Narcolepsy

Narcolepsy is a malfunction of the sleep/wake regulating system in the brain of unknown origin. Its most common manifestation is an irresistible tendency to fall asleep, even in unlikely circumstances such as in the middle of a conversation or at a meal. These sleep attacks are brief periods of sleep during the person's normal waking. In order for narcolepsy to be diagnosed, a person must have suffered from the sleep attacks for at least three months. The diagnostic criteria is as follows:

Each day for 3 months or more the patient has had irresistible attacks of refreshing sleep.

The person experiences either or both of:

Cataplexy (sudden, brief loss of muscle tone bilaterally, usually associated with intense emotion) Intrusions of REM sleep into transitions between waking and sleeping, as shown by

either of:

Hypnagogic or hypnopompic hallucinations or Sleep paralysis at the beginning or end of sleep.

These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Associated Features:

Substance-Related
REM Sleep Behavior
Enuresis

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

MDD
Dysthymia

Cause:

Narcolepsy can occur in people of both sexes. Symptoms, particularly sleepiness usually begin in late childhood, the teen years or the early twenties. Narcolepsy can begin after the age of 30: but such is relatively uncommon. In contrast, while sleep apnea can develop in childhood, it more often becomes a significant and progressive problem later in life.

The usual cause appears to be a problem with the chemical neurotransmitters that regulate communications between different groups of nerve cells in the brain. Only rare cases have been reported of narcolepsy arising as the consequence of such structural causes as brain tumors, brain infections and head injuries. CT/MRI scans of the brain are normal in the vast majority of cases.

Narcolepsy can run in families such that some individuals appear genetically predisposed to develop it. Its onset sometimes follows stressful events, but such does not indicate that it is a psychological disorder. In fact, some breeds of dogs develop narcolepsy on a genetic basis.

Treatment:

Narcolepsy may be complicated by emotional or physical problems therefore treatment my have to involve a multi-discipline approach. There is no known cure for narcolepsy and treatment therefore is aimed at control of the symptoms.

Counseling and Psychotherapy

Lifestyle adjustments and learning to cope with the emotional and other effects of the disorder may improve functioning in work and social activities. Planned naps and sleeping may help to regulate daytime sleep and reduce the number of unplanned, sudden sleep attacks.

Pharmacotherapy

Prescription medications may be required for some persons, including stimulants . Antidepressant medications such as  may be helpful in reducing episodes of cataplexy but usually do not reduce the number of sleeping episodes.

Stimulants:
Dextroamphetamine (Dexedrine).
Methylphenidate (Ritalin).
Pemoline (Cylert).

Antidepressants:
Imipramine (Janimine, Tofranil).
Protriptyline (Vivactile).