Do you suddenly fall asleep during the day? This could be Narcolepsy! Let's talk about it

Have you ever felt unbearably sleepy while working during the day or chatting with friends? You might think, "Oh... I didn't get enough sleep last night." But it's not just a case of tiredness. Today we're going to talk about a slightly different type of sleep problem. That's a condition called Narcolepsy . Although it's not very common, it's something that many people have heard of because of the symptoms associated with it . It can be treated, but it can have a big impact on your life, work, and social relationships.

What is Narcolepsy?

Simply put, Narcolepsy is a neurological condition that causes sudden, uncontrollable sleep during the day. Specifically, your brain can't properly regulate sleep and wakefulness. This can cause you to feel excessively sleepy during the day, no matter how much sleep you get at night.

What are the main symptoms of Narcolepsy?

There are four main symptoms of Narcolepsy. But most people don't have all four at once. Some people may have one or two. Let's see what these symptoms are.

• Excessive Daytime Sleepiness : This is a common symptom of Narcolepsy. It's like having a "sleep attack" where you suddenly fall asleep. No matter what you're doing, you feel like stopping and going to sleep.
• Cataplexy: This is a sudden loss of muscle control . Sometimes it can be mild, like a twitching of the muscles on one side of the face or neck. If it's severe, you may suddenly fall to the ground. Let's talk about this in more detail.
• Sleep-related hallucinations : These are hallucinations that occur when you are falling asleep or when you are about to wake up, and they can be very frightening.
• Sleep Paralysis : You may have heard of this as "being scared in a dream and unable to move" or as some say, "feeling like a demon has climbed up." This is when you are unable to move your body even when you wake up, or maybe not fully awake. Let's look at this a little more.

A little more about (Cataplexy)

We mentioned earlier that cataplexy is a sudden loss of muscle strength. Narcolepsy is divided into two main types depending on whether or not this cataplexy symptom is present:

• (Narcolepsy Type 1) : This type has the symptom of (Cataplexy) . About 20% of (Narcolepsy) patients belong to this type.
• (Narcolepsy Type 2) : This type does not have the symptom of (Cataplexy) . The majority, that is, about 80%, fall into this type.

Normally, when we sleep, our brain largely stops controlling our muscles so that we don't act on our dreams. People with cataplexy experience sudden muscle loss, similar to that experienced during REM sleep, even when they are awake.

In mild cases, cataplexy may affect only the muscles of the face and neck - for example, the jaw may droop. Or it may affect only one side of the body. In severe cases, cataplexy can cause sudden collapse, which can be fatal. These episodes usually last a few minutes, but you may not be able to speak or move during this time.

Another special thing about cataplexy is that it can be triggered by certain emotions . It can especially occur when you are happy, laughing, or joking. It can also occur when you are surprised, scared, or angry, but it is less common.

Cataplexy can look a little different in children and those who are about six months old when symptoms first appear. They may suddenly grimace, stick out their tongues, or experience muscle weakness that is unrelated to the emotion.

A little more about sleep paralysis

When we sleep, the brain stops controlling our muscles so that they don't act on what we see in our dreams. But when we wake up, this control should be working properly again. But if you have sleep paralysis, your body doesn't get that muscle control back. You can breathe and move your eyes, but you can't talk or move other parts of your body.

Hallucinations are very common during sleep paralysis. They can be very vivid, sometimes unimaginably frightening. Fortunately, sleep paralysis usually lasts for a few minutes (although it can feel like a long time to the person experiencing it).

Are there other symptoms?

In addition to the four main symptoms, people with narcolepsy may experience some other symptoms and behaviors. Some of them include:

• Automatic Movements : People with narcolepsy may sometimes continue to move body parts, such as their hands, even when they fall asleep.
• Amnesia or Forgetfulness : It is common for these people to forget what they did before going to sleep.
• Sudden outbursts/speech during sleep attacks : A person with narcolepsy may suddenly say something (often nonsensical or irrelevant at the time). When this happens, they may wake up completely again. But they often don't remember it.

Who gets narcolepsy? How common is it?

Doctors usually diagnose narcolepsy in people between the ages of 5 and 50. However, it is most common in young adulthood , between the ages of 18 and 25. Men are more likely to develop the condition.

Narcolepsy is not a very common condition.Research shows that between 25 and 50 per 100,000 people worldwide have it. However, because it takes years to diagnose the disease, it is difficult to say exactly how many people actually have it.

How does Narcolepsy affect my body?

To understand narcolepsy, it helps to know a little about how our sleep works. There are several main stages of our sleep:

• Stage 1: Light Sleep . This is a short stage. It begins as soon as you fall asleep. It makes up about 5% of your total sleep.
• Stage 2: Deep Sleep . This is a little deeper. It makes up about 45%-50% of total sleep (this amount increases as we age).
• Stage 3: Slow Wave Sleep . About 25% of total sleep (this decreases with age). It is very difficult to wake someone in this stage. If you wake them up suddenly, they will go into a state of mental fog called "sleep inertia". Sleepwalking and sleep talking also occur in this stage.
• (REM) Sleep : (REM) stands for (Rapid Eye Movement) , which means that the eyes move rapidly. It is during this stage that we dream. When a person is in (REM) sleep, you can see the eyes moving under the eyelids.

If you don't have narcolepsy, when you go to sleep, you start in stage 1, then go to stages 2 and 3. You cycle between these stages, and finally enter REM sleep, where you start dreaming. After the first REM cycle, you start a new cycle and go back to stage 1 or 2. One cycle usually lasts about 90 minutes. Most people go through about four to five cycles per night (if they sleep for 8 hours).

But if you have narcolepsy, your sleep cycle doesn't happen like that. Instead, you go into REM sleep almost as soon as you fall asleep . Throughout the night, you sleep in short bursts, often without completing the normal sleep cycle.

In narcolepsy, no matter how well you sleep at night, you feel unbearably sleepy during the day. It is very difficult to stop falling asleep. But this sleep that comes during the day is also short (about 15-30 minutes). When you wake up, you feel refreshed and ready to do what you were doing before again. However, it is because this happens several times a day that narcolepsy becomes so disruptive to your life.

What are the causes of narcolepsy?

The causes of narcolepsy vary depending on the type of narcolepsy you have, but they all involve a special area of ​​your brain called the hypothalamus , which controls sleep and wakefulness.

Causes of (Type 1 Narcolepsy)

In 1998, researchers discovered a chemical called orexins (sometimes called hypocretins) . These are used by certain neurons (brain cells) to send messages. The neurons that use orexins are located in a part of the brain called the hypothalamus. These neurons are the ones that primarily help keep us awake.

Orexin levels are normally found in cerebrospinal fluid (CSF) – the thin layer of fluid that surrounds the brain and spinal cord. However, in people with narcolepsy, orexin levels in the CSF are very low or undetectable. This means that the cells that make orexin have stopped working or have been destroyed by something.

Other research suggests that the reason these neurons don't work is most likely an autoimmune problem . This means that your body's own immune system attacks either the neurons that make and use orexin, or the orexin itself, or both.

About 90%-95% of people with Type 1 Narcolepsy have a specific genetic mutation that affects their immune system (identified as HLA-DQB1*06:02 ). However, about 25% of the general population also has this mutation but does not have Narcolepsy. Therefore, experts do not test for this mutation, and they are not sure what role it plays. There is also some evidence that the condition can run in families. If a first-degree relative (parent, sibling, child) has Narcolepsy, you are at increased risk of developing it too.

However, Type 1 Narcolepsy can also develop after certain viral and bacterial infections, especially influenza viruses like H1N1 influenza and the bacteria that cause strep throat. Experts believe that this may be because infections can sometimes cause changes and malfunctions in the immune system.

Causes of (Type 2 Narcolepsy)

While much is known about the causes of Type 1 Narcolepsy, not so much about Type 2 Narcolepsy. Experts still don't fully understand why Type 2 Narcolepsy develops. But they think it may have similar causes. For example, it could be due to less severe damage to the neurons that use orexin, or a problem with the way orexin travels in the brain.

Secondary Narcolepsy

In rare cases, narcolepsy can be caused by damage to your hypothalamus. This damage can be caused by things like head injuries (concussions), traumatic brain injuries (traumatic brain injuries), strokes, and brain tumors.

Narcolepsy can also be a symptom of other unrelated conditions that you may have inherited. Examples:

• (Autosomal Dominant Cerebellar Ataxia, Narcolepsy and Deafness (ADCADN))
• (Autosomal Dominant Narcolepsy, Type 2 Diabetes and Obesity)

Is Narcolepsy contagious?

No, Narcolepsy is not a contagious disease. You cannot catch it from someone else, nor can someone catch it from you.

How to recognize narcolepsy?

Your symptoms may lead a doctor to suspect that you have narcolepsy. However, the symptoms of narcolepsy are similar to those of many other brain and sleep disorders. Therefore, it is important to know whether you have narcolepsy.A definitive diagnosis can only be made through specific diagnostic tests.

Before performing many of the main tests for narcolepsy, a doctor will first check to see if you are getting enough sleep. This is usually done using simple methods that monitor your sleep-wake patterns. An example is actigraphy . This involves using a device, such as a wristwatch, to monitor your movement patterns (such as when you are asleep and when you are awake and moving around).

What tests are used to diagnose narcolepsy?

There are several tests that can be done to diagnose narcolepsy:

• Sleep Study (Polysomnogram) : This test uses various sensors to monitor how you sleep. The main part of a complete sleep study, called a polysomnogram , is the use of electroencephalogram (EEG) . These sensors monitor your brain waves. This allows doctors to see what stage of sleep you are in minute by minute. People with narcolepsy go into REM sleep faster than normal, so this test can detect this. It also records when they wake up during sleep. Another reason why this test is important is that excessive daytime sleepiness can also be a symptom of a condition called sleep apnea . A sleep study can confirm that you do not have sleep apnea.
• Multiple Sleep Latency Test (MSLT) : This test measures how easily you fall asleep during the day. It involves taking several naps within a specific time frame. It can determine whether you have excessive daytime sleepiness. This is a common symptom of narcolepsy. It is often done the day after a nighttime sleep study.
• Maintenance of Wakefulness Test : This test measures how well you can stay awake during the day, even when you are easily falling asleep. It is not commonly used to check for narcolepsy, but it can help rule out other problems. It is also useful to see if stimulant medications are working.
• Spinal Tap (Lumbar Puncture) : This test can detect low levels of orexin in your cerebrospinal fluid (CSF). This is a key way to diagnose Type 1 Narcolepsy. Low orexin levels can be a sign that someone with Narcolepsy is not yet experiencing cataplexy, but may be a sign that they may be developing cataplexy in the future. However, since orexin levels do not change in people with Type 2 Narcolepsy, this is not always a diagnostic test.

Other tests

People with narcolepsy may have many other tests. For example, if you have cataplexy, it can be similar to the movement-related symptoms of other brain disorders, such as seizures. Therefore, doctors may first test for more serious conditions, such as epilepsy. Therefore, it may take a while to diagnose narcolepsy. Your doctor is the best person to explain what tests you need to have and why they are being done.

How is narcolepsy treated? Can it be cured?

Narcolepsy can be treated, but it cannot be cured . Treatment usually starts with medication. But making changes to your daily routine and lifestyle can also help. Narcolepsy usually responds well to treatment. This can help limit the disruption caused by the symptoms.

Remember, narcolepsy is a lifelong condition, but it doesn't get worse over time.

What are the medications for narcolepsy?

Medication is the main treatment for narcolepsy. Most medications target excessive daytime sleepiness. However, some medications also affect other symptoms. Here are some types of medications that can be given for this condition:

• Wakefulness Medications : These are usually the first treatments. Examples include Modafinil and Armodafinil . These medications stimulate your nervous system. This can help reduce the intensity and frequency of daytime sleepiness.
• Amphetamines and Amphetamine-like Stimulants : Drugs such as methylphenidate (known under the brand names Ritalin®, Concerta®, Qullivant®) and amphetamine/dextroamphetamine combinations (known under the brand name Adderall®).
• Antidepressants : These may include Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g. Venlafaxine - known as Effexor®), Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g. Fluoxetine - known as Prozac®), or Tricyclic Antidepressants (e.g. Clomipramine or Protriptyline - these are now less commonly used).
• (Sodium Oxybate) : This medicine helps you sleep better and also reduces the frequency of (Cataplexy). Due to the effects of this medicine, it is strictly controlled in many countries. However, it is often used to treat (Type 1 Narcolepsy).
• Histamine-affecting drugs : An example of such a drug is Pitolisant.. This is a histamine receptor antagonist. Receptor antagonists are medicines that stop certain chemicals in your body from attaching to cells. This reduces or stops the cells from doing certain things.

While there are several treatment options for adults (narcolepsy), the treatment options for children are very limited. Your child's pediatrician or a specialist can best tell you what treatment options are available to you and what they recommend.

Complications/side effects of treatment

Many medications used to treat narcolepsy and its symptoms have a high chance of interacting with other medications. High blood pressure and irregular heart rhythms are just two of the complications that can occur with any type of stimulant medication. Sodium Oxybate, in particular, is very dangerous when combined with other medications that depress the central nervous system. Also, never use this medication with alcohol .

In general, your doctor is the best person to tell you what side effects, complications, and drug interactions you should be aware of. He or she can provide information tailored to your specific condition, health history, and personal circumstances.

How can I take care of myself and manage my symptoms?

You should never try to diagnose or treat narcolepsy yourself . This is because the symptoms of this condition are also common in other serious conditions, such as sleep apnea and epilepsy. Also, this condition can make some activities, such as driving and swimming, dangerous. Therefore, always see a doctor for diagnosis and treatment .

How soon will I feel better after treatment?

The time it takes for treatment to start working, or for the effects of treatment to be felt, depends on many factors. Your doctor is the best person to tell you what to expect based on your condition, how long it will take for the medication to work, and how long it will take to see a change in your symptoms.

Can the development of narcolepsy be reduced or prevented?

In most cases, narcolepsy develops unexpectedly. Therefore, it is not possible to reduce the risk of developing it or prevent it from developing.

What should I expect if I have Narcolepsy?

Narcolepsy itself is usually not dangerous. But sudden, uncontrollable sleep onset can be a major disruption to life. People with this condition may be unable to drive (either temporarily or permanently - it depends on their symptoms and condition).

Although narcolepsy is usually not dangerous, in Type 1 narcolepsy, there is an increased risk of injury from falls during episodes of cataplexy. Narcolepsy can also cause dangerous situations when driving, using power tools or heavy machinery, or swimming.

When children develop narcolepsy

Children with narcolepsy often struggle with the effects of the condition. Daytime sleepiness can make it difficult to focus on schoolwork, maintain social relationships, and participate in school and extracurricular activities.

However, Narcolepsy is a medical condition. As such, children with Narcolepsy are entitled to legal protections. Schools are also required by law to make accommodations. For example, changing class schedules, setting aside time for sleep or rest, and making it easier for children to take their medications at school. Your child's pediatrician or other specialists can help you find solutions that will help your child.

For working adults (Narcolepsy)

Just as children are protected by law in schools, adults with narcolepsy are also protected by law. Discrimination against someone based on a medical condition, including narcolepsy, is prohibited (for example, in the United States, under the Americans with Disabilities Act).

Because of that legal protection, people with narcolepsy can talk to their employers at their workplaces and get accommodations so they can continue working while managing their condition.

How should I take care of myself? (Practical advice)

If you have narcolepsy, there are several things you can do to manage your condition and get the most out of your treatment. Many of these things involve maintaining good sleep habits (Good Sleep Hygiene) and changing your schedule and routine.

• Maintain a consistent sleep routine : Getting into the habit of going to bed and waking up at the same time can improve the quality of your sleep.
• Set a bedtime : Set a bedtime that allows you to get the amount of sleep that is appropriate for your age. Also, set aside time to relax and calm your mind before going to bed.
• Limit exposure to bright light and electronic devices : The light from these devices close to bedtime can disrupt your body's natural sleep-wake cycle.
• Avoid drinking alcohol, caffeine, using tobacco, and eating close to bedtime.: If you feel hungry before bed, a light meal is best. If you are taking certain medications, you should completely stop drinking alcohol (your doctor will tell you if you have been prescribed such medications). Experts also strongly recommend completely stopping tobacco products (including cigarettes, electronic cigarettes ((vaping)), and smokeless tobacco ((smokeless tobacco))).
• Be physically active : Even if it's just something like walking, staying active can help with your sleep quality.
• Take a nap : People with narcolepsy often feel better after taking a nap. It can help to figure out what times of day you feel most sleepy and schedule your sleep around those times.

Avoid dangerous activities, or take precautions.

Narcolepsy can cause serious, even fatal, accidents. To protect yourself and those around you, never drive unless specifically cleared by a doctor .

If you experience symptoms of narcolepsy while driving, stop driving immediately and contact your doctor. As uncomfortable as this may be, it is essential to prevent a fatal or life-changing accident from occurring due to falling asleep at the wheel.

Another area where narcolepsy can be particularly dangerous is in the water . If you have narcolepsy, it is very important to always wear a life jacket properly when you are swimming or on any boat or watercraft that recommends a life preserver. Without a life preserver, a sleep attack in the water can have fatal consequences.

When should I see a doctor?

If you suddenly, unexpectedly fall asleep, it's a sign that you need to see a doctor. This is not just narcolepsy, but it can also indicate a variety of medical conditions. Some of them are serious. In many cases, the longer you delay diagnosis and treatment, the greater the risk of complications or the less effective the treatment.

When should I go to an Emergency Treatment Unit (ETU) ?

If you suddenly collapse or lose consciousness, seek medical attention immediately at a hospital or emergency room. This is a major symptom of many conditions, including heart attacks, strokes, and irregular heart rhythms. These conditions are medical emergencies and require immediate treatment.

Fall-related injuries are injuries that occur when you fall unexpectedly, such as from being pulled or losing consciousness.There is a risk of injury. Always seek medical advice if you think you may have sustained an injury to your head, neck, or any part of your back. Fractures and injuries to the spinal cord can cause permanent damage, paralysis, and even death.

If you fall, and you are taking any type of blood-thinning medication, especially if you hit your head, you should seek immediate medical attention. Falls and injuries can cause dangerous internal bleeding. You need medical attention to make sure you don't have any injuries that could lead to life-threatening complications.

The most important things you need to remember (Take-Home Message)

So, I hope you've been able to remember some of the most important things from what we've talked about (Narcolepsy).

• Narcolepsy is not just sleepiness caused by exhaustion. It is a problem with the brain's ability to regulate sleep and wakefulness.
• Be aware of the main symptoms of excessive daytime sleepiness, cataplexy (sudden muscle weakness), sleep-related hallucinations, and sleep paralysis . Not all of these symptoms occur in everyone.
• The cause of this condition is often a decrease in the chemical orexin in the brain, or autoimmune problems.
• Narcolepsy requires specialized medical tests to diagnose. So don't jump to conclusions on your own.
• Although this cannot be completely cured, it is a condition that can be largely controlled with medication and lifestyle changes .
• Think carefully about safety. Be especially careful when driving, swimming, and working at heights. Follow medical advice.
• If you have these symptoms, don't be afraid to see a doctor. You are not alone. Help is available.

I hope this information is helpful to you. If you or someone you know is experiencing this type of problem, it is best to seek medical advice as soon as possible.

` Narcolepsy, excessive daytime sleepiness, cataplexy, sleep apnea, sleep hallucinations, orexin, brain diseases