Narcolepsy & Cataplexy

Narcolepsy: A lifelong sleep disorder characterized by excessive daytime sleepiness (EDS) and sudden, involuntary attacks of sleep that often make it difficult to stay awake for long periods of time regardless of the circumstances. Narcolepsy comes in two types, distinguished by the presence (type 1) or absence (type 2) of cataplexy. In addition to EDS and cataplexy, sleep paralysis and hallucinations are typical symptoms of narcolepsy, however, these last two only affect 10%-25% of people with narcolepsy.

Cataplexy: Abrupt and brief muscle weakness/relaxation often triggered by strong emotion (usually positive) such as laughter. It is diagnostic of type 1 narcolepsy, and in this context it is associated with deep dreaming (REM) sleep.


Am I susceptible to Narcolepsy or Cataplexy?

Narcolepsy equally affects males and females, with symptoms typically beginning in childhood, adolescence or young adulthood (7-25 yo). The exact prevalence of narcolepsy is difficult to determine since it is often undiagnosed, however It is estimated that 1 in 2,000 people in Canada suffer from narcolepsy. The cause of narcolepsy is still under investigation, but research suggests it is a result of multiple factors interacting to cause low levels of hypocretin, also known as orexin, which is a chemical produced in the brain that has an important role in sleep and arousal states. These factors include autoimmune disorders, a family history of narcolepsy, and brain injury.

 Diagnosis

Two routine tests are conducted at Jodha Tishon to asses for narcolepsy

  •  Polysomnography (PSG)

    Commonly referred to as a “night-sleep study”

    Thorough overnight recording of brain, eye, jaw, limb and breathing activity that can illuminate features of sleep architecture consistent with narcolepsy (eg. time from sleep onset to REM).

  • MULTIPLE SLEEP LATENCY TEST (MSLT)

    Commonly referred to as a “day-sleep study”

    An assessment of daytime sleepiness, at 4 or 5 times separated by 2 hours during the day participants are asked to take a nap while PSG data is collected. If one falls asleep in less than 8 minutes on average, they are classified as excessively sleepy (EDS); however people with narcolepsy tend to fall quickly into REM sleep (within 15 minutes).

Treatments

While there is no defined cure for narcolepsy, the goal of treatment remains to maximize life functioning and quality of life through treatment of symptoms and lifestyle changes associated with the disorder. EDS and cataplexy are often controlled with the following treatments:

  • Modafinil

    Modafinil is an alerting agent and typically the first line of treatment. It is less addictive and has fewer side effects than older, more well-known stimulants. Research suggests modafinil works best for persons who have not previously been treated with traditional stimulants.

  • Stimulants

    Stimulants such as amphetamine (Adderall) or methylphenidate (Ritalin) may be prescribed as stronger alerting agents, however they are not usually the first line of treatment due to adverse effects on nighttime sleep.

  • Sodium oxybate

    Sodium oxybate aka GHB is a strong sedative occasionally used to enhance nighttime sleep and reduce EDS, although it inconveniently needs to be taken twice a night.

  • Planned naps

    Planned naps throughout the day have been shown to improve symptoms of narcolepsy and are sometimes advised by sleep doctors.

Are you unsure if you have Narcolepsy?

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