DAY TIME SLEEPINESS, NARCOLEPSY

A chronic sleep disorder, narcolepsy, is identified by excessive need to sleep during the daytime accompanied by lethargy and sudden bouts of sleep which may or may not be accompanied by cataplexy (loss of muscle tone). This condition is difficult to cure, but its symptoms can be lowered by medications and some changes in daily routine.

Symptoms

The prognosis of this disease is poor and it worsens as the life advances. The symptoms are as follows.

Uncontrolled need of sleep during the daytime
Delusions and hallucinations
Cataplexy (absence of muscle control)
REM sleep is attained quickly after falling asleep
Episodes of paralysis during sleep (sleep paralysis)

Causes

The etiology of narcolepsy is not known yet. However, a neurochemical named Hypocretin is secreted in brain, has found to have a role in maintaining REM sleep pattern and awakeness. Patients who have narcolepsy along with cataplexy usually have decreased amounts of hypocretin and hence, the symptoms are shown. Autoimmune diseases and genetics could also be the reason behind decreasing levels of hypocretin.

Complications

Harm or accidents are more common
Emotional disturbances
Social denial and not being understood
Decreased metabolism (obesity)

Diagnosis

Based on the following:

Sleep schedule (history)
Details about sleep patterns (detailed record in a diary)
A sleep test done by spending night at a medical center (polysomnography)
Test to measure the duration of falling asleep.

Treatment

The treatment is aimed to lessen the symptoms because narcolepsy cannot be cured.

Medications

Nervous system stimulants are first line of treatment for narcolepsy. These include modafinil and armodafinil having low dependence level. Methylphendilate (Aptensio XR, Concerta, Ritalin, others) or various amphetamines are also used and have high dependence level.
SSRIs and SNRIs are used to repress REM sleep and decreasing the symptoms. They are fluoxetine (Prozac, Sarafem, Selfemra) and venlafaxine (Effexor XR).
Tricyclic antidepressants: protriptyline (Vivactil), imipramine (Tofranil) and clomipramine (Anafranil), are effective for muscle atony.
Sodium oxybate (Xyrem) assists in ameliorating the nighttime sleep. It should be divided into two doses.

Patients having conditions like diabetes mellitus, hypertension should concern doctor about the medications because they can interact with the medicines mentioned above.

Lifestyle and home remedies

Make a proper schedule to get work done and stick to it.
Take short naps of atleast 20 mins each.
Do not take alcoholic and nicotinic substances.
Make exercise a part of your daily routine, preferably few hours before going to bed.

DAY TIME SLEEPINESS, NARCOLEPSY