A chronic sleep disorder or dyssomnia characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school. Narcoleptics usually experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which is often confused with insomnia. Another problem that some narcoleptics experience is cataplexy, a sudden muscular weakness brought on by strong emotions. It often manifests as muscular weaknesses ranging from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually only speech is slurred, vision is impaired, but hearing and awareness remain normal. In some rare cases, an individual's body becomes paralyzed and muscles become stiff. Narcolepsy is a neurological sleep disorder. It is not caused by mental illness or psychological problems. It is most likely affected by a number of genetic abnormalities that affect specific biologic factors in the brain, combined with a set off from environment, such as a virus.
- Excessive daytime sleepiness (EDS), even after adequate nighttime sleep.
- Daytime naps occurring with little warning and feeling physically irresistible.
- Continuing to function (talking, putting things away, etc.) during sleep episodes, but awakening with no memory of performing such activities
- Loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse.
None of the currently available medications enables people with narcolepsy to consistently maintain a fully normal state of alertness. But EDS and cataplexy, the most disabling symptoms of the disorder, can be controlled in most patients with drug treatment. Often the treatment regimen is modified as symptoms change. Whatever the age of onset, patients find that the symptoms tend to get worse over the two to three decades after the first symptoms appear. Many older patients find that some daytime symptoms decrease in severity after age 60.
Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are also frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important.
The main treatment of excessive daytime sleepiness in narcolepsy is with central nervous system stimulants such as Ritalin, Adderall or Dexadrine or newer agents that promote wakefulness such as Provigil or Nuvigil. Planned regular short naps can reduce the need for pharmacological treatment of the EDS to a low or non-existent level. Lifestyle changes involving reduced stress, more exercise (especially for overweight persons experiencing EDS caused by sleep apnea and snoring) and less stimulant intake (such as coffee and nicotine) are likely to be ideal forms of assistive treatment. Some people with narcolepsy have a nocturnal body clock and are helped by selecting an occupation that properly coincides with their body's natural sleep cycle (such as sleeping in the day and working at night). In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Ongoing communication between the health care provider, patient, and the patient's family members is important for optimal management of narcolepsy.