BDC #29 - Narcolepsy: Are you sure sleeping is a good thing?

Have you ever watched some movies where there are some characters can suddenly fall a sleep, while eating, talking, or even walking? Weird... right? Sounds so unreal?! INDEED... !!

 

BUT, it's not actually a hyperbolic medical condition. It is a real one, and it's called narcolepsy.

Narcolepsy is a chronic neurological disorder where the patient's brain fail to regulate the sleep-awake cycle properly. It's not because of psychological problems nor mental illness, but more likely due to some abnormalities which affect the biological factors in the brain. Narcolepsy could as be triggered by environmental influence, such as virus infection.

There are some consistent symptoms of narcolepsy, as written in Wikipedia (I know.. I am too lazy to write my own words);

「The classic symptoms of the disorder, often referred to as the "tetrad of narcolepsy," are cataplexy, sleep paralysis, hypnagogic hallucinations, and excessive daytime sleepiness.　Other symptoms include automatic behaviors. It is important to be noted that these symptoms may not occur altogether in all patients.

• Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness such as limpness at the neck or knees, sagging facial muscles, weakness at the knees (often referred to as "knee buckling"), or inability to speak clearly, to a complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. In some cases, cataplexy may resemble epileptic seizures. Usually speech is slurred and vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. Cataplexy also has a severe emotional impact on narcoleptics, as it can cause extreme anxiety, fear, and avoidance of people or situations that might elicit an attack. Some narcolepsy affected persons also experience heightened senses of taste and smell.
• Sleep paralysis is the temporary inability to talk or move when waking (or less often, when falling asleep). It may last a few seconds to minutes. This is often frightening but is not dangerous.
• Hypnagogic hallucinations are vivid, often frightening, dreamlike experiences that occur while dozing, falling asleep. Hypnopompic hallucinations refer to the same sensations while awakening from sleep.
• Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. Sleep paralysis and hypnagogic hallucinations also occur in people who do not have narcolepsy, but more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in rapid eye movement behavior disorder.」

「There is no cure for narcolepsy, but medications and lifestyle modifications can help you manage the symptoms. As the Mayo Clinic suggests:

• Stimulants. Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day. Doctors often try modafinil (Provigil) or armodafinil (Nuvigil) first for narcolepsy because it isn't as addictive as older stimulants and doesn't produce the highs and lows often associated with older stimulants. Side effects of modafinil are uncommon, but they may include headache, nausea or dry mouth.
  Some people need treatment with methylphenidate (Concerta, Ritalin, others) or various amphetamines. These medications are very effective but may sometimes cause side effects such as nervousness and heart palpitations and can be addictive.
  
• Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Doctors often prescribe these medications, which suppress REM sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis. They include fluoxetine (Prozac, Sarafem, others) and venlafaxine (Effexor XR). Side effects can include sexual dysfunction and digestive problems.
• Tricyclic antidepressants. These older antidepressants, such as protriptyline (Vivactil), imipramine (Tofranil) and clomipramine (Anafranil), are effective for cataplexy, but many people complain of side effects, such as dry mouth and lightheadedness.
• Sodium oxybate (Xyrem). This medication is highly effective for cataplexy. Sodium oxybate helps to improve nighttime sleep, which is often poor in narcolepsy. In high doses it may also help control daytime sleepiness. It must be taken in two doses, one at bedtime and one up to four hours later. Xyrem can have serious side effects, such as nausea, bed-wetting and worsening of sleepwalking. Taking sodium oxybate together with other sleeping medications, narcotic pain relievers or alcohol can lead to difficulty breathing, coma and death.」

In short.... It is a TROUBLESOME condition... and the medicines basically lead to side effects. Thus, BE GRATEFUL you have a normal sleeping pattern.. and DON'T EVER...EVER ruin it by serial all nights....

I did mention before, narcolepsy is mainly caused by abnormalities in the brain's biological function, though the exact related genes are not revealed yet. However, there is a rising concern that virus infection in the form of vaccination might became the lead cause of the increase of narcolepsy cases for these past 5 years. By the early of this year, there are some reports stating that the swine flu (A/H1N1) vaccine has increase the number of narcolepsy cases in 3 countries; Finland, Sweden, and UK. (psst...there are some links to papers investigating the relation of the vaccine and the increasing cases of narcolepsy. You can try to read it thoroughly). Although the government already agreed that the vaccine might be the cause of narcolepsy, they don't immediately agree to give some compensation to the patients; as what Josh and Chloe are fighting to get. 
As the accumulation of the evidence getting bigger, the governments in European countries finally stated that the swine flu vaccine should not be given to people under 20 as the high risk of narcolepsy.


So, how is your sleep?