Narcolepsy: Life is short, stay awake for it!
A Brochure

An Outreach Project by Karee JuVette | Return To Outreach Projects 2010

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A Brief History and Definition

Narcolepsy is a (currently) incurable chronic sleep disorder most prominently characterized by overwhelming daytime drowsiness and sudden "attacks of sleep"

Regardless of circumstances, victims find it difficult to stay awake for long periods of time

Most unique to narcolepsy, victims suffer from fits of muscle weakness, known as cataplexy

Westphal formally stated the first & most compelling descriptions of narcolepsy in 1877

Westphal described an abnormal connection between muscle weakness & extreme sleepiness; his reports also suggested a genetic component of disorder

In 1880, Gélineau first gave the name narcolepsy, subsequently recognizing it as a specific clinical entity

In 1902 Loewenfeld differentiated the muscle weakness episodes as cataplexy

Medical research from 1917-1927 led to Von Economo proposing correctly that the posterior hypothalamus was lesioned in human narcolepsy

Further work by Yoss & Daly (Mayo Clinic) and Bedrich Roth (Prague, Austria) led to classic description of narcolepsy tetrad

Research continues today

Symptoms

Note: most of the following symptoms are note indicative of narcolepsy exclusively
Excessive Daytime Sleepiness:

most universal symptom of narcolepsy

uncontrollable need to sleep during day

fall asleep without warning, anywhere and any time

low alertness throughout day

cannot concentrate and function fully

+Cataplexy:

varying degrees of severity: last few seconds to minutes; slurred speech to complete weakness of most muscles

uncontrollable and triggered by intense emotions

about 70% of narcolepsy victims experience cataplexy: varying levels of severity: 1 or 2 episodes/year to several each day

Sleep Paralysis:

experience temporary inability to move/speak while falling asleep or upon waking

usually brief episodes, but victim can often recall what happened and is, in fact, aware of the body's paralysis

these paralyses mimic those that occur during REM sleep

Narcolepsy victims can also experience hypnagogic hallucinations

Trends and Treatment

Occurs in all racial and ethnic groups, but rates vary by country:

Example countries:

US: 1/2,000 affected Israel: 1/500,000 affected Japan (world high): 1/600 affected
Complications:

misunderstand victim as lazy, rude, lethargic, etc., affecting victim's overall performance

interference with intimate relationships, especially because cataplexy triggered by intense emotions

physical harm

-increased risk of car crashes (should not drive alone)
-affects ability to carry out daily routines
Stimulants:

drugs prescribed that stimulate the central nervous system, allowing one to stay awake during the day

-some drugs have many side effects, new medicine Modafinil (Provigil) better

Antidepressants:

alleviate: cataplexy, hypnagogic hallucinations, sleep paralysis

Sodium Oxybate (Xyrem):

controls cataplexy, daytime sleepiness; strictly regulated by FDA because serious side effects

Causes

Note: the exact cause of narcolepsy is still unknown; genetics may play a role in the disorder; larger influence may be a trigger, like an infection, leading to damage to certain brain cells
Normal sleep pattern vs. Narcolepsy:

most sleep begins with process known as NREM sleep, during which brain waves slow down considerably

narcolepsy victims immediately fall into REM sleep, during which the brain is much more active, effectively bypassing the NREM cycle

victims also fall into REM sleep randomly throughout day

other aspects of REM sleep (lack muscle tone, sleep paralysis, vivid dreams) occur at other times during sleep or day

Brain chemicals:

hormone hypocretin (also known as orexin) regulates REM sleep & staying awake throughout day

cells that make hypocretin severely damaged in narcolepsy victims; low levels hypocretin in all, lowest in those with cataplexy

this lack of hypocretin has led to a diagnostic test: measuring levels of hypocretin in spinal fluid

Thank-you for reading this brochure! If you have any questions regarding narcolepsy, please email me at: kareej[at]stanford.edu.
Further information regarding narcolepsy can be found at: www.mayoclinic.com/health/narcolepsy.
If you are experiencing any symptoms of a sleep-related disorder, please contact your physician immediately!
Remember, drowsiness is red alert!