Narcolepsy is a nervous system disorder that cause excessive sleepiness during the day and asleep suddenly without knowing time and place. Not only can it interfere with daily activities, this condition can also harm the sufferer.
Narcolepsy may be accompanied by other symptoms, which include: sleep paralysis, hallucinations, and cataplexy, which is weakness or loss of control of the muscles of the face, neck, and knees.
Narcolepsy that is accompanied by cataplexy is called type 1 narcolepsy, while that which is not accompanied by cataplexy is called type 2 narcolepsy.
Causes of Narcolepsy
The exact cause of narcolepsy is not known. However, most people with narcolepsy have low hypocretin levels. Hypocretin is a chemical in the brain that controls sleep. The cause of low hypocretin is thought to be an autoimmune disease.
Narcolepsy is also thought to be caused by diseases that damage the hypocretin-producing parts of the brain, such as:
- Brain tumor
- Head injury
- Encephalitis
- Multiple sclerosis
In addition to the above diseases, there are several factors that can increase the risk of narcolepsy or trigger autoimmune diseases to cause narcolepsy, namely:
- 10–30 years old
- Hormonal changes, especially at puberty or menopause
- Stress
- Sudden changes in sleep patterns
- Infections, such as a streptococcal bacterial infection or swine flu infection
- Hereditary genetic disorders
Symptoms of Narcolepsy
Symptoms of narcolepsy can appear within a few weeks or develop slowly over years. The following are the most common symptoms of narcolepsy:
- Excessive sleepiness during the dayPeople with narcolepsy are always sleepy during the day, have trouble staying awake, and have trouble concentrating.
- Sleep attackSleep attacks that cause narcolepsy sufferers to fall asleep anywhere and anytime suddenly. If narcolepsy is not controlled, sleep attacks can occur several times a day.
- CataplexyCataplexy or sudden muscle weakness is characterized by limp limbs, double vision, drooping head and lower jaw, and slurred speech. This condition can last from a few seconds to a few minutes and is usually triggered by certain emotions, such as surprise, anger, joy, or laughter. Patients usually experience cataplexy attacks 1-2 times a year.
- Overlapping or sleep paralysisThis condition occurs when the patient is unable to move or speak when he is about to wake up or begins to fall asleep.
- hallucinationPeople with narcolepsy can sometimes see or hear things that are not real, especially when going to sleep or waking up.
In addition to these general symptoms, narcolepsy can also be accompanied by other symptoms, such as:
- Memory disorder
- Headache
- Depression
- Desire to overeat
- Extreme fatigue and constant lack of energy
The process of sleeping with narcolepsy is different from normal people. There are two phases in the normal sleep process, namely the REM phase (rapid eye movement) and the non-REM phase. Here's the explanation:
Non-REM phase
The non-REM phase consists of three stages that can last 5–15 minutes each. Here are the steps:
- Stage 1, where the eyes have closed and are not easy to wake up.
- Stage 2, the heart rate slows down and body temperature drops. This indicates the body is preparing for a deeper stage of sleep.
- Stage 3, the stage where someone who is asleep will be more difficult to wake up. If he wakes up, he will feel dazed for a few minutes.
REM phase
The REM phase occurs after a person has fallen asleep for 90 minutes. In this phase, the heart rate and breathing will accelerate. The REM phase will occur alternately with the non-REM phase.
The first phase of REM phase will usually last for 10 minutes, and its duration will continue to increase in subsequent stages until the last stage which can last as long as 1 hour.
In people with narcolepsy, the sleep process will immediately enter the REM phase, either when the patient is preparing to sleep or when he is awake and active. This condition then causes the symptoms of narcolepsy.
When to go to the doctor
Check with your doctor if you experience excessive sleepiness during the day that interferes with daily activities. It is also advisable to see a doctor if narcolepsy does not improve after treatment or if new symptoms develop.
Narcolepsy Diagnosis
As a first step in diagnosis, the doctor will examine the patient's medical history and the patient's family. Then, the doctor will ask about the patient's sleeping habits and symptoms.
To confirm the diagnosis, the doctor will also perform a physical examination and other tests, such as blood pressure tests and blood tests. Further examination using some of the methods below will also be carried out to detect the severity of the condition:
1. Epworth Sleepiness Scale (ESS)
In ESS, doctors will use a questionnaire to assess the likelihood of a patient falling asleep while doing different activities, such as sitting, reading, or watching television. Questionnaire scores can be used as a reference for doctors to diagnose and measure the severity of the condition.
2. Polysomnography
In this method, the doctor will monitor the electrical activity of the brain (electroencephalography), heart (electrocardiography), muscles (electromyography), and eyes (electrooculography) while the patient is sleeping, by placing electrodes on the patient's body surface.
3. Multiple Sleep Latency Test (MSLT)
MSLT is used to determine how long it takes the patient to fall asleep during the day. Patients will be asked several times to sleep during the day and measured how long it takes for the patient to start falling asleep, and also assessed the sleep phase.
If the patient can sleep easily and enters the sleep phase rapid eye movement (REM) rapidly, the patient is more likely to have narcolepsy.
4. Hypocretin level measurement
Examination of hypocretin levels is carried out using samples of brain and spinal fluid (cerebrospinal fluid) taken through a lumbar puncture procedure (Fig.lumbar puncture), which is sucking fluid from the lower spine using a needle.
Narcolepsy Treatment
There is no cure for narcolepsy yet. The goal of treatment is only to control symptoms, so that the patient's activities are not disturbed.
For mild narcolepsy, treatment can be done by changing sleep habits. The following are some ways you can do to reduce daytime sleepiness and improve sleep quality at night:
- Exercise regularly for at least 30 minutes every day, and don't do it too close to bedtime. It is recommended to exercise at least 2 hours before bedtime.
- Avoid eating heavy meals before bed.
- Try to get up in the morning and go to bed at the same time every day.
- Get in the habit of napping for 10-15 minutes after lunch.
- Do not consume caffeine and alcohol, and avoid smoking before bed.
- Do things that can relax your mind before bed, such as reading or taking a warm bath.
- Make the atmosphere and room temperature as comfortable as possible.
If the symptoms are severe enough, the patient needs to be given medication. The drugs given will be adjusted to the severity, age, medical history, overall health condition, and side effects that may be caused.
Some of the medications used to relieve narcolepsy symptoms include:
- Stimulants, such as methylphenidate, to stimulate the central nervous system thereby helping sufferers stay awake during the day
- Tricyclic antidepressant medications, such as amitriptyline, to help relieve symptoms of cataplexy
- Types of antidepressants selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), to suppress sleep, relieve symptoms of cataplexy, hallucinations, and sleep paralysis
- Sodium oxybate, to prevent cataplexy and relieve excessive daytime sleepiness
- Pitolisant, to help release histamine in the brain to relieve daytime sleepiness
Narcolepsy Complications
Narcolepsy can cause complications that have an impact on the patient's physical and mental. Possible complications include:
- ObesityThis condition can be caused by excessive eating patterns and lack of movement due to frequent sleep.
- Negative assessment of the social environmentNarcolepsy can also make sufferers get a negative assessment of the surrounding environment. In this case, the sufferer may be considered lazy because he often falls asleep.
- Physical injuryThe risk of physical injury can occur when sleep attacks occur at inopportune times, such as when driving or cooking.
- Impaired concentration and memoryNarcolepsy that is not treated properly can lead to decreased concentration and memory. This condition can make it difficult for sufferers to do assignments or work at school or work.
Complications of narcolepsy can be avoided by doing regular exercise to prevent obesity, not driving or operating dangerous equipment to prevent injury, and explaining to those around you about your condition to avoid negative judgments.
Narcolepsy Prevention
Narcolepsy cannot be prevented, but regular medication can help reduce the number of sleep attacks that may occur. In addition, by doing the ways mentioned above to improve sleep quality, the onset of narcolepsy symptoms can also be prevented.