Narcolepsy

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Author:

Joyce Walsleben, Ph.D.

New York University School of Medicine, New York City, NY

Medically Reviewed On: March 31, 2006

What is narcolepsy?

Narcolepsy is a disorder of excessive sleepiness that appears to be neurologically based. Research shows that there is a difficulty in the release of brain chemicals known to enhance wakefulness as well as an over excitement of brain areas involved in REM (dream) sleep. Therefore, persons with this disorder experience sudden, profound and unavoidable attacks of daytime sleep. They may also experience one or all of the following additional symptoms which are thought to be intrusions of REM sleep into wakefulness: cataplexy, best described as muscle weakness or paralysis in response to sudden emotion (laughter); sleep paralysis, the inability to move or call out when first awake; hallucinations when fighting off sleep or when just waking up. Additionally, persons can experience fragmented nighttime sleep. In a sense, persons with narcolepsy cannot comfortably stay in any state of consciousness, be it wake or sleep.

How common is narcolepsy?


The disease, although underreported, is thought to affect 1 in 2500 Americans. Onset of the disease usually occurs in the second decade of life but onset has been seen in young children and older persons as well. It is, unfortunately, not uncommon for persons with narcolepsy to see as many as 7 physicians and wait up to 15 years for a correct diagnosis. In young children of school age, the symptoms are often mistaken for mental retardation, learning disabilities or sleep deprivation. In older people symptoms have been frequently misinterpreted as psychiatric in nature. In the past, narcoleptics have been diagnosed incorrectly as schizophrenic.

What causes narcolepsy?

We are unclear as to the cause(s) of narcolepsy. Many times the onset will follow an exciting or unsettling life event such as going off to college or the death of a loved one. For some, we can track a genetic factor. There is an increased risk of developing narcolepsy or narcoleptic-like symptoms among families with affected persons. On the other hand there are cases of identical twins where only one has narcolepsy. Although the genetic link is not completely defined, there is evidence of an association with a particular gene (called HLA allele DQB1*0602). The association is not sufficient to cause narcolepsy but it may predispose persons to the disorder if other contributing factors coexist. The presence of the genetic factor can be found with a special blood test. While a positive blood test may confirm the diagnosis in the presence of other diagnostic tests, it should not be used as the sole method of diagnosis.

How does one diagnosis narcolepsy?


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