Everything you need to know about narcolepsy
For the population of the United States of America, there is a 1 in 2000 chance of suffering from narcolepsy. Based on various studies, it has been determined that the probability of this disorder is the same in men and women. Usually 10% of people with narcolepsy have someone in their family who suffers from this disorder. As mentioned, narcolepsy can occur at any age, but the first signs of this disease are seen in teenagers or people under 20 years of age. However, it is interesting to know that the symptoms of narcolepsy are similar to the symptoms of depression or other psychological disorders. For this reason, most of the time this disorder remains unknown in the person and the person in question does not even know that he has this rare disease.
Narcolepsy generally has two types as described below. is:
- Narcolepsy type 1 (or narcolepsy with cataplexy): People with narcolepsy type 1 suffer from cataplexy disorder in addition to sleeping too much during the day. . Cataplexy means loss of muscle tone in an awake person, which causes weakness and loss of voluntary control of striated and voluntary body muscles. In this type of narcolepsy, a small amount of a chemical substance called hypocretin is secreted in the human brain.
- Narcolepsy type 2 (or narcolepsy without cataplexy): a patient with this type From narcolepsy, he has not experienced cataplexy, and on the other hand, he has a certain and normal amount of hypocretin in his body. https://safirsoft.com/picsbody/2211/17634-2.jpg">
Scientists have discovered that people with narcolepsy have a small amount of a special chemical signal in the brain called hypocretin in their bodies. Hypocretin is important for regulating the sleep/wake cycle, such as the rapid eye movement (REM) state. The decrease or lack of hypocretin causes excessive sleepiness and the REM phase is activated when the person wakes up; The process that a person dreams in this process. With all these interpretations, there are other possible factors that scientists believe are involved in the development of narcolepsy:
- an autoimmune disorder: the immune system of the individual, to It attacks brain cells that produce hypocretin. For this reason, the level of hypocretin decreases.
- Family history: Some patients may know people in their family who suffer from exactly this kind of sleep attacks. li>
- Brain injury or tumor: In a limited number of patients, the areas of the brain that control the process of REM sleep and wakefulness can be disrupted by disease, tumor, or a severe injury. li>
- Environmental toxins: These substances include pesticides, heavy metals, and inhalation of smoke from cigarettes and drugs. narcolepsy symptoms The basis of the age of different people is reported. However, the symptoms caused by narcolepsy can be summarized as follows:
Excessive daytime sleepiness (EDS)
All patients with narcolepsy have this symptom. In general, EDS is associated with normal activities such as work, school, and even daily social activities. Although a short nap during the day can make a person feel better, the feeling of tiredness comes back after one to two hours. Patients with EDS reports are usually at a very low level in terms of concentration power and energy level, and they also have sensory and memory disorders. The feeling of depression or excessive fatigue is very noticeable in these patients.
This symptom, as mentioned, is a sudden loss of tone and muscle strength. Seizures can occur at any time while awake. Attacks have a diverse scope; From locked knees, muscle weakness The jaw or tearing from the eyes to the complete paralysis of the body, due to which the person may fall suddenly.
Cataplexy can usually last from a few seconds to a few minutes. The patient is fully aware and awake during the attacks. However, one patient may experience only a few limited episodes of cataplexy in his lifetime, and another person may experience several episodes of cataplexy each day. Although a frightening situation is evoked for the patient and those around him, no damage is done to the body during these attacks. Of course, provided that the patient does not fall from a height all at once.
Night sleep disorder
A patient with narcolepsy wakes up several times during the night. This process can induce a fatal negative effect on the patient's quality of life.
This symptom is defined as the inability to move or speak before falling asleep or after waking up. Sleep paralysis is usually removed from a few seconds to a few minutes after this happens.
Usually hallucinatory experiences are clear and transparent and therefore possible. It is scary for the patient. Hallucinations often occur before the patient falls asleep. Patients often report that the hallucinations are visual in nature and that they are easily confronted with them. However, in some medical records, it has been reported that patients with narcolepsy have also experienced auditory and olfactory hallucinations. Examples of hallucinations include seeing a person or animal in a closed space, feeling touched or floating in the environment, and hearing an alarm or the voice of others.
Automatic behavior means that the sudden falling asleep of a patient for a few seconds can be defined as a routine activity during the day and night for the patient. Just as the patient has to eat, talk to others, drive and do other things during the day, sleeping for a few moments is done routinely among these activities.
Diagnosis of narcolepsy h2>
Typically, narcolepsy is diagnosed with a physical exam, patient history, medications the person is taking, and sleep studies. They recognize In the sleep centers, the sick person is given a wristband with a motion sensor called Actigraph, which monitors the state of sleep for several weeks. This wristband reminds the person how many years he slept during the day and how many hours of the day he was awake.
To definitively diagnose narcolepsy, two important tests called polysomnogram (PSG) and multiple sleep latency test (MSLT) exists. These tests are usually performed in sleep disorders centers and in order to successfully perform the tests, the patient must be present in these centers for one night. PSG test is a midnight test that measures several factors such as heart rate, It measures oxygen, breathing rate, eye and leg movements, and brain waves during sleep
PSG test is a midnight test that measures several factors such as heart rate, oxygen level, breathing rate, eye and leg movements, and It measures brain waves during sleep. In fact, by performing the PGS test, it is determined how fast a person falls asleep, how many times he wakes up during the night, and how many times the REM stage of sleep is disturbed. This test is done so that researchers can check whether the symptoms of sleep attacks are not caused by another disease such as obstructive sleep apnea. Normally, patients with narcolepsy show disturbances in their normal sleep patterns.
The MSLT test is performed during the day, right after the PSG test. During the MSLT test, the patient is programmed to take five short naps spaced two hours apart. By performing the MSLT test, researchers check how quickly the patient falls asleep and how quickly he enters the REM stage.
Treatment of narcolepsy
Management of narcolepsy includes medication and lifestyle changes. The goal of treating narcolepsy is to reduce the amount of sleep during the day and improve the person's state of consciousness during the waking period. Treatment for EDS or excessive daytime sleepiness is available in the market.
These drugs, as their name suggests, help the patient to be awake during the day. But they are unable to treat cataplexy or other symptoms associated with REM sleep in narcolepsy. Modafinil (Provigil) or armudafinil (Novigil) are usually the first medications prescribed; Because it has few side effects and is less addictive than other drug stimulants.
Solriamphetol (Sanosi) and Pitolisant (Vikis) can be mentioned among the drugs that have been recently approved for use. Solriamfetol is used to improve wakefulness in adults with narcolepsy. Pitolisant is the first drug to treat EDS narcolepsy has been approved. The latter two drugs work in the brain in a different way than other drugs on the market.
Zairem brand sodium Oxibit is the only drug approved by the United States Food and Drug Administration, which is used to treat daytime sleepiness and cataplexy in patients with narcolepsy. This medicine is in liquid form and should be taken before going to bed and 2.5 to 4 hours after sleeping. This medicine should not be given to the patient during the day. Due to the presence of very high amounts of sodium, patients who take this drug should be careful about the consumption of salt in their food basket. Such as amphetamine/dextroamphetamine or the combined salts of dextroamphetamine and methylphenidate, which are effective in the treatment of EDS, but have many side effects compared to stimulants that enhance wakefulness. Stimulants can produce side effects similar to those of caffeine, such as anxiety, irritability, and palpitations. These side effects start at a low dose and increase over time. For this reason, in case of taking stimulants, the patient's condition should be carefully monitored; Because increased blood pressure and cardiac arrhythmia (irregular heart beat) have been reported in patients. Antidepressant treatment: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Examples of TCAs include protriptyline, clomipramine, and desipramine. Examples of SSRIs include fluoxetine, atomoxetine, and sertraline. SSRIs usually have fewer side effects than TCAs. However, it is interesting to know that these drugs are not yet fully available in the market because they have not yet been approved by the US Food and Drug Administration.
It may take from several weeks to several months for the effective drug To find the treatment of the patient and on the other hand to find the best dose for the patient. In any case, the doctor may advise the patient to avoid taking antihistamine products; Because antihistamines block histamine in the blood, which helps the body to stay awake and alert.
Lifestyle changes; Another way to manage narcolepsy
To reduce the condition of sleep disorder, you can manage your lifestyle with the following recommendations
- Follow a regular sleep/wake schedule. Go to bed at the same time every day and wake up at the same time. Do not deliberately induce sleep deprivation in your body. It means don't stay up late on the weekend.
- Keep your bedroom quiet, dark, cool and pleasant. Do not watch TV in bed and do not bring smartphones and computers into bed.
- Do not consume caffeine and alcoholic beverages a few hours before sleep.
- Avoid smoking, especially in the evening. Avoid separately.
- Exercise every day for at least 20 minutes a day. Do not exercise three hours before going to bed.
- Do not consume heavy food with a large volume of liquids near the bed.
- Relax before going to bed. Take a hot bath and try yoga. Listen to soothing music. Use the scent of eucalyptus and mint to perfume the environment.
- If you feel very tired, take a short nap of 20 to 30 minutes. Of course, if possible!
Is it possible to prevent narcolepsy?
There is still not much information available about the prevention of narcolepsy. Currently, we know that this disease is caused by the lack of hypocretin chemical signal. Hypocretin is important for regulating the sleep/wake cycle. Other causes include an autoimmune disease that attacks hypocretin-producing cells. This disease is currently not curable. For this reason, it is currently not possible to suggest a way to definitively prevent the occurrence of narcolepsy in a person.Currently, there is no definitive treatment for narcolepsy. There is no definitive diagnosis for narcolepsy. For this reason, the patient must deal with this disorder in a reasonable way for the rest of his life. Fortunately, usually this complication does not become more serious and acute with increasing age. The use of chemical drugs and of course lifestyle changes can only prevent the development of narcolepsy symptoms.
A person with narcolepsy must be extremely careful in performing some activities such as driving. For this reason, it is usually recommended that the patient take a short nap before driving and only then start driving. On the other hand, it is highly recommended to have another person in the car to talk to the driver. Refer to one of the sleep treatment centers as soon as possible. Early diagnosis of this disease can prevent the symptoms of narcolepsy from progressing further. Undoubtedly, the use of various drugs can significantly reduce the risks of sleep attacks and, on the other hand, lead to a better quality of life for a person.