Every individual with narcolepsy has excessive daytime sleepiness throughout the day.
The following are some of the more common signs and symptoms of excessive daytime drowsiness caused by narcolepsy:
- Sleep Attacks - Irrational desire to sleep
- Frequent Tiredness - Having difficulty keeping awake and alert throughout the day
- Unrefreshing Sleep - Regardless of how much sleep you've had, you're exhausted.
- Brain Fog - Having trouble focusing and paying attention during the day
How is narcolepsy-related excessive daytime sleepiness assessed?
The Epworth Sleepiness Scale is a frequently used measure by physicians to determine a patient's level of fatigue. This quiz assesses an individual's proclivity for napping or falling asleep in common settings such as reading, watching television, conversing with a friend, or driving. The Epworth Sleepiness Scale can be used to screen for sleepiness, but a sleep study is usually required to establish a diagnosis.
Numerous healthcare providers (HCPs) can help in the diagnosis of narcolepsy-related excessive daytime sleepiness. If you suspect you are experiencing any of the aforementioned signs or symptoms, contact your primary care physician or another HCP, such as a sleep specialist, neurologist, psychiatrist, nurse practitioner, or physician's assistant.
Narcolepsy is a chronic, possibly severe neurologic disorder that is believed to develop when specific chemicals in the brain are unable to regulate your body's sleep-wake cycle.
In the United States, narcolepsy is believed to affect one out of every 2,000 persons.
Due to the difficulty in recognizing the signs and symptoms, people living with narcolepsy may visit multiple doctors over a period of years before receiving a diagnosis.
If you've been diagnosed with narcolepsy and are still having trouble staying awake throughout the day, see your doctor.
Narcolepsy is an uncommon illness that affects both sexes equally — with an incidence of 0.02 percent to 0.06 percent. The majority of patients with narcolepsy develop symptoms during adolescence, with a peak onset age of between 15 and 25 years. If a patient is over the age of 30, practitioners should evaluate OSA before narcolepsy.
Narcolepsy is classified into two subtypes: type 1 (hypocretin insufficiency with cataplexy) and type 2 (hypocretin deficiency without cataplexy) (hypocretin deficiency without cataplexy). Patients with narcolepsy have an 85–95 percent loss in the number of hypocretin neurons, resulting in an inability to maintain stable wake and sleep states. Narcolepsy, which is believed to be an autoimmune illness of the brain, is strongly related to the DQB1*0602 allele of the human leukocyte antigen (HLA).14
EDS with or without cataplexy, sleep paralysis, and hypnagogic hallucinations are the typical triad of narcolepsy symptoms. Throughout the day, unwanted sleep episodes occur, most frequently when a patient is sedentary or bored. Patients with narcolepsy have more dreams and enter REM sleep more quickly than non-narcoleptic patients, who normally need 90 minutes to enter REM sleep.
Cataplexy occurs in around 60% to 70% of people with narcolepsy. It is a sudden reduction of muscle tone that occurs most frequently during periods of intense emotional response such as laughter, wrath, or surprise. Cataplexy can manifest in a variety of ways; some patients will collapse to the ground, while others will only have weakness in their extremities. Asleep specialists or neurologists can assist in diagnosing cataplexy in milder forms.
Sleep paralysis, which affects 25% to 50% of patients with narcolepsy, is a terrifying experience for the individual. Patients awake is unable to move or talk and with a sense of impending death, along with related anxiety. Although sleep paralysis can occur in persons without narcolepsy, any patient presenting with sleep paralysis should be evaluated for narcolepsy.
Hypnagogic hallucinations are reported to occur in 33% to more than 80% of patients with narcolepsy. These hallucinations, which occur at the onset of sleep, can be powerful and distressing, manifesting as aural or visual hallucinations. They can seem so genuine that patients have reported calling the police to report an intruder in their house, only to discover afterward that the invader was a part of their dream.
A clinical diagnosis of EDS and a positive Multiple Sleep Latency Test are required for narcolepsy (MSLT) which can be treated by modvigil 200 mg as well as waklert 150 mg. A mean sleep-onset delay of 8 minutes on MSLT and two sleep-onset REM episodes during five scheduled naps are required. An MSLT should be performed following an overnight polysomnogram to rule out other sleep disorders such as obstructive sleep apnea (OSA). Additionally, genetic testing can be utilized to identify persons at risk of developing narcolepsy.