How to tell if you suffer Narcolepsy and when to see a specialist

Written by: Dr. Javier Brualla Coll
Edited by: Patricia Pujante Crespo


Narcolepsy: what is it ?

Narcolepsy is a chronic disease characterized by excessive daytime sleepiness and sudden sleep attacks. Episodes or sleep attacks usually last from a few seconds to several minutes and can occur at any time, so it ends up affecting significantly to all daily activities. These people can fall asleep unintentionally at work, at school, while they are talking to someone, playing, eating, or, which is more dangerous, while driving a car or are handling potentially dangerous equipment or machinery.

Symptoms of narcolepsy to identify risk

The symptoms of narcolepsy can occur at any age (from infancy to 45-55 years), but more often than not the first symptoms appear between 10 and 25 years.

Typical symptoms of narcolepsy (need not all be present) are:• Excessive daytime sleepiness (first and most common symptom). People with narcolepsy fall asleep without warning, anywhere, anytime.• Cataplexy or loss of muscle tone abruptly. Cataplexy is considered the only specific sign of narcolepsy, but not all people with narcolepsy have cataplexy (occurs in 60-70% of narcoleptic). These episodes are not associated with loss of consciousness, are episodes that usually the patient remembers and can describe later. Sometimes they consist only of a kind of subjective feeling of uncontrollable weakness that often triggered by strong emotions such as laughter, fear, surprise ...• Sleep paralysis at the beginning or waking from sleep: is a temporary inability to move or speak. Usually brief episodes of 1-2 minutes, but very distressing.• hypnagogic hallucinations (when falling asleep) or hipnapómpicas hallucinations (the awakening). Usually usually visual, as a kind of very real and very vivid dreams.• nocturnal sleep disturbances with sleep disruption or fragmentation. About half of patients with narcolepsy have trouble sleeping at night.• Other accompanying symptoms: recurrent naps throughout the day, automatic behavior, memory lapses, etc.


Causes of narcolepsy

Today it is considered to narcolepsy as an autoimmune disease, although the exact cause remains unknown. The immune system to infection (for example, the influenza flu virus) may end up attacking error by a group of neurons (located in a brain region called the hypothalamus) that produce a neurotransmitter called hypocretin or orexin, a neurotransmitter that usually helps regulate wakefulness and REM sleep.

How to diagnose narcolepsy

Despite frequent early onset of disease, most patients with narcolepsy remain undiagnosed for many years (usually not definitively diagnosed until they pass between 10 and 15 years from the first symptoms.

A thorough clinical examination and medical history are essential for diagnosis. However, this lack of specificity of symptoms of narcolepsy makes more specialized diagnostic tests (that can be made at any Sleep Disorders Unit) to help establish the diagnosis definitively generally necessary.

There are two tests that are considered essential to confirm the diagnosis of narcolepsy:• The polysomnography (PSG) or Sleep Study: consists of a night test taking measurements of several variables over all night to see if it is a normal dream or some kind of sleep disturbance.• The test latencies Multiple Sleep (TLMS) is done during the day, the next morning, and consists of four or five short naps of 20 minutes, usually scheduled 2 hour intervals to measure the level of sleepiness during the day. Rate the ease of a person to fall asleep or sleep latency (a latency period of 5 minutes or less is considered highly suggestive of narcolepsy) and if there are intrusions of REM sleep (if a person enters REM sleep for at least two these scheduled naps, is also considered a positive sign of narcolepsy).

Although rarely it used (only to confirm cases of difficult diagnosis) can also be determining CSF hypocretin levels by lumbar puncture useful.

If a person tends to sleep as long is it due to narcolepsy or there may be other problems preventing the break?

Excessive daytime sleepiness, the most common symptom of narcolepsy is not unique to this disease and may also appear in other diseases, such as infections, depression, head injuries, tumors of the central nervous system, etc.. or other sleep disorders, such as:- Sleep apnea- Circadian rhythm disorders- Restless Leg Syndrome- Any other disorder with ability to interrupt normal sleep patterns

Various drugs or substances of abuse can also cause increased sleepiness clinically simulate a narcolepsy.

Previously, you should always rule out that there is no chronic sleep deprivation, a fact that has become today one of the most common causes of excessive daytime sleepiness.

Treatment of narcolepsy and results

There is no cure for narcolepsy, but it is a manageable disease with medication and changes in lifestyle. Excessive daytime sleepiness and cataplexy (the most disabling symptoms of the disorder) can be controlled in most patients with drug treatment.

The most commonly used drugs are usually methylphenidate, modafinil or sodium oxabato. However, none of the currently available medications enables people with narcolepsy maintain a state of alert so completely normal maintained. Therefore, drug therapy is often complemented by consistent nonpharmacological measures on behavioral techniques and education to understand the disease, which is necessary for both the patient and the people they interact (as these patients may benefit and much of support from family, friends, teachers, coworkers, etc.).

Among the most important measures of common sense that patients can take to improve sleep quality are maintaining a regular sleep schedule, avoid snuff, alcohol and beverages containing caffeine, and make some changes in lifestyle (which may include also scheduled short naps less than 20 minutes long so they do not interfere with nighttime sleep).

Children and adolescents with narcolepsy may try to adapt, to the extent possible, their school schedules, school staff informing your needs.

Adults can try to talk and reach an agreement with their bosses or company about the possibility of changing their work schedules and can take short naps if they are necessary, or perform the most demanding tasks when they are in a state of alert.

These patients are also advised to take some safety precautions. Actions that are usually safe, and go down a flight of stairs or driving can become potentially very dangerous if you fall asleep suddenly or lost muscle control. People with untreated narcoleptic symptoms have a frequency about 10 times more likely to have a traffic accident than the general population. In contrast, the frequency of accidents among patients who have received adequate drug treatment is similar to the rest of the population.

People with narcolepsy are often judged unfairly lazy, unintelligent, undisciplined or unmotivated. Such stigma often increases the tendency toward isolation, therefore the join support groups with others who suffer from this disease can provide important assistance, both practical and emotional.


Short Self-Test to see if you suffer from narcolepsy

• Have you had sleep attacks during the day even having enough sleep the night before?• Have you ever fallen asleep while working, eating or talking to someone?• Have you felt alert after a short nap but soon he quickly returned to appear the feeling of drowsiness?

If you answered yes to these three questions it is likely that you suffer from narcolepsy. Consult a specialist in clinical neurophysiology and / or Sleep Medicine.


Edited by Patricia Crespo Pujante

*Translated with Google translator. We apologize for any imperfection

By Dr. Javier Brualla Coll

Dr. Brualla is a neurophysiologist at first specialized in sleep unit level. Currently, it belongs to the medical staff of the International Hospital Medimar Vithas in Alicante. He has authored and co-authored several publications on national and international level and has attended several conferences of sleep disorders.


*Translated with Google translator. We apologize for any imperfection

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