Narcolepsy-cataplexy hallucinations

Antidepressants. In addition to increasing alertness, the psychostimulants also mildly suppress the REM phase of sleep. Because the auxiliary symptoms of narcolepsy (cataplexy, hypnagogic hallucinations, and sleep paralysis) are basically... 

The sleep disorder narcolepsy, which affects around 1 in every 2000 people, is characterized by a tetrad of symptoms excessive daytime sleepiness, cataplexy (loss of muscle tone triggered by emotional arousal), hypnagogic hallucinations,... 

The essential features are sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis. Individuals with narcolepsy complain of excessive daytime sleepiness, sleep attacks that last up to 30 minutes, fatigue, impaired performance, and disturbed nighttime sleep. They have multiple arousals during the night. 

Narcolepsy can usually be distinguished from insomnia by the presence of one of the auxiliary symptoms (cataplexy, sleep paralysis, hypnagogic hallucinations). When the diagnosis remains unclear, then a sleep study is necessary. 

Narcolepsy (ICD G47.4) and other types of hypersomnia are severe disturbances of vigilance expressed as a sudden and irresistible requirement for sleep during the day, so-called sleep attacks (Aldrich. 1990). Apart from sleep attacks, the classical tetrad of narcolepsy includes cataplexy (sudden loss of muscular tone), sleep paralysis (waking from sleep with the feeling of not being able to move) and hypnagogic hallucinations (linages or sequences of... 

Sleepiness is a primary symptom of narcolepsy, often preceding the onset of the other well-known symptoms of the disease, namely cataplexy, sleep paralysis, and hypnagogic hallucinations (44). Evaluation of the MSLT of narcoleptic patients has demonstrated a short sleep latency (<5 min) and multiple sleep-onset REM periods (SOREMPs). The more specific finding in the MSLT of narcoleptic patients is more than 2 SOREMPs, shown to reach a specificity of 99% by Amira et al. (45), which further increased to 99.2% if 3 SOREMPs were recorded (46). On the other hand, more than one SOREMP can occur in nonnarcoleptic patients, such as those with sleep apnea, sleep deprivation, depression, periodic limb movements, circadian rhythm disruption, or withdrawal from REM-suppressing medications (5,47). Thus, the findings of the MSLT, which is always performed for suspected narcoleptic patients, must be interpreted in view of the clinical history and nocturnal PSG. 

The prevalence of narcolepsy with cataplexy is 1 in 10,000 or 0.02% to 0.16% worldwide (69). Patients usually present with complaints of excessive daytime sleepiness before the onset of hypnogogic/hypnopompic hallucinations, sleep... 

The word narcolepsy refers to a syndrome of unknown origin that is characterized by abnormal sleep tendencies, including excessive daytime sleepiness and often disturbed nocturnal sleep and pathological manifestations of REM sleep. The REM sleep abnormalities include sleep onset REM periods and the dissociated REM sleep inhibitory processes, cataplexy and sleep paralysis. Excessive daytime sleepiness, cataplexy, and less often sleep paralysis and hypnagogic hallucinations are the major symptoms of the disease [12]. 

At the present time, there is no cure for narcolepsy, and treatment goals include control of EDS, cataplexy, hypnagogic hallucinations, and sleep paralysis improvement of nocturnal sleep and reduction of psychosocial problems. 

Narcolepsy genetic characteristics. Rare, disabling sleep disorder of unknown origin. Characterized by sudden attacks of flaccid paralysis (cataplexy), extensive daytime sleepiness, sleep paralysis, hypnagogic hallucinations and rapid onset of rapid eye movement (REM) phase of sleep. 

In a double-blind, randomized, placebo-controlled, crossover study in 24 patients with narcolepsy, gammahydroxybutyrate 60 mg/kg in a single night-dose for 4 weeks reduced the daily number of hypnagogic hallucinations, daytime sleep attacks, and the severity of subjective daytime sleepiness, and tended to reduce the number of daily attacks of cataplexy (2). It reduced the percentage of wakefulness during REM sleep and the number of awakenings out of REM sleep, and tended to increase slow wave sleep. Adverse events were few and mild. 

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

Narcolepsy is a chronic neurological disorder and is characterised by excessive daytime sleepiness (EDS), usually accompanied by cataplexy (attacks of weakness on emotional arousal). These symptoms are often associated with the intrusion into wakefulness of other elements of rapid eye movement (REM) sleep, such as sleep paralysis and hypnagogic hallucinations, i.e. in a transient state preceding sleep. 

The primary objective of pharmacologic treatment of narcolepsy is to reduce symptoms that adversely impact the quality of life. This includes alleviating daytime sleepiness with modaflnil or stimulants. The goal is to produce the fullest possible return of normal function for patients at work, school, home, and socially. Cataplexy, hypnagogic hallucinations, and sleep paralysis should be treated when they are present and troublesome. The health care provider should consider... 

Narcolepsy is characterized by excessive daytime sleepiness that is typically associated with cataplexy and other rapid-eye-movement (REM) sleep phenomena such as sleep paralysis and hypnagogic hallucinations. Sleepiness, the main symptom in narcolepsy, leads to repeated daily episodes of naps or lapses into sleep of short duration. 

---