The Insomnia and Sleep Institute of Arizona treats narcolepsy, other sleep disorders

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What is Narcolepsy?
Narcolepsy is a lifelong disorder that is associated with excessive daytime sleepiness, cataplexy, and frequent sleep attacks.  The definition of cataplexy is the sudden loss of muscle weakness while a person is awake and experiences a sudden emotion such as laughter, happiness, anger, etc.  This can lead to sudden weakening of the legs or arms, for example, when the individual bursts out into laughter or tells a funny joke.  Cataplexy is actually a state when the brain quickly attempts to go directly from being awake to dream sleep (REM sleep).  It must be noted that Type I Narcolepsy is associated with cataplexy but Type II Narcolepsy is not associated with cataplexy, i.e., one can have Narcolepsy without having cataplexy.
This disorder is present in nearly 1 out of 2000 Americans and typically begins to present itself in childhood and adolescent years yet the most common time of it being diagnosed is not until the late 20s or early 30s.  The reason for the delayed time to diagnosis is oftentimes the symptoms are not recognized or are not considered to be potentially secondary to Narcolepsy.
What causes Narcolepsy?
Until recently, narcolepsy was known to be caused by the destruction of specific neurons in the brain that are responsible for producing the main neurotransmitter or protein that is responsible for keeping us awake, hypocretin.  The exact reason these neurons being destroyed was not entirely clear until a group of researchers at Standard University in CA recently discovered that Narcolepsy appears to be an autoimmune disorder and in fact our own immune system attacks and destroys these neurons.  Keep in mind these findings from Stanford also indicated that the specific part of immune system that was involved in Narcolepsy was only found in patients with the disorder and not in individuals with Narcolepsy.
What are the symptoms of Narcolepsy?
The most common symptom of Narcolepsy is excessive sleepiness.  The individual with Narcolepsy is essentially always sleepy regardless of the number of hours of sleep he or she obtains.  They often report that they always have dreams either at night or even during their daytime naps.  One of the most common symptoms especially in children is the need for frequent napping regardless of how much sleep the child obtains.  In my clinical experience, I have diagnosed Narcolepsy in a child as young as 7 years of age.  
Other symptoms of narcolepsy include cataplexy, as discussed above, frequent napping, sleep paralysis, leg kicking during sleep, and even sudden sleep attacks.
Many individuals will report to me in my clinic that he or she is so sleepy that they believe they have Narcolepsy.  One must keep in mind that the sleepiness that is associated with Narcolepsy is generally similar to the sleepiness that can occur as a result of having untreated obstructive sleep apnea (OSA), sleep deprivation, and/or another underlying sleep disorder.  I see many individuals with sleep apnea that have had sleepiness to the same extent as my narcolepsy patients but his or her sleepiness gradually improved and resolved once I successfully treated the underlying sleep apnea.
How is Narcolepsy diagnosed and treated?
The diagnosis of Narcolepsy must be made by a board certified sleep medicine physician after undergoing a consultation.  It is important that a proper history of symptoms be taken to determine if the symptoms of excessive sleepiness are secondary to possible Narcolepsy or possibly secondary to another sleep disorder such as sleep apnea.  If there are no signs or symptoms suggestive of another sleep disorder causing the excessive sleepiness then the diagnostic protocol is as such:  the individual comes into the sleep center to spend the night to undergo a polysomnography (PSG or sleep study) to evaluate the night time sleep and to ensure that there is no underlying sleep disorder.  If there is no obvious source of the night time sleep being disrupted then the individual will undergo a multiple sleep latency test (MSLT) the next day following the overnight sleep study.  The MSLT is commonly referred to as "the nap study".  The purpose of this test is to see how quickly does that individual fall asleep over the course of 5 naps knowing that the person has normal night time sleep as documented by the overnight sleep study.  We also want to see if the individual enters into dream sleep or REM sleep during these naps as well as this is a very important feature of Narcolepsy during this test.
The treatment for Narcolepsy is medication treatment that is designed to help the person stay awake during the day.  These medications include wake-promoting agents such as Nuvigil and Modafinil, stimulants such as Adderall or Ritalin, and a very powerful sedative, Xyrem, which is only indicated for Narcolepsy.  However, with the recent findings that Narcolepsy is an autoimmune

disorder new therapies that will be targeted towards the immune system are very likely to emerge in the future.

If you or someone you know has symptoms of possible Narcolepsy then a consultation with a board certified sleep medicine specialist should be performed.

Sleep and dream well,
Ruchir P Patel, M.D., FACP
Medical Director, The Insomnia and Sleep Institute of Arizona
Board Certified and Fellowship trained in Adult and Pediatric Sleep Medicine

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