A Family Doctor's Life - NARCOLEPSY

DOC I HAVE NARCOLEPSY
NARCOLEPSY is a condition characterized by sleeping at inappropriate times with intense feeling of sleepiness which ironically result in normal number of hours of sleep.

NARCOLEPSY is usually caused by the following:

1. There is a familial incidence of 60 times in a close family member.

2.There is also a one in twenty possibility of inheriting lifelong syndrome

It is a rare condition with onset in adolescence or young adults.

It is much more common in men than in women.

The danger of inappropriate sleepiness is that it may result in poor productivity, social isolation, confusion and depression.

Persons who has Acute NARCOLEPSY has the following symptoms:
1.excess daytime sleepiness - sleep episodes  occur at inappropriate times lasting minutes to hours

2.cataleptic attacks - overwhelming feelings of helplessness associated with momentary paralysis as a consequence of loss of muscle tone following laughter, anger, excitement, fear or surprise

3.hypnogogic hallucinations - vivid auditory or visual sensations occurring at onset of sleep

4.sleep paralysis - occasional motor inhibition occurring just before falling asleep or immediately on awakening

5.rapid eye movement sleep (REM) classically begins when a narcoptic falls asleep unlike normal progression from non-REM to REM sleep

Diagnosis can usually be made by :
1.History of inappropriate sleep

2.neurological examination to exclude organic central nervous system conditions

3.Pupillography and electro-encephalography

4.Polysomnography and investigation in a sleep laboratory

Treatment is by:
Non medicinal methods:
1.Explanation to family and patient with advice on how to cope with the sleepiness problem.

a.Avoiding sudden emotional upsets such as anger, laughter which could spark off an attack of sleep paralysis or catalepsy

b.Safe driving is important as car accidents are 10 times more common in narcoleptic patients than normal persons. He must keep himself awake while driving. If sleepy , he must stop the car and park somewhere safe to have a good sleep.

c.Negotiating a work schedule with the patient's employer will allow the patient to work when he feels most alert and rest when he is feeling sleepy

d.Children and adolescents can also modify their class schedule if their parents can inform the school of their conditions and get the co-operation of the school teachers and principal.

2.Instructions on how to regulate sleep habits:

a.Maintain a regular night sleep routine

b.Avoid smoking, alcohol or caffeine a few hours before sleep

c.Avoid excitement and over exercising before sleep

d.Relaxing before sleep makes falling to sleep easier

e.Keep the bedroom environment comfortable and conducive to sleep


A proper night sleep can reduce the excess daytime sleepiness.

Medicinal methods:
1.Pyschostimulants such as amphetamines, ephedrine, pseudoephedrine in dosages enough to maintain the patient's ability to work


2.Antidepressant of tricyclic type may help prevent sleep paralysis and catalepsy


Prognosis:

Narcolepsy is considered a lifelong illness and cannot be cured.