NarcolepsyNarcolepsy is a disabling disorder that is characterized by excessive daytime sleepiness, the recurrent need to sleep, and unintended daytime lapses into sleep.[1] This disorder affects approximately 1 in every 2, 000 people worldwide, and once symptoms emerge, they are often lifelong—especially when it is associated with cataplexy, the sudden, involuntary loss of skeletal muscle tone that can last from a couple seconds to a couple minutes.1 Often, cataplexy manifests as jaw sagging and knee buckling; however, it can also cause temporary body paralysis and hallucinations, often when the transition from wake to sleep and vice versa occurs.1

Usually, symptoms of narcolepsy appear in late adolescence or early adulthood.1 Unfortunately, as narcolepsy is a difficult disease to diagnose, it can often take up to 10 years before one is accurately established.1 The broad array of symptoms that narcolepsy presents is often difficult to differentiate from symptoms of other disorders.1 However, as the diagnosis is often significantly delayed, the patient’s quality of life has often significantly decreased by that time.1

Narcolepsy has many symptoms that often occur with other mental illnesses, and often co-occurs with them, such as bipolar disorder, depressive disorders, and schizophrenia.1 These comorbidities often mask the symptoms of narcolepsy, resulting in missed diagnoses.1 For example, patients with depression may have excessive daytime sleepiness and fatigue and patients with psychosis often have hallucinations.1

Diagnosing narcolepsy requires an in-depth clinical history and diagnostic testing.1 People who know the patient well should also be interviewed to obtain a clear, unbiased picture of their symptoms.1 It is common for the nocturnal polysomnography and the multiple sleep latency test (MSLT) to be used to confirm the disorder and evaluate for other potential causes of excessive daytime sleepiness.1 With the MSLT, patients are allowed a series of five naps, separated by two-hour intervals throughout the period of a day.1 The MSLT gauges natural sleep tendencies, and an average sleep latency of eight minutes or less with rapid eye movement sleep during at least two of the five naps calls for a diagnosis.1

There exist both behavioral and pharmacological interventions for the treatment of narcolepsy.1 Patients are often encouraged to adopt a regular sleep schedule and daytime activity schedule.1 In fact, irregular sleep-wake scheduled can worsen sleepiness in narcolepsy.1 Regarding pharmacological interventions, there are several FDA-approved medicines for the treatment of excessive daytime sleepiness in patients with narcolepsy.1 These include modafinil, dextroamphetamine, methylphenidate, and sodium oxybate.1 Also, sodium oxybate is an FDA-approved treatment for cataplexy.1

As many patients with narcolepsy experience a significant delay in receiving an accurate diagnosis and appropriate treatment, it is important for clinicians to remember the possibility of the disease when evaluate all patients with evidence of excessive daytime sleepiness, especially those whose symptoms continue despite therapy.1

One Comment

  • Ashley

    March 6, 2014, 9:04 pm

    Real clear web site, regards for this post.

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