Narcolepsy: Symptoms, Diagnosis and Treatment

If you have excessive daytime sleepiness with sudden, irrepressible attacks of sleep and find it difficult to stay awake for a long period of time, you may have a chronic condition called narcolepsy.

This disease occurs due to a decrease in alertness caused by a deficit of hypocretin or orexin (a substance that is normally released in the hypothalamus and promotes wakefulness). The cause of the loss of the cells that produce this substance in the brain is not known exactly, although it is thought to have a probable autoimmune origin.

Some of the typical symptoms of narcolepsy are:
– Excessive daytime sleepiness (usually the first and most prevalent symptom): People with narcolepsy fall asleep without warning, anywhere and at any time.
– Sudden loss of muscle tone (cataplexy): It is uncontrollable and is usually triggered by intense emotions such as laughter, fear, surprise, etc. Some people with narcolepsy experience only 1 or 2 episodes of cataplexy per year, while others may have several episodes per day. Not all people with narcolepsy have cataplexy.
– Sleep paralysis (which may occur at sleep onset or upon awakening): Temporary inability to move or speak. These are usually brief episodes of 1-2 minutes, but very distressing.
– Hypnagogic hallucinations (those that occur at the moment of falling asleep): A state of semi-consciousness when dreaming begins that makes the dreams very real and vivid.
– Nocturnal sleep disturbances with episodes of sleep fragmentation.
– Other accompanying symptoms: ReEEcurrent naps throughout the day, automatic behaviors,etc.

Although the symptoms of narcolepsy can appear at any age (from infancy to 45-50 years of age), the first symptoms most often appear between 10 and 25 years of age. However, the definitive diagnosis is almost always delayed by 5 to 10 years, with the consequent detriment to the patient who will remain all these years without receiving adequate treatment.

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To correctly diagnose whether the patient suffers from narcolepsy, we must always perform a previous nocturnal polysomnography to assess the quantity and quality of the patient’s sleep during the night and, the following day, a Multiple Sleep Latency Test (MSLT) which will serve to confirm or not the diagnosis.

Treatment of narcolepsy

Treatment should include both pharmacological measures to treat daytime sleepiness and cataplexy, as well as non-pharmacological measures based on education for both the patient and his or her immediate environment to help them better understand the disease. It will also be key factors for the patient to maintain an adequate sleep hygiene, as well as to make some changes in habits and lifestyle.