NARCOLEPSY

SIGNS
SIGNS AND
AND SYMPTOMS
SYMPTOMS
People
People with
with narcolepsy
narcolepsy have
have various
various day
day and
and night
night sleep
sleep
problems associated
problems
associated with
with disturbances
disturbances in
in REM
REM sleep.
sleep. These
These
disturbances can
can begin
begin subtly
disturbances
subtly and
and may
may change
change over
over time.
time.
Symptoms
Symptoms usually
usually appear
appear between
between the
the ages
ages of
of 7
7 and
and 25.
25.
Daytime
Daytime sleepiness
sleepiness is
is usually
usually the
the fi
fi rst
rst clinical
clinical sign
sign of
of
narcolepsy. It
narcolepsy.
It interferes
interferes with
with normal,
normal, daily
daily activities
activities even
even if
if
the
person
has
had
an
adequate
night
sleep.
People
the person has had an adequate night sleep. People with
with
narcolepsy usually
usually describe
describe having
narcolepsy
having a
a mental
mental fogginess,
fogginess,
depression,
lack
of
energy
and
extreme
exhaustion
depression,
lack
of
energy
and
extreme
exhaustion
throughout
throughout the
the day.
day. Some
Some people
people experience
experience memory
memory lapses
lapses
and the
the inability
inability to
to concentrate
concentrate at
at work
work or
or school.
school. These
These
and
involuntary
involuntary daytime
daytime sleep
sleep episodes
episodes usually
usually only
only last
last a
a few
few
seconds. However,
However, the
the person
person can
can still
still perform
perform tasks
tasks while
while
seconds.
asleep
but
they
have
no
recollection
of
their
activity
asleep but they have no recollection of their activity
during
during this
this time.
time. For
For example,
example, they
they may
may continue
continue to
to take
take
notes in
in class
class but
but have
have no
no memory
memory of
of doing
doing so
so and
and their
their
notes
handwriting
may
have
become
illegible.
handwriting may have become illegible.
The
The most
most common
common sign,
sign, other
other than
than daytime
daytime sleepiness
sleepiness is
is
cataplexy. This
cataplexy.
This is
is a
a sudden
sudden weakness
weakness of
of the
the muscles
muscles in
in the
the
body,
generally
involving
the
legs
and
drooping
body, generally involving the legs and drooping eyelids.
eyelids.
This
This sudden
sudden loss
loss of
of muscle
muscle tone
tone can
can lead
lead to
to feeling
feeling weak
weak and
and
losing voluntary
voluntary muscle
muscle control.
control. The
The most
losing
most severe
severe cases
cases
involve
complete
loss
of
voluntary
muscle
tone
resulting
involve complete loss of voluntary muscle tone resulting in
in
collapse and
and being
being unable
unable to
to move
move or
or speak.
speak. However,
However, most
most
collapse
people
people remain
remain fully
fully aware
aware of
of their
their surroundings
surroundings during
during these
these
episodes.
Often these
these symptoms
symptoms are
are misdiagnosed
misdiagnosed as
as
episodes.
Often
epilepsy.
epilepsy. Cataplexy
Cataplexy is
is most
most often
often initiated
initiated by
by sudden,
sudden, strong
strong
emotions
such
as
laughing,
stress,
fear
or
excitement.
emotions such as laughing, stress, fear or excitement.
Approximately 70%
70% of
of people
people with
with narcolepsy
narcolepsy experience
experience
Approximately
cataplexy.
cataplexy. Narcolepsy
Narcolepsy also
also aff
aff ects
ects energy
energy levels,
levels, balance,
balance,
metabolism and
and appetite.
appetite.
metabolism

PROGNOSIS
PROGNOSIS

CAUSES AND RISK FACTORS

Narcolepsy is a neurological disorder sleep disorder caused by low
levels of hypocretin (also called orexin). This chemical regulates the
bodys sleep and wakefulness patterns. The hypothalamus is the
part of the brain responsible for producing hypocretin, but in
narcolepsy, the cells are destroyed leading to a lack of hypocretin.
Certain factors like heredity, infections, brain injuries, autoimmune
disease, level changes in hormones and neurotransmitters, and
environmental toxins may play a role in triggering the damage of
hypocretin cells. Narcolepsy has a strong familial association. A
person with a family history of narcolepsy is 20 to 40 times more
likely to develop it. The risk goes higher for first degree relatives. It
also occur more in men than in women.

FACTORS THAT CONTRIBUTE TO THE DAMAGE

OF HYPOCRETIN CELLS
Low levels of histamine
Low levels of epinephrine

Currently,
Currently, none
none of
of the
the available
available treatments
treatments for
for
narcolepsy
narcolepsy can
can maintain
maintain a
a full
full level
level of
of alertness
alertness but
but
certain medications
medications and
certain
and a
a healthy
healthy lifestyle
lifestyle can
can help
help
manage
manage the
the symptoms.
symptoms. Treatments
Treatments are
are modifi
modifi ed
ed as
as
symptoms changes.
changes. Symptoms
Symptoms could
could get
symptoms
get worse
worse thirty
thirty
years
after
the
onset.
Many
older
patients
reported
years after the onset. Many older patients reported a
a
decrease
decrease in
in severity
severity after
after the
the age
age of
of 60.
60.

TREATMENTS
TREATMENTS
Advances
Advances in
in the
the medical
medical management
management of
of narcolepsy
narcolepsy
has
has been
been apparent
apparent in
in recent
recent years.
years. Narcolepsy
Narcolepsy has
has
been treated
treated by
been
by two
two groups
groups of
of drugs:
drugs: stimulants
stimulants and
and
tricyclic
antidepressants.
Current
available
tricyclic
antidepressants.
Current
available
medications are
are the
the following:
following:
medications

Sodium
oxybate
responds
well
Sodium
oxybate which
which
responds
well with
with
cataplexy and
and positively
functioning
cataplexy
positively aff
aff ect
ect daytime
daytime functioning

Ritanserin
Ritanserin which
which have
have been
been shown
shown to
to improve
improve
sleep
sleep quality
quality

Melatonin
Melatonin which
which regulates
regulates the
the rhythms
rhythms of
of the
the body
body
by increasing
by
increasing REM
REM sleep
sleep continuity
continuity 1
1

Low levels of leptin

Low levels of the enzyme monoamine oxidase

Modafi
Modafi nil
nil which
which promotes
promotes wakefulness
wakefulness

Increase levels of dopamine

Increase levels of acetylcholine

NON-PHARMOCOLOGICAL
NON-PHARMOCOLOGICAL MANAGEMENT
MANAGEMENT
EPIDEMIOLOGY
EPIDEMIOLOGY

DIAGNOSIS
Diagnosing narcolepsy is a challenge because there is
no standard of diagnosis that exists. The signs and
symptoms vary widely among patients and can often
lead to a misdiagnosis. Recent research tried to help
alleviate this situation and categorized recurring
symptoms into two groups:

Excessive
daytime
automatic behaviors

sleepiness,

Sleep paralysis, hallucinations, and parasomnias

Several clinical procedures are

diagnose the disorder including:

cataplexy

used

Nocturnal polysomnogram

Multiple sleep latency tests

Cerebrospinal fl uid hypocretin levels

Genetic testing

to

and

correctly

Statistics
Statistics on
on narcolepsy
narcolepsy indicated
indicated that
that the
the disorder
disorder aff
aff ect
ect as
as
many
many as
as 200,000
200,000 Americans,
Americans, although
although fewer
fewer than
than 50,000
50,000
have been
been diagnosed.
have
diagnosed. About
About 8
8 to
to 12
12 percent
percent of
of people
people with
with
narcolepsy
narcolepsy have
have a
a family
family history
history of
of the
the disorder.
disorder. Data
Data on
on
narcolepsy indicate
indicate that
that occurrence
occurrence rates
rates vary
vary among
narcolepsy
among
populations
but
is
estimated
to
aff
ect
about
3
million
populations but is estimated to aff ect about 3 million people
people
worldwide. It
It can
can aff
aff ect
ect any
any gender
gender at
at any
any age.
age. The
The onset
onset of
of
worldwide.
symptoms
symptoms usually
usually occur
occur during
during the
the teenage
teenage years
years and
and
reaches its
its peak
peak at
at around
around 30
30 years
years of
of age.
age. It
It can
can also
also
reaches
develop
develop during
during the
the early
early years
years of
of childhood
childhood but
but is
is rare
rare and
and
not often
often diagnosed.
diagnosed. A
A smaller
smaller number
number of
of people
people also
also
not
develop
narcolepsy
at
ages
50
to
65.
develop narcolepsy at ages 50 to 65.

Epsworth sleepiness scale

SLEEP HYGIENE: FUNDAMENTAL

PRINCIPLES
Avoid late afternoon naps
Avoid alcohol, tobacco, and caffeine

REFERENCES
REFERENCES
Cook,
Cook, N.
N. (2008).
(2008). Understanding
Understanding narcolepsy,
narcolepsy, part
part 1:
1: epidemiology
epidemiology and
and
neurophysiology.
British
Journal
neurophysiology. British Journal Of
Of Neuroscience
Neuroscience Nursing,
Nursing, 4(3),
4(3), 108.
108.
Cook,
N.
(2008).
Understanding
narcolepsy,
part
2:
accurate
Cook, N. (2008). Understanding narcolepsy, part 2: accurate diagnosis
diagnosis
and
management. British
British Journal
Journal Of
Of Neuroscience
Neuroscience Nursing,
Nursing,
and eff
eff ective
ective management.
4(4),
4(4), 170-176.
170-176.
Sleep Foundation.org.
Foundation.org. (2011).
(2011). Narcolepsy
Narcolepsy Fact
Fact Sheet.
Sheet. Bethesda,
Bethesda, MD:
MD:
Sleep
National
National Institute
Institute of
of Neurological
Neurological Disorders.
Disorders.
.

Recent
research
Recent
research has
has shown
shown that
that a
a low-carbohydrate,
low-carbohydrate,
ketogenic
ketogenic diet
diet (such
(such as
as Atkins
Atkins Diet)
Diet) improved
improved the
the
symptoms of
of narcolepsy
narcolepsy by
symptoms
by 18%.
18%. Carbohydrates
Carbohydrates in
in a
a diet
diet
can
also
help
produce
serotonin
which
can also help produce serotonin which infl
infl uences
uences a
a
persons degree
degree of
of sleepiness.
sleepiness. Behavioral
Behavioral practices
practices and
and
persons
lifestyle
lifestyle changes
changes also
also help
help manage
manage narcolepsy.
narcolepsy.

Implement and adhere to a strict bedtime routine and

timetable
Avoid bedtime activities that stimulate physiologically,
cognitively or emotionally
Sleep alone if possible
Maintain bedroom as an environment solely for sleep
Ensure sleeping environment is comfortale, quiet, and toxinfree