Doctor's Notes on Narcolepsy
- one or more of the following: excessive daytime sleepiness,
- cataplexy (sudden but temporary loss of muscle tone) triggered by emotions,
- hallucinations (vivid dream-like situations) when falling asleep or upon waking up, and
- sleep paralysis (when falling asleep or upon waking up, unable to move for a few minutes).
Such symptoms can cause social, work, school, and other problems; patients can get into dangerous situations (while driving a car, for example) during an attack of narcolepsy.
The cause of narcolepsy is believed to be due to a genetic predisposition (a small number of patients inherit [autosomal dominant] the disease) and to an abnormal level of a neurotransmitter, hypocretin, as it may, at low levels, trigger an attack. The hypothalamus is associated with sleep and hypocretin is thought to modulate the activity of the hypothalamus.
What are the treatments for narcolepsy?
The treatments for narcolepsy are mainly various drugs that stimulate the patient’s nervous system to help keep them awake or to suppress REM sleep; some drugs are used for cataplexy (sudden loss of muscle tone resulting in weakness and loss of voluntary muscle control) that may be a type of narcolepsy. The medicines used for treating narcolepsy may include;
- Nervous system stimulants
- Selective serotonin or norepinephrine reuptake inhibitors (SSRIs and SNRIs that suppress REM sleep)
- Tricyclic antidepressants (mainly for cataplexy)
A medication, sodium oxybate, that is very effective in treating cataplexy may be used in treating some patients with narcolepsy. Lifestyle changes may also help reduce symptoms:
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.