Narcolepsy And REM Sleep
A normal night sleep for most adults lasts about 8 hours and consists of 4-6 sleep cycles. A sleep cycle starts with three stages in the non-rapid eye movement sleep followed by the final phase of the rapid eye movement sleep. The non-rapid eye movement (NREM) sleep begins with the light stage of sleep and gradually increasing to deeper stages of sleep. After about 90 minutes you will enter the first phase of rapid eye movement (REM) sleep. Dreams usually occur during the REM sleep due to the heightened brain activity. Also, the muscles are temporary paralyzed to control posture and body movement.
People with narcolepsy almost immediately enter the REM sleep after they fall asleep. Also, fragments of REM sleep occurs involuntarily during the day. Narcolepsy is often associated with sleep paralysis and hallucinations. Since muscles are paralyzed and dreams occur during REM sleep.
Impact Of Narcolepsy
Narcolepsy patients do not sleep more than other people. They sleep an average amount, but they are not able to control the timing of sleep. This can have a significant effect on their daily life, dangerous even. Since you may fall asleep or experience excessive sleepiness at any time of the day. When you are working, exercising, studying or having a conversation, you name it. Imagine you suddenly fall asleep when you’re driving. You’re not putting your life at risk but also others. In some countries, it’s illegal to drive with untreated narcolepsy.
Luckily, only one in 2000 people has some form of narcolepsy. Signs of narcolepsy in adults are more common than in children. Narcolepsy in children is extremely rare. It usually starts between the age 15 and 25. However, narcolepsy is often difficult to diagnose and remains untreated.
What Are The Signs And Symptoms Of Narcolepsy
Not everyone will have the same signs and symptoms of narcolepsy. Some people experience them frequently, and others are less affected. The symptoms can occur and develop over a few years or suddenly in a few weeks time.
Narcolepsy has 6 primary symptoms:
- Excessive daytime sleepiness
One of the first signs and symptoms of narcolepsy is usually excessive daytime sleepiness. Feeling extremely exhausted and drowsy during the day. Also, having a difficult time to stay awake, even though you had sufficient sleep at night. People with excessive daytime sleepiness find it difficult to concentrate and fully function, which can interfere with normal activities on a daily basis. They are often misjudges being lazy or rude.
- Sleep attacks
Sleep attacks are also one of the common signs and symptoms of narcolepsy. People with narcolepsy tend to fall suddenly asleep, without any warning, during any activity, at any time or place. Although, sleep attacks often occur after eating, you may quickly fall asleep in the middle of a conversation as well. The sleep attacks can last a few seconds to a few minutes or even up to a half hour depending on the person. If narcolepsy is not treated, sleep attacks may occur several times a day. Making it hard for people with narcolepsy to live generally.
Cataplexy is the most specific symptom out of all the signs and symptoms of narcolepsy. Approximately, one-third of the people with narcolepsy will not have cataplexy. The symptom can also appear in a later stage of narcolepsy. The first attack usually occurs after several weeks or months of excessive daytime sleepiness.
Cataplexy is a sudden and temporary loss of muscle tone while being awake. Cataplexy attack can vary in duration from a few seconds to several minutes. It may involve all muscles and result in collapse. It may only affect certain muscle groups such as:
- Jaw dropping
- Head slumping down
- Uncontrollable legs collapsing
- Slurred speech
- Double vision or hard time focusing
People maintain full consciousness throughout an episode, even in the complete loss of tone in all muscles. This distinguishes cataplexy from seizure disorders. However, patients are unable to speak, move or keep their eyes open during an attack.
Cataplexy is often triggered by intense emotions such as laughter, excitement, surprise or anger. Some people become emotionally withdrawn and socially isolated as an attempt to avoid attacks. Some attacks vary per person; some have once or twice a year while others experience them on a daily basis.
- Sleep paralysis
Some people with narcolepsy will experience episodes of sleep paralysis as one of the signs and symptoms of narcolepsy. Sleep paralysis is the temporary inability to move or speak when you are waking up or falling asleep. These episodes usually only last a few seconds to several minutes. Sleep paralysis doesn’t cause any harm, but it can be frightening.
Sleep paralysis is similar to a cataplexy attack with all the muscles involved. In both situations, you remain conscious, while being temporarily paralyzed. The type of temporary paralysis would usually occur during the rapid eye movement (REM) sleep. It’s the period of sleep in which most dreams occur. That’s also the reason hallucinations often come along with sleep paralysis. The temporary paralysis prevents the body from acting out the dream.
After the episode, you will be able to speak and move again. Even though, you had no control over the situation. You may be fully aware of what happened and have no problem in recalling it afterward.
Keep in mind that, people who are experiencing episodes of sleep paralysis doesn’t necessarily have narcolepsy. Other causes could be irregular sleep patterns or sleep deprivation. Also, sleep paralysis is more prevalent in teenagers and young adults. While signs of narcolepsy in adults are reported more often compared to in childhood.
- Hypnagogic hallucinations
Hallucinations may accompany sleep paralysis. Hallucinations are vivid, realistic, bizarre, often frightening dream-like experiences that occur while falling asleep, during sleep or while awake. They are called hypnagogic hallucinations when they appear during sleep onset. When occurring during awakening, it’s called hypnopompic hallucinations. The content is usually visual, but other senses can be involved.
- Disrupted Nighttime Sleep (DNS)
People with narcolepsy have no trouble falling asleep. Most of them experience night-time disrupted sleep instead. Disturbed nighttime sleep (DNS) is the inability to maintain sleep for more than a few hours and as the result, you wake up multiple times throughout the night. Disruption of sleep can be caused by vivid dreams, insomnia, sleep talking or periodic leg movements. The frequent awakenings throughout the night make you feel more tired and not refreshed in the morning.
Other Signs And Symptoms Of Narcolepsy
The automatic response involves carrying on with an activity and not being aware of doing it or recalling it afterwards. If you were typing before falling asleep, you might continue hitting random letters on your keyboard. You continue to function while sleeping, but you’re not aware of your actions and don’t perform them well either.
Difficulty in remembering recent events, actions or words.
What Are The Causes Of Narcolepsy
Scientists haven’t found the exact cause of narcolepsy yet. Narcolepsy may have several causes. Most people with the signs and symptoms of narcolepsy have low levels of brain chemicals hypocretin (orexin). Hypocretin is neurotransmitters that regulate wakefulness and REM sleep.
Experts suspect that the immune system is attacking parts of the brain that produce hypocretin. In normal circumstances, antibodies only destroy disease-carrying organisms and toxins. However, when antibodies mistakenly attack healthy cells or tissue, it’s called autoimmune response. This explains the lack of production in hypocretin. Hypocretin levels are unusually low in the people who experience cataplexy.
This doesn’t explain the causes for the people with narcolepsy who don’t experience cataplexy. Neither for the people with narcolepsy that produce near-normal levels of hypocretin.
Inherited genetic fault
In some cases, genetics can also play a role in narcolepsy. 10 percent of the people with narcolepsy who experience cataplexy reported to have a close relative with the same symptoms. However, narcolepsy does not have a pattern of inheritance. Parents, siblings and children of people with narcolepsy and cataplexy have 40 times higher risk of developing the condition compared with persons in the general population. In extremely rare cases, the disease is caused by a genetic defect that prevents normal production of hypocretin.
Other possible causes of narcolepsy include:
- Hormonal changes (including puberty or the menopause)
- Significant psychological stress
- Change in sleep patterns
- Infection, such as flu or a streptococcal infection
- Flu vaccine Pandemrix
Research has shown that there is a possible association with exposure to the H1N1 virus (swine flu) and a certain form of H1N1 vaccine Pandemrix. It’s not certain yet if the virus directly triggers narcolepsy or whether exposure to the virus increases the likelihood that someone will have narcolepsy. Pandemrix is no longer given to people under the age of 20.
Treatment Of Narcolepsy
There is currently no cure or natural remedies for narcolepsy. However, some signs and symptoms of narcolepsy can be treated with lifestyle changes and medications. This can help you minimize the impact on your daily life.
In mild cases of narcolepsy, simple lifestyle changes can already help, such as:
- Take short, regular, scheduled naps throughout the day
(Let an expert help you plan a program that fits your other activities)
- Create and stick to a strict sleep schedule
(wake up and sleep at the same time every day)
- Keep your sleep area calm, clean, distraction-free and at a comfortable, cool temperature
- Exercise regularly, but avoid them few hours before sleep
- Avoid drinking caffeine and alcohol or smoking before sleep
- Don’t eat large, heavy meals few hours before going to bed
It is also important to inform and talk to the people around you. Narcolepsy can be a painful condition for others to understand. They may get frightened when a cataplexy or sleep attack occur if they are not aware of the situation.
In a work environment, people may assume you are lazy or rude. It is, therefore, important to inform your boss and colleagues to avoid misunderstandings. The same goes with a school environment, advise teachers about the condition. So they won’t mistake your child’s behavior as lazy or assume they stayed up late last night.
Go to counseling for advice on future careers, adjustments to be made to work or school, financial or relationship problems. Join support groups that offer advice about living with the condition and can put you in touch with other people in a similar situation.
If the signs and symptoms of narcolepsy are more severe, you will usually need to take medication.
Stimulants improve alertness and minimize excessive daytime sleepiness.
Side effects: headaches, irritability, mood changes, nervousness, insomnia, nausea and irregular heartbeat.
- Sodium Oxybate
Sodium Oxybate is often given to reduce excessive daytime sleepiness and improve disturbed nighttime sleep.
Side effects: nausea, excessive sedation, diarrhea, vomiting, mood changes and bedwetting.
(tricyclics and selective serotonin and noradrenergic reuptake inhibitors)
Antidepressants are often used to treat hallucinations, cataplexy and sleep paralysis.
Side effects: nausea, anxiety or decreased emotions, weight gain, drowsiness, sexual dysfunction and changes in blood pressure.
Natural remedies for narcolepsy
If you don’t want to take medication because of the side effects. You can try natural remedies for narcolepsy instead. Below are herbs that help to treat narcolepsy and various other sleep disorders.
- Gotu kola
- Country Mallow
- Gingko Biloba
- St John’s Wort