Driving, narcolepsy

The sleepiness associated with narcolepsy may result from impaired circadian influences (Broughton et al, 1998), particularly of the circadian alertness signal which contributes to the timing and consolidation of the sleep period (Dijk Czeisler, 1994 Edgar et al, 1993). Confirmatory data for this hypothesis was provided by Dantz et al. (1994), who, using a forced desynchrony protocol, showed that narcoleptic patients have a normal circadian pacemaker and homeostatic sleep drive, but a deficit in alertness associated with the circadian signal. Although results are more difficult to interpret in an animal with... 

Psychostimulants are medications that can increase drive and performance. Their most frequent use is in attention deficit hyperactivity disorder (ADHD) and in narcolepsy. They are also called stimulants or, less commonl today, analeptics. 

In narcolepsy, subjects may reverse the normal trajectory as shown in figure 2.8 and enter REM directly from waking at both nocturnal sleep onset and during daytime sleep attacks. This propensity is caused by a combination of relatively weak aminergic drive and reciprocally intensified cholinergic drive, which result in a marked lowering of the wake-REM threshold. 

Prior to the use of wakefulness-promoting agents, and in some pediatric patients, maintenance of wakefulness is dependent on stimulant medications and antidepressants. The safety of such medications during reproductive years and the risk of driving accidents without medication are typically handled during discussions between the prescribing practitioner and the patient. Irritability, anxiety, and erectile or ejaculatory dysfunction have been reported with these medications (78). The costs of newly approved medications for the treatment of narcolepsy,... 

Obviously, sleep disorders are a major cause of traffic accidents because of their prevalence but also because of their danger (high-risk ratio of death and injury). If OS AS is a well-covered field, other diseases such as narcolepsy and hypersomnias are not as frequently investigated. This could be explained by the low prevalence and therefore the limited public-health impact of accidents generated by these patients. We strongly believe that research must be conducted in this field to provide better information on the driving aptitude of these patients. 

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