep and awake times
- short scheduled naps at lunch and the early evening
- avoid the use of alcohol
- prevent exhaustion
- cease driving or other hazardous activities if symptoms are not controlled
- notify school officials or work supervisors so that the condition can be understood and accommodations can be made
Sleep Disorders Center at Regional Medical Center
Madisonville, Kentucky
(270) 825-5730 or 1-800-635-6506
Medical Director James Davis, MD
Clinical Coordinator Penny Hardison, RRT, RPSGT
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