Narcolepsy symptoms

Narcolepsy is sometimes termed a dyssomnia, but whatever classification is used, it essentially represents an intrusion of REM sleep into wakefulness. Narcolepsy is comprised of a quartet of potential symptoms, but only a few individuals exhibit all four narcolepsy symptoms. The most common symptom of narcolepsy is the sleep attack. Sleep attacks consist of an irresistible urge to fall asleep and can occur several times each day. Patients with narcolepsy usually feel refreshed and energized after a 10-20 minute nap however, their sleepiness returns after just a few hours. 

Cataplexy A sudden attack of muscle weakness with retention of clear consciousness that follows a strong emotional stimulus (e.g., elation, surprise, or anger) a characteristic symptom of narcolepsy. 

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,... 

Presenting with the complaint of hypersomnolence, the percentage of patients who do not have narcolepsy and who do not have the sign or symptom. 

Characterization of the receptor knockout mice (OXjR / and 0X2R l ) provided important information about the differential roles of the two receptors in both vigilance state control and the symptoms of narcolepsy (Kisanuki et al., 2000 Willie et al., 2003). In contrast to the direct transitions to REM sleep and abrupt behavioral arrests that characterized orexin mice, 0X,R l mice exhibited no direct transitions to REM sleep and only a modest decrease in REM sleep latency (Kisanuki et al, 2000). 0XiR / mice also showed slight fragmentation of vigilance states when compared with the normal animals (Kisanuki et al., 2000). 

Amphetamine Clinically used for narcolepsy (sudden day-time onset sleep) and Attention Deficit Hyperactivity Disorder (ADHD) formerly used as a short-term slimming agent, as an antidepressant and to boost athletic performance recreational use widespread tolerance develops readily highly addictive regular users suffer many health problems and a reduced life expectancy amphetamine psychosis may develop, with similar symptoms to acute paranoid schizophrenia. 

One peculiar effect of GHB is that it seems to reduce the symptoms of narcolepsy, a relatively rare sleep disorder. People with narcolepsy are excessively sleepy all the time and often have a condition called cataplexy, in which the person can suddenly and unexpectedly lose all muscle tone and fall immediately into rapid eye movement (REM) sleep (the stage of sleep during which dreaming occurs). 

In clinical studies, GHB has been shown to effectively reduce the symptoms of narcolepsy. These findings are quite... 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

A third symptom of narcolepsy is sleep paralysis. Sleep paralysis is an inability to move while falling asleep or shortly after waking. Normal people may occasionally and briefly experience sleep paralysis when waking, but sleep paralysis at the beginning of sleep is unique to narcolepsy. 

The first symptoms of narcolepsy usually begin during childhood or in the early teen years and commonly involve excessive drowsiness and sleep attacks. Several years later, one or more of the auxiliary symptoms arise. 

Insomnia. It may seem odd to include this in the differential diagnosis of a hypersomnia, but insomnia is in fact the most common cause of daytime drowsiness. In addition, it is common for patients with narcolepsy to have some difficulty sleeping at night and for their daytime symptoms to worsen at those times. 

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. 

Stimulants. Treatment for narcolepsy has focused on its most disabling symptoms namely, sleep attacks and daytime drowsiness. The mainstay of treatment has... 

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... 

Tricyclic Antidepressants (TCAs). TCAs were introduced in the 1950s and over the years have become the mainstay of treatment for cataplexy and the other REM-related symptoms. The doses used are usually less than the doses required in the treatment of depression. Imipramine (Tofranil) is the most widely used TCA for narcolepsy and is usually effective at doses from 10 to 75 mg given once a day. Some doctors prefer the TCA protriptyline (Vivactil) because it has mild stimulant effects, but it has not been as widely used or as thoroughly studied in narcolepsy. The common side effects of TCAs are drowsiness, dry mouth, and constipation, but these are usually not a problem at the lower doses used for narcolepsy. Patients should receive a baseline electrocardiograph (EKG) before starting a TCA and should have blood levels of the medication checked periodically. 

Short-Term Treatment. In the acute phase of treatment, a stepwise approach is often warranted. The medication should be targeted at the most distressing symptom of narcolepsy first. This is almost invariably the sleep attacks and daytime drowsiness. 

One change that is sometimes made during long-term treatment is the addition of a second medication to treat the auxiliary symptoms of narcolepsy. For many patients, these other symptoms do not occur often enough or are not severe enough to require treatment. However, the auxiliary symptoms (especially cataplexy) can be a big problem for some narcolepsy patients. The stimulants used to treat the sleep attacks can also provide some mild relief of cataplexy, but the benefit is often not sufficient. 

After checking a baseline EKG to rule out undetected heart rhythm abnormalities, many clinicians use a low dose of imipramine or protriptyline to treat the auxiliary symptoms of narcolepsy. Either of these can be started at 10 mg taken once a day and then slowly increased over several weeks as needed until the symptoms... 

One of the oldest uses for dextroamphetamines is in the treatment of narcolepsy, a sleep disorder characterized by constant daytime fatigue and sleepiness, with a disturbance in nighttime REM sleep (the period of sleep when dreams occur). During the day or other periods of time when they would normaly be awake, people with narcolepsy often experience sudden episodes of REM sleep. They may also suffer from sleep paralysis and/or cataplexy, an abmpt, total loss of muscle control. Central nervous system stimulants like dextroamphetamine help to relieve these symptoms. 

Sleep disorders are common, and are generally underdiagnosed. The two major complaints related to sleep are insomnia ( I can t sleep ) and excessive daytime sleepiness (EDS, I can t stay awake ). EDS is a relatively nonspecific symptom. It can be the end result of any factor that causes sleep disruption, and it can be caused by primary or intrinsic sleep disorders. Insomnia of any cause can result in sleep deprivation and subsequent EDS. The most common cause of EDS in the general population is self-imposed sleep deprivation, or insufficient sleep syndrome. By contrast, the most common causes of EDS seen in a sleep center are primary (intrinsic) disorders of EDS. The American Academy of Sleep Medicine (AASM, formerly the American Sleep Disorders Association) classification of sleep disorders includes over 80 diagnoses that are associated with EDS, but the majority of patients evaluated at sleep centers have sleep apnea, narcolepsy, idiopathic hypersomnia, or periodic limb movements of sleep. 

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. 

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