What does it really mean?
For a long time when I heard the word “narcolepsy” I imagined an unfortunate person who would fall unconscious in the middle of the sentence and wake up the next day – an image based on River Phoenix character from the early 90s movie “My Private Idaho”. There was surprisingly little education on the subject of sleep disorder in medical school but fortunately I have opted to do a three- week elective at a sleep center during my residency where I have learned the truth about this condition.
How is it diagnosed?
Narcolepsy is suspected when a person is suffering from excessive sleepiness despite adequate amount of sleep and the diagnosis is made by performing a sleep study (polysomnogram) that is done during the night and then MSLT (multiple sleep latency test) which measures tendency to fall asleep during the day. The whole thing amounts to a rather involved and cumbersome test, the patients get a couple dozen electrodes glued to their heads and get to hang out in a hotel-like sleep suite for almost 24 hours.
Narcoleptics are all around us.
You too have probably seen quite a few people affected by narcolepsy – it may be the girl in your college class who used to sleep through most of the lectures, the guy at your work who tends to nod off during most of the conferences, the uncle who falls asleep on the couch watching a football game, a friend who is always complaining of being tired and not being able to get a refreshing sleep… It never occured neither to any of these people nor to anyone around them that their brains simply doesn’t function normally when it comes to sleep. Narcolepsy is one of the most under-diagnosed medical conditions, partially because the sleep deprivation – an alternative explanation to symptoms is so common that people accept their symptoms as part of life and may never find out that they are affected.
What causes narcolepsy?
The modern science of genetics attributes narcolepsy to a mutant gene that codes for a specific neutrotransmitter region. The disruption of proper function leads to abnormal regulation of sleep cycle sequences and often intrusion of REM sleep into wakefulness. People with narcolepsy also are prone to sleep paralysis, they are uncomfortably aware of not being able to move or see when they are asleep. They can also experience hallucinations when they either fall asleep or waking up. While helpful at hinting toward epilepsy, neither one of these symptoms is required to be present in order for diagnosis of epilepsy to be established, and they also can occur on occasion in perfectly healthy individuals.
How do you treat it?
For many years, the traditional medication for treatment of narcolepsy were amphetamine derived drugs, such as Ritalin. Lately, however there has been a surge of new drugs on the market, that are more specifically directed at the sleep wake cycle regulation (Nuvigil) and are less prone to abuse. Also there is a medication called GHB (the substance with a tainted past of a popular date rape drug in the 80s). It is sold under the brand name Xyrem. This medication induced deep stages of sleep, which are deficient in narcoleptics, and has been extremely effective in controlling the symptoms. The downside is that it is very tightly regulated and quite expensive.
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We live in the world of sleep deprived people.
The sleep science has been booming with new and exciting data over the past few decades. Once recording brain waves during sleep became possible, we learned that there is slow wave sleep and REM sleep. Each one is very important to our wellbeing. During REM sleep, we experience dreams and our brain neurons are working hard at data clean up and storage. Lack of this type of sleep will result in impaired memory and concentration as well as decreased thinking capacity.
The slow wave sleep, is the dreamless “shut down” mode, which allows your body to undergo all the necessary housekeeping and maintenance. Vital hormones are produced during this time and molecules, and the buildup of toxic byproducts is eliminated on the cellular level. The mechanisms that govern our sleep are so complicated and enigmatic, that modern science still is only glimpsing into it, but even that glimpse is enough to convince us that the value of sleep is absolutely crucial to our well-being.
The role of sleep in medical illness.
Recent breakthrough in treatment of fibromyalgia, a condition associated with chronic pain, depression and severe fatigue, revealed that the disease had its root in lack of slow wave sleep. So even when the fibromyalgia patient sleeps more than eight or nine hours per day, their brain for a number of reasons spends less in the slow wave sleep than necessary. Among many other things, this results in decreased production of the very important neurotransmitter serotonin and decreased production of human growth hormone. The result is depressed mood, low energy and in fibromyalgia patients also causes increased sensitivity to pain. While not everyone is genetically predisposed to develop fibromyalgia, most people will feel the diminished lack of sleep to certain degree.
So how much sleep do you really need?
There are some people who require less sleep than others, usually due to their ability to go through sleep cycles with higher efficiency than others. Most people, however do require a minimum or seven or eight hours to complete the required amount of sleep cycles. If you always wake up to the alarm clock, you are probably interrupting one cycle in the middle; if you have trained yourself to wake up at certain time on your own then your then your brain will adjust to complete the cycle on time.