$Unique_ID{BRK02035}
$Pretitle{}
$Title{Characteristics of Narcolepsy and Other Sleep Disorders}
$Subject{narcolepsy sleep disorders sleep disorder sleepiness REM sleep rapid
eye movement sleep paralysis cataplexy hypnagogic phenomena hallucinations
multiple sleep latency test MSLT antigens HLA-DR2 hypoglycemia sleep apnea
thyroid disorders thyroid disorder low blood sugar sedative medication abuse
antidepressants antidepressant naps napping stimulants daytime}
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Copyright (c) 1993  Tribune Media Services, Inc.


Characteristics of Narcolepsy and Other Sleep Disorders


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QUESTION:  My daughter-in-law writes that they have discovered that some of
the recent problems my son has been through have been the result of a
condition called "narcolepsy".  It is a frightening term, sounding like a
mixture of narcotics and epilepsy.  Can you help us overcome our deep anxiety
by telling us what this condition is, where it comes from and any possible
treatments.  This is certainly a recent development for our son had no such
problems before he was married.

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ANSWER:  Narcolepsy is neither connected with narcotics nor epilepsy but is
one of the disorders of sleep that have been closely studied closely only
during the past 20 years.  It is not a rare disease, for it affects an
estimated 200,000 Americans and often goes undiagnosed, even when many of the
problems caused by the disease are evident in the patient's social history.
Essentially the major symptom is excessive daytime sleepiness often showing as
a sudden sleep attack during normal waking hours.  The occur suddenly,
sometimes several times a day in severe cases, and the sleep may last from
minutes to hours.  It is a stage of sleep known as REM sleep (for Rapid Eye
Movements) which may be observed in the patient.  Other associated symptoms
include sleep paralysis (when upon falling asleep or awakening the patient
wants to move but can't for the moment), cataplexy (momentary paralysis
without a loss of consciousness often accompanied by sudden emotional
reactions such as anger, fear or joy) or hypnagogic phenomena (vivid auditory
or visual illusions or hallucinations).  About 70 to 80 percent of people with
narcolepsy experience one or more of these associated symptoms.  In addition,
nighttime sleep is often disrupted by frequent awakenings, cravings for food
or sweets, and excessive leg movements during sleep.
     In the beginning, before the correct diagnosis is made, the patient is
often suspected of being lazy, disorganized or neurotic.  Problems at work, in
the home, and even a series of work place and auto accidents may be the clues
that something is going on that requires attention and help.  Though the
disease may strike first at any age, it most often begins during the patient's
second decade of life, with the highest incidence in people ages 15 to 25.
Although there are a number of tests that aid with the diagnosis, the most
useful is the Multiple Sleep Latency Test (MSLT), which measures how rapidly
the patient falls asleep and how quickly REM sleep develops.  This pattern can
be used to identify narcoleptic patients.  There is also a strong relationship
between narcolepsy and the presence of certain antigens in the blood
(HLA-DR2).  However there are no changes detectable in the brain itself.
Narcolepsy must be distinguished from other causes of excessive daytime
sleepiness which include sleep apnea, thyroid disorders, low blood sugar
(hypoglycemia) and even sedative medication abuse.
     Although the disease is a chronic one, without a total cure, treatment is
effective and can return the patient to a normal existence.  In mild cases a
series of short, scheduled naps during the day may be all that is necessary to
reestablish a productive routine.  These naps can reduce the daytime
sleepiness while restoring the patient's alertness.  Medications including
stimulants are useful, and antidepressants are used when cataplexy is a
problem.  Patients need much psychological support, while those around them
must be educated to the nature of the disease, with the all the explanations
needed to help restore the patient's own self esteem and self confidence.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.