NARCOLEPSY AND HYPERSOMNIA
LATEST ADVANCES By Dr. Manvir Bhatia and Ms. Garima Sharma INTRODUCTION We hated to sleep in childhood and now we just want to lie down on the bed for just even as little as 5 minutes. We consider sleep as a reward. What if this reward turns into a curse? Some people have excessive daytime sleepiness despite completing 7- hours of sleep at night. They consider it a blessing as not everyone is lucky to get sleep as they age. But what if this becomes an obstacle in your daily activities, workplace, school, college, and public places like travel or while driving? Dangerous, right? Excess sleep can be a sign of a condition called hypersomnia, narcolepsy, or OSA. We will look at the different aspects of narcolepsy and hypersomnia in this blog and we assure you that by the end you will be confident that you have hope for a better future with us. WHAT IS HYPERSOMNIA? Hypersomnia is defined as an increased quantity of sleep during a 24 h period or objectively assessed excessive need for sleep (an objective assessment of an excessive quantity of sleep requires ≥10 h of sleep duration during 24 h, with night-time providing ≥9 h of sleep duration). SYMPTOMS OF HYPERSOMNIA: If you have hypersomnia, you may: Causes of hypersomnia Other conditions may be related to excessive sleepiness (hypersomnia) that can have additional symptoms. Some medicines, drinking too much alcohol, and taking drugs can also cause excessive daytime sleepiness. Sometimes there is no known cause. This is called idiopathic hypersomnia. WHAT IS NARCOLEPSY? A chronic neurological sleep-wake disorder, narcolepsy is characterized by excessive daytime sleepiness and cataplexy (sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control) in narcolepsy type 1. It is common for patients with narcolepsy to have difficulties with concentration, memory retention, and daytime fatigue. If you or your loved one have a lifelong sleep-wake disorder that’s impairing their quality of life, productivity, and educational and employment outcomes, you need to pay attention. The burden of this disease relates to frequent comorbid conditions, including aspects of emotional, metabolic, sleep, and immune health. We hope to encourage a multidisciplinary approach, to collaborate with the one suffering from the disease and a broad clinical team, and to maximize clinical and quality-of-life outcomes, for those living with narcolepsy. SIGNS AND SYMPTOMS OF NARCOLEPSY If you notice any of the following symptoms, please consult your doctor: If you have narcolepsy, you may be falling asleep without warning, anywhere, anytime. For example, you may be working or talking with friends and suddenly nod off, sleeping for a few minutes up to a half-hour. When you awaken, you feel refreshed, but you get sleepy again after a while. 2. Decreased alertness and focus. You may also experience decreased alertness and focus throughout the day. 3. Sudden loss of muscle tone (Cataplexy). If your speech is slurred or Complete weakness of most muscles that may last up to a few minutes.It is uncontrollable and is triggered by intense emotions, usually positive ones such as laughter or excitement, but sometimes fear, surprise or anger. It is possible to experience unexpected drooping of the head or bending of the knees when you laugh, for instance.The experience of episodes of cataplexy may range from only one or two a year, while others have numerous episodes daily. You may not experience cataplexy as well as not everyone does. 4. Sleep paralysis. You may experience a temporary inability to move or speak while falling asleep or upon waking. These episodes are usually brief — lasting a few seconds or minutes — but can be scary. The condition may have been obvious to you and you can recall it without difficulty afterward, even though you didn’t control what was going on.This sleep paralysis mimics rapid eye movement (REM) sleep, which is characterized by temporary paralysis. This temporary immobility during REM sleep may prevent your body from acting out dream activity.5. Changes in rapid eye movement (REM) sleep. Dreamy sleep. It can occur at any time of the day if you have narcolepsy. Transition to REM sleep is usually within 15 minutes of falling asleep. 6. Hallucinations. These hallucinations happen as you fall asleep or occur upon waking up. Feeling as if there is a stranger in your bedroom, for instance. When you begin dreaming, you may not yet be asleep, so your dreams may seem real to you, causing particularly vivid and frightening hallucinations. WHEN DOES THE FIRST SYMPTOM PRESENT?: First symptoms of narcolepsy typically present between the ages of 10–25 years with significant variation in its presentation. Other associated problems: 1. WHAT CAUSES NARCOLEPSY? 1. An autoimmune disorder. A person’s immune system attacks the brain cells that produce hypocretin, resulting in a shortage of this chemical. 2. Family history. If you got the gene for it in the family. 3. Brain injury or tumor. The area of the brain that controls REM sleep and wakefulness is injured by trauma, tumor, or disease. 4. Infections. 5. Environmental toxins, such as pesticides, and heavy metals. 6. Smoking or secondhand smoke. 2. HOW IS NARCOLEPSY DIAGNOSED? A neurologist and sleep specialist doctor can make the diagnosis of narcolepsy only after the following tests are done and analyzed. It’s crucial that you get the diagnosis right as it guides the whole course of your future treatment plan. TREATMENT OF NARCOLEPSY Timely, effective, and appropriate treatment results in improved clinical outcomes, education and employment opportunities, and enhanced quality of life. Medications and lifestyle changes are the management options. The goal is to reduce daytime sleepiness and improve alertness. MEDICATIONS A number of medications that has many different mechanisms of action in the brain are available because of advancement in medical science, for the treatment of excessive daytime sleepiness (EDS). Medications that promote wakefulness. These agents help you stay awake during the day. Modafinil (Provigil®) or armodafinil (Nuvigil®). They are first tried as they have fewer side effects