Imagine eating at the table when your eyes suddenly close and you fall asleep! This is a strange situation, isn’t it? 

Narcolepsy, or sleep apnea, is a chronic sleep disorder that includes sleep apnea attacks. 

The exact cause of this disease is not known and there is no specific treatment. Read on to find out the symptoms, ways to control the disease, and the types of narcolepsy.

Narcolepsy, or sleep apnea, is a chronic sleep disorder characterized by drowsiness, daily fatigue, and sudden sleep onset. It is very difficult for people with narcolepsy to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disturbances in a person’s daily routine.

Sometimes narcolepsy may be accompanied by a sudden decrease in muscle strength (cataplexy), which may be caused by intense emotions. Narcolepsy that occurs with cataplexy is called type 1 narcolepsy. Narcolepsy that occurs without cataplexy is also known as type 2 narcolepsy.

The Narcolepsy is a chronic disease for which there is no cure. However, medications and lifestyle changes can help manage the symptoms. Also, the support of others (family, friends, employers and teachers) will help you cope with narcolepsy and its symptoms.

Signs of sudden sleep onset

The signs and symptoms of narcolepsy may worsen in the first few years and then continue for the rest of your life. These symptoms include:

1. Excessive daytime sleepiness (EDS)

People with narcolepsy sleep without warning, anywhere, anytime; For example, you may be working or talking with your friends and suddenly fall asleep for a few minutes to half an hour. When you wake up, you feel refreshed; But eventually you fall asleep again. You may also have decreased alertness and concentration throughout the day. Excessive daytime sleepiness is usually the first symptom to appear and is often the most troublesome problem; So it makes it difficult for you to be fully focused and functional.

2. Sudden loss of muscle strength

This condition, called cataplexy, sometimes causes physical changes; From speech disorders to complete muscle weakness, it can take up to a few minutes. Cataplexy is uncontrollable and results from intense emotions. These emotions are usually positive emotions such as laughter or excitement; But sometimes it can be fear, surprise or anger; For example, when laughing, your head may sag uncontrollably or your knees may suddenly bend.

3. Sleep paralysis

People with narcolepsy often experience a temporary inability to move and talk while sleeping or waking up. These disabilities are usually short and last a few seconds or minutes; But they can be scary for a person. You may be fully aware of your condition during sleep paralysis and have no problem remembering it after the attack is over. Even if you have no control over what happened to you.

This sleep paralysis is similar to temporary paralysis that typically occurs during a period of sleep called REM sleep. This temporary immobility during REM sleep may prevent your body from engaging in activity while sleeping. However, not all people with sleep paralysis have narcolepsy. Many people with narcolepsy only occasionally experience sleep paralysis.

4. Change in sleep with rapid eye movements (REM)

REM sleep is the stage in which most dreams usually occur. REM sleep occurs at any time of the day in people with narcolepsy. People with narcolepsy usually transition quickly to REM sleep, usually 15 minutes after bedtime.

5. Delusion

If these hallucinations occur during sleep, they are called hypnagogic hallucinations, and if they occur during waking, they are called hypnotic hallucinations (Hypnopompic hallucinations); For example, you feel like there is a stranger in your bedroom. These hallucinations can be vivid and frightening, as you may not be fully asleep while dreaming and experience your dreams as reality.

6. Other symptoms

People with narcolepsy may have other sleep disorders such as sleep apnea ; A condition in which breathing begins and stops during the night. Other disorders include restless legs syndrome and even insomnia.

Some people with narcolepsy experience automatic behavior during short periods of narcolepsy; For example, they may fall asleep while performing a task they normally perform (such as writing, typing, or driving) and continue to do so during sleep. When they wake up, they do not remember what they did and probably did not do well.

Are the symptoms of sleep apnea different in children?

There is considerable overlap between the symptoms of narcolepsy in children and adults; But there are also important differences.

In children, EDS is more commonly seen as restlessness or irritability, which may be interpreted as a behavioral problem. At night, children with narcolepsy may sleep more and be more active during sleep. Cataplexy is often milder in children; Although it occurs in 80% of cases. This condition usually affects the face rather than the body and may occur as a tic. Cataplexy in children may not be related to an emotional response.

Causes of Narcolepsy

The exact cause of narcolepsy is unknown. People with type 1 narcolepsy have low levels of a chemical called hypocretin. Hypocretin is an important neurochemical chemical in the brain that helps regulate REM wakefulness and sleep.

Hypocretin levels are low, especially in those who experience cataplexy. It is not clear exactly what causes the destruction of hypocretin-producing cells in the brain; But experts believe this is due to an autoimmune reaction. Genetics may also be involved in the development of narcolepsy; But the risk of transmission from parent to child is very low, only about 1%.

Normal sleep pattern compared to narcolepsy

The normal sleep process begins with a fuzzy sleep called non-rapid eye movement (NREM). During this stage, the brain waves slow down dramatically. After an hour or so of NREM sleep, brain activity changes and REM sleep begins. Most sleep disorders occur during REM sleep. However, in narcolepsy, you may suddenly fall into REM sleep without experiencing NREM sleep, whether at night or during the day.

risk factors

There are only a few known risk factors for narcolepsy, including:

• Age: Narcolepsy usually begins in people between the ages of 10 and 30.
• Family history: If a family member has narcolepsy, they are 20 to 40 times more likely to develop narcolepsy.

Complications of narcolepsy

1. Misunderstanding of others about one’s situation

Narcolepsy can cause serious problems for you, both professionally and personally. Others may see you as lazy or lethargic. Your performance at school or at work may also be impaired.

2. Interference in intimate relationships

Intense emotions such as anger or happiness may cause narcolepsy symptoms such as cataplexy and cause people with emotional distress to leave the relationship.

3. Physical injury

Sleep attacks can cause physical harm to people with narcolepsy. If you are attacked while driving, you are at greater risk of an accident. If you fall asleep while preparing food, the risk of cuts and burns is higher.

4. Obesity

People with narcolepsy are more likely to be overweight . Weight gain may be due to metabolism or low metabolism in the body.

When to see a doctor?

See your doctor if you feel too drowsy during the day that disrupts your personal or professional life.

Diagnose a sleep attack or narcolepsy

Your doctor may make the initial diagnosis of narcolepsy based on your excessive daytime sleepiness and sudden decrease in muscle strength (cataplexy). After the initial diagnosis, your doctor may refer you to a sleep specialist for further evaluation. For a formal diagnosis, you should stay overnight at a sleep center, for in-depth sleep analysis by specialists.

Methods of diagnosing narcolepsy and determining its severity include the following:

1. Sleep history

Your doctor will ask you for accurate sleep history. Part of this history is obtained by completing the Epworth Sleepiness Scale (ESS). This questionnaire uses a series of short questions to assess your level of drowsiness; For example, in a question, by putting a certain score on a specific scale, you show how likely you are to nap in certain situations, such as after a lunch break.

You may be asked to make a detailed diary of your sleep pattern for 1 or 2 weeks. By examining these records, your doctor can compare how your sleep patterns and alertness relate to each other. In addition to your sleep history, your doctor will ask you to use a device called an Actigraph. This device is similar to a watch and measures activity and rest periods and records how and when to sleep.

2. Sleep test or polysomnography

Sleep test uses electrodes placed on your scalp to measure different signals during sleep. For this test, you have to spend a night in a medical center. This test measures the electrical activity of the brain (electroencephalogram) and heart (electrocardiogram) and the movement of the muscles (electromyogram) and the eye, as well as your breathing.

3. Multiple Sleep Latency Test

This test measures how long it takes you to fall asleep during the day. The patient is asked to take 4 or 5 naps, each taking 2 hours apart. Experts will monitor your sleep patterns. People with narcolepsy fall asleep easily and enter the REM phase quickly. These tests can also help doctors rule out other possible causes of your signs and symptoms.

Control the symptoms of sleep apnea

There is no cure for narcolepsy; But medications and lifestyle modifications help manage the symptoms of the disease.

1. medicines

Narcolepsy medications include the following:

• Triggers

Drugs that stimulate the central nervous system are the main treatment to help people with narcolepsy wake up during the day. Doctors often prescribe modafinil or armodafinil for narcolepsy. Modafinil and armodafinil are not as addictive as the old stimulants and do not produce the fluctuations that are often caused by the old stimuli. These drugs do not have abnormal side effects; But they can cause headaches, nausea or anxiety.

Sunosi and pitholizans are newer stimulants used for narcolepsy, headaches and anxiety. Pitolizan may also be useful for cataplexy. Some people need treatment with methylphenidate or various amphetamines. These drugs are very effective; But they can be addictive and cause side effects such as nervousness and palpitations.

• Serotonin reuptake inhibitors (SSRIs)

Doctors often prescribe drugs that suppress REM sleep to help reduce the symptoms of cataplexy, hallucinations, and sleep paralysis. These drugs include fluoxetine and venlafaxine. Side effects may include weight gain, insomnia , and digestive problems .

• Tricyclic antidepressants

These antidepressants, such as protriptyline, imipramine, and clomipramine, are effective for cataplexy; But many people complain of side effects such as dry mouth and lightheadedness.

• Sodium oxibate

This drug is very effective for cataplexy. Sodium oxibate helps improve sleep at night. High doses may also help control daytime drowsiness. This drug should be taken in two doses, one at bedtime and the other up to 4 hours later. This medicine may have side effects such as nausea, nocturia, and worsening sleepwalking conditions.

Drug Interactions

If you have other conditions, such as high blood pressure or diabetes , ask your doctor if the medications you are taking for your other conditions may interfere with medications used for narcolepsy. Certain over-the-counter medications, such as allergies and cold medicines, can cause drowsiness. If you have narcolepsy, your doctor may advise you to avoid these medications.

2. Lifestyle and home remedies

Lifestyle modification is important in the management of narcolepsy symptoms. Use these methods to improve your situation:

• Have a regular schedule for your sleep

Go to bed and wake up at a set time every day, even on weekends.

• Take a short nap

During the day, take a short nap at a specific time. A 20-minute nap will refresh you and take 1 to 3 hours of drowsiness away from you. Some people may need more sleep.

• Do not consume alcohol or nicotine

Using these substances, especially at night, may worsen your signs and symptoms.

• Exercise regularly

Moderate and regular exercise at least 4 to 5 hours before bedtime helps you stay awake during the day and sleep better at night.

Coping with sleep apnea and support from others

Coping with narcolepsy can be challenging. It is better to consider these points:

1. Talk about it

Talk to your employer or teachers about your situation and work with them to find ways to meet your needs. These may include napping during the day, eliminating monotonous tasks, recording meetings or classes, standing in meetings or lectures, and brisk walking at different times of the day.

2. be careful

If you have to drive long distances, get a medication plan from your doctor that ensures you are most likely to wake up while driving. Whenever you feel drowsy, stop napping and exercising, and do not drive if you feel too drowsy.