Narcolepsy

DESCRIPTION: Narcolepsy is a disabling neurological disorder of sleep regulation that affects the control of sleep and wakefulness. It may be described as an intrusion of the dreaming state of sleep (called REM or rapid eye movement) into the waking state. Symptoms generally begin between the ages of 15 and 30. The four classic symptoms of the disorder are excessive daytime sleepiness; cataplexy (sudden, brief episodes of muscle weakness or paralysis brought on by strong emotions such as laughter, anger, surprise or anticipation); sleep paralysis (paralysis upon falling asleep or waking up); and hypnagogic hallucinations (vivid dream-like images that occur at sleep onset). Disturbed nighttime sleep, including tossing and turning in bed, leg jerks, nightmares, and frequent awakenings, may also occur. The development, number and severity of symptoms vary widely among individuals with the disorder. There appears to be an important genetic component to the disorder as well.

Unrelenting excessive sleepiness is usually the first and most prominent symptom of narcolepsy. Patients with the disorder experience irresistible sleep attacks, throughout the day, which can last for 30 seconds to more than 30 minutes, regardless of the amount or quality of prior nighttime sleep. These attacks result in episodes of sleep at work and social events, while eating, talking and driving, and in other similarly inappropriate occasions. Although narcolepsy is not a rare disorder, it is often misdiagnosed or diagnosed only years after symptoms first appear. Early diagnosis and treatment, however, are important to the physical and mental well-being of the affected individual.

TREATMENT: There is presently no cure for narcolepsy; however, the symptoms can be controlled with behavioral and medical therapy. The excessive daytime sleepiness may be treated with stimulant drugs, while cataplexy and other REM-sleep symptoms may be treated with antidepressant medications. At best, medications will reduce the symptoms, but will not alleviate them entirely. Also, some medications may have side effects. Basic lifestyle adjustments such as regulating sleep schedules, improving diet, increasing exercise and avoiding "over-stimulating" situations may also help to reduce the effects of excessive daytime sleepiness and cataplexy.

PROGNOSIS: Although narcolepsy is a life-long condition, most individuals with the disorder enjoy a near-normal lifestyle with adequate medication and support from teachers, employers, and families. If not properly diagnosed and treated, narcolepsy may have a devastating impact on the life of the affected individual, causing social, psychological, and financial difficulties.

RESEARCH: The NINDS supports a broad range of clinical and basic research on sleep disorders including narcolepsy. NINDS has notified investigators that it is seeking grant applications in both clinical and basic sleep and wakefulness research, and has a program announcement specifically addressing basic and clinical research in narcolepsy.

These articles, available from a medical library, may provide more in-depth information on narcolepsy:

Mitler, M, Nelson, S, and Hajdukovic, R. "Narcolepsy: Diagnosis, Treatment, and Management." Psychiatric Clinics of North America, 10:4; 593-606 (December 1987).

Aldrich, M. "Narcolepsy." Neurology, 42:supplement 6; 34-43 (July 1992).

"Wake up America: A National Sleep Alert, Volume 1. Executive Summary and Executive Report." Report of the National Commission on Sleep Disorders Research, DHHS, (January 1993).

Information may also be available from the following organizations:

Narcolepsy Network
P.O. Box 42460
Cincinnati, OH 45242
(513) 891-3522

National Sleep Foundation
729 15th Street NW, 4th Floor
Washington, DC 20036

Narcolepsy & Sleep Disorders: An International Newsletter
P.O. Box 51113
Palo Alto, CA 94303-9559
(415) 424-8533

National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
May 1997