Does your child often fall asleep in class? Maybe the teacher says, "Your son/daughter always falls asleep in class, he/she is very bored." Or does he/she suddenly fall asleep while playing with his/her friends? Some parents think that this is something they do out of boredom, or something else because they don't sleep well at night. However, this can sometimes be a more serious neurological condition related to the brain. We are talking about that today. We call this condition Narcolepsy.
Simply put, what is narcolepsy?
Narcolepsy is a condition in which a child's brain is unable to regulate their sleep and wakefulness. It's like our body's "internal clock" being disrupted. In particular, this has the biggest impact on a child's ability to stay awake.
One of the first signs of this neurological condition is excessive daytime sleepiness , which can interfere with a child's ability to learn, play, and socialize with friends.
A child with this condition may feel tired and sleepy throughout the day. Sometimes, they may suddenly have a "sleep attack" and fall asleep while doing something. Think about the dangers that can occur if they suddenly fall asleep while walking on the street, playing, or eating. Therefore, this is a condition that we should not take lightly.
There are two main types of Narcolepsy:
Yes, this situation is mainly divided into two parts. There are slight differences between the two.
| Type of narcolepsy | Simply description |
|---|---|
| Type 1 (Formerly known as Narcolepsy with Cataplexy) | In this type, the child also experiences excessive daytime sleepiness and a condition called cataplexy . This is when the body's muscles suddenly weaken and feel like they're losing control. In addition, the level of a chemical called hypocretin, which helps the brain stay alert, is low. In this type, the body may also suddenly gain weight. |
| Type 2 (Formerly known as Narcolepsy without Cataplexy) | In this type, the child only has excessive daytime sleepiness. The previously mentioned cataplexy condition does not occur. Also, the levels of hypocretin in the brain are not affected. |
The important thing is that both types can affect a child's daily life, so it is very important to recognize the symptoms.
What are the symptoms of narcolepsy in children?
Not all children with narcolepsy experience all of these symptoms in the same way. Some symptoms may start early, while others may appear later. There are four main symptoms.
1. Excessive daytime sleepiness
2. Cataplexy - sudden muscle weakness
3. Sleep paralysis
4. Seeing/hearing various things while falling asleep or waking up (Hallucinations)
In addition, you can also see these symptoms:
- Disturbed sleep
- Falling asleep for a few seconds without being aware of what you are doing (Automatic behaviors)
- Sudden weight gain
- Premature puberty
Let's now look at these main symptoms in some detail.
Excessive daytime sleepiness
This is usually the first sign. It goes beyond just being "sleepy." It disrupts almost everything the child does at home, at school, and with friends.
See if these things happen to your child:
- Feeling extremely tired throughout the day, especially when sitting, reading a book, or riding in a vehicle.
- "Sleep attacks" occur. That means you suddenly, uncontrollably fall asleep.
- Continues to nap during the day after age 5, or naps longer than the average child (two to three hours).
- Even if you take a nap during the day and wake up, you'll feel sleepy again after a while.
- The head feels sluggish, forgetful, and lacks energy.
- Attention and concentration are easily lost.
- Becoming angry, irritable, hyperactive, or depressed for no reason.
Cataplexy - sudden muscle weakness
This is a very specific symptom. Cataplexy is a sudden, brief loss of muscle strength in the body. This can last from a few seconds to a few minutes.
This can feel like your knees are going numb, or your entire body may feel numb and you may fall to the ground.
You will first notice these features on your baby's face:
- The hook is lifeless and the mouth opens.
- The eyelids are heavy and drooping.
- Sticking out tongue.
- Words get tangled when speaking.
- Shows unusual facial movements or expressions.
The important thing is that this cataplexy state occurs when a strong emotion such as happiness, laughter, anger, fear, or excitement arises. Imagine, when your child laughs out loud at a joke, he suddenly bends his knees and sits on the floor. Or when he is happy after winning a game, he drops what he is holding on the floor.
About 70% of children with narcolepsy experience this condition. However, in young children, it can be mistaken for inattention, a seizure, fainting, or just a way to get attention .
Sleep paralysis
This is something that many people have experienced, but it can be very scary. Sleep paralysis is a condition where you are unable to move your body or speak when you are about to fall asleep, or when you wake up in the morning.
Even if this lasts for a few seconds or minutes and then goes away, the child feels very scared, as if they are trapped and unable to ask for help. This can have a big impact on the child's mental health. Usually, this condition goes away if someone else touches the body.
Seeing/hearing various things (Hallucinations)
These are dream-like experiences that seem real but are not. They occur either when you are about to fall asleep (hypnagogic hallucinations) or when you wake up from sleep (hypnopompic hallucinations).
Often, children see or hear things that scare them, such as images of animals or sounds of animals. Often, this condition occurs along with the previously mentioned sleep paralysis.
Why do children develop narcolepsy?
There is no single exact cause for this, but it is mainly thought to be due to a problem in the area of the child's brain that controls sleep and wakefulness (the hypothalamus).
Specifically, Type 1 narcolepsy is caused by a decrease in the brain chemical hypocretin , which helps keep us awake. There are several possible causes for this:
- Autoimmune condition: Simply put, the child's own immune system mistakenly attacks the healthy cells in the brain that produce hypocretin, causing a deficiency of that chemical. Sometimes, this condition can occur after a simple infection.
- Family history: If someone in the family has this condition, there may be a genetic link to the child also having it.
- Brain injury or tumor: Very rarely, this condition can occur due to damage to the area that controls sleep due to a brain injury, tumor, or other medical condition.
What are the possible complications of narcolepsy?
This condition can affect various aspects of the child's life.
- Poor school performance.
- Difficulty meeting friends and maintaining social relationships.
- Mental problems (depression, anxiety).
- Behavioral problems (such as attention deficit hyperactivity disorder - ADHD).
- Physical accidents due to sudden sleep attacks.
How do doctors diagnose this condition?
If you suspect that your child has these symptoms, the first thing to do is see your doctor, especially a pediatrician.
The doctor will examine the child and ask you about symptoms and sleep patterns. Sometimes the child does not understand all of his or her symptoms, so what you see is most important.
After that, you may be referred for several tests to confirm the disease.
| Test method | What simply happens |
|---|---|
| Keeping a Sleep Diary | For a few weeks, they will ask you to record things like when your child goes to bed, when they wake up, and how long they sleep during the day. |
| Actigraph device | This is a small device that looks like a wristwatch. It measures the baby's movements and collects data about when the baby is sleeping and when he is awake. |
| Polysomnogram (PSG) | This is an overnight test at a sleep study center. While the child is sleeping, things like brain waves, heart rate, breathing, eye and leg movements are continuously measured. |
| Multiple Sleep Latency Test (MSLT) | This is done during the day after the PSG test. During this, the child is asked to take a short nap every two hours. How quickly the child falls asleep and how quickly they enter deep sleep (REM sleep) is measured. |
Sometimes, these symptoms are similar to those of other childhood illnesses (e.g., ADHD, seizures), which can lead to misdiagnosis . Therefore, these tests are very important to make an accurate diagnosis.
Is there a treatment for narcolepsy?
Unfortunately, there is no cure for narcolepsy yet. However, although it is a lifelong condition, there are very effective treatments that can help control the symptoms and help the child live a normal life.
Treatment is mainly divided into two parts:
1. Medications
2. Behavior and lifestyle modifications
Treatment with medication
Your doctor may prescribe various medications to reduce daytime sleepiness, control cataplexy, reduce symptoms such as sleep disturbances and hallucinations.
For example:
- Stimulants
- Wake-promoting agents
- Central nervous system depressants
- Antidepressants
The most important thing is that your doctor will determine the most appropriate medication and dosage for your child. This may take several weeks. Therefore, it is essential to follow the doctor's instructions exactly.
Behavioral and lifestyle changes
In addition to medication, small changes in a child's lifestyle can make a big difference.
- Create a regular bedtime schedule: Get your child used to going to bed and waking up at the same time every day.
- Get your child used to short naps: Give your child a 20-30 minute nap when they feel most sleepy.
- Create a comfortable sleep environment: Your bedroom should be quiet, dark, cool, and comfortable. Avoid watching TV or using your phone while sitting in bed.
- Stop consuming caffeine: Avoid soda, coffee, tea, and chocolate a few hours before bedtime.
- Exercise: It's good to exercise for at least 20 minutes a day. But it's not advisable to exercise three hours before bedtime.
- Avoid dangerous activities: Keep your child under adult supervision when doing activities like swimming and cooking that could be dangerous if they suddenly fall asleep.
- Get support from the school: Inform the teachers and principal about your child's condition. This will help them get the necessary accommodations (e.g., allowing the child to take a nap during the day).
- Provide psychological support: Living with this condition can be emotionally difficult for a child, so it is very important to provide them with the support of a mental health professional.
How can you, as a parent, help your child?
As a parent, you are your child's greatest strength on this journey. It can take some time to get an accurate diagnosis and find the right treatment plan. Be patient during that time.
Stay in touch with the school teachers. Explain your child's situation to them. Talk to them about ways you can help your child learn.
Remember, you are not alone in this. Working as a team with your doctor, your child's teachers, and, if necessary, mental health professionals, can give your child the strength they need to cope with this condition.
Finally, if your child is experiencing excessive daytime sleepiness, don't just label it "laziness," but talk to a doctor about it. The sooner the condition is diagnosed, the better your child can be helped to have a successful childhood.
Take-Home Message
- Narcolepsy is not laziness, it is a neurological condition related to the brain.
- The main symptoms are excessive daytime sleepiness and sudden loss of consciousness (Cataplexy) accompanied by strong emotions such as laughter.
- If you have these symptoms, definitely see a pediatrician.
- Special sleep studies may be required for an accurate diagnosis.
- Although there is no complete cure, medication and lifestyle changes can effectively control symptoms and help the child live a normal life.
- If the child is in danger due to sudden sleepwalking, immediately take them to the nearest hospital's Emergency Treatment Unit (ETU).
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