Definition

Narcolepsy is a prolonged sleep disorder characterized by excessive daytime sleepiness and sudden sleep attacks. People with narcolepsy find it difficult to stay awake for long periods of time, whatever the situation. Therefore, narcolepsy can cause significant interference with daily activities.

Causes

The initial trigger for narcolepsy is unknown. However, in people with narcolepsy, there is a decrease in a brain chemical called hypocretin or orexin, which functions to regulate alertness. This decrease in hypocretin levels is thought to occur due to the body's immune system mistakenly attacking the cells that produce this compound or capturing this compound (which is needed for the compound to work). Apart from that, narcolepsy is also related to disorders of the part of the brain that regulates sleep phases.

The sleep phase is divided into two large parts: rapid eye movement (REM) and non-rapid eye movement (NREM). Usually, the sleep phase starts in the NREM phase, which is deep sleep. In this phase, brain waves slow down. After about one hour, the sleep phase moves to the REM phase, which is where dreams occur.

However, in narcolepsy, a person can suddenly enter the REM phase without entering the NREM phase first, both during naps and sleep at night. Some of the characteristics of narcolepsy are also similar to changes that occur in the REM sleep phase but appear when you wake up or are drowsy.

Risk Factor

The most obvious risk factors for narcolepsy are age and family history. Usually, narcolepsy begins at the age of 10-30 years. If you have a family member with narcolepsy, you have a 20-40 times higher risk of developing the same condition.

Symptoms

Symptoms of narcolepsy are as follows:

• Sleeping excessively during the day. People with narcolepsy fall asleep without notice, anytime, and anywhere. This sleep can last from a few minutes to half an hour. You may feel refreshed when you wake up, but feel sleepy again after a while. These symptoms often interfere with daily activities.
• Cataplexy. Cataplexy is a sudden, uncontrollable loss of muscle strength and is triggered by strong emotions such as laughter, happiness, fear, surprise or anger. This loss of muscle strength can range from slurred speech to weakness of all muscles which can last for several minutes. Cataplexy can occur 1-2 times per year to several times a day
• Paralyzed while sleeping. People with narcolepsy are often unable to move or speak when falling asleep or near awakening. These symptoms usually occur briefly, ranging from a few seconds to a few minutes, but are scary. This temporary paralysis occurs in the REM phase and can prevent your body from moving according to dreams. However, sleep paralysis is not always synonymous with narcolepsy, because this phenomenon can occur in people without narcolepsy.
• Changes in REM sleep phase. REM is the phase when dreams occur. In people with narcolepsy, REM sleep can occur at any time of the day, and REM occurs quickly, about 15 minutes after falling asleep (normally about 1 hour).
• Hallucinations. These hallucinations can be hypnagogic if they occur just before falling asleep or hypnopompic hallucinations if they occur just before waking up. These two hallucinations not only occur in people with narcolepsy, but also in normal people

Diagnosis

Narcolepsy has symptoms that can be confused with other conditions. To confirm the diagnosis, a thorough history and body examination is necessary. Additionally, your doctor may ask you to record your symptoms and when you fall asleep for several weeks. Another alternative is a polysomnogram examination. This examination is carried out throughout the night in a special clinic or laboratory and records problems that occur during sleep. In addition, a polysomnogram can show if you enter the REM phase at unusual times. A polysomnogram can also be used to rule out other conditions.

The multiple sleep latency test (MSLT) can be done in addition to a polysomnogram. Like a polysomnogram, an MSLT is performed in a particular location. This examination is done daily to measure your tendency to fall asleep and determine whether REM phase elements occur at unusual times. You will take 4-5 short naps during the examination, with a 2-hour break.

Management

So far, narcolepsy cannot be completely cured. However, there are several things you can do to relieve symptoms, as follows:

• Sleep briefly but frequently every few hours a day. You can sleep for 10-15 minutes every few hours. If you work or go to school, your healthcare provider can help you set a sleep schedule so that you can snooze regularly
• Go to bed at the same time every day
• Avoid caffeine, alcohol and nicotine, because these three things affect the body's work related to sleep
• Eat small portions but often

If your symptoms seriously interfere with your daily activities or are even dangerous, you may receive medication to reduce your symptoms. Stimulant medications, for example, can reduce drowsiness. Antidepressants can help treat problems related to the REM phase. In addition, other medications can help prevent cataplexy or help you stay awake longer.

Complications

The complications of narcolepsy are closely related to the symptoms. These complications are as follows:

• Other people's misunderstandings about the condition. Narcolepsy causes a person to fall asleep anytime and anywhere, so others may easily think you are lazy or sleepy. Your performance at work or school may suffer as a consequence.
• Disruption of close relationships. Intense feelings, such as anger or happiness, can trigger cataplexy, preventing people around you from interacting emotionally
• Physical danger. Sleep attacks cause a high risk of accidents if they occur while driving. In addition, if you experience sleep attacks while cooking, your risk of being cut by a knife or exposed to fire is much higher
• Obesity. People with narcolepsy tend to be overweight. This excess weight can occur due to digestion working slowly

Prevention

Narcolepsy cannot be prevented, but it can be treated. This condition is very rare, and not everyone with a family history will develop narcolepsy. If your child has narcolepsy, you need collaboration between therapists and teachers at school to understand and help your child at school. If you as an adult experience narcolepsy, you should stop driving because it can endanger yourself and others. You can consult a therapist who treats you regarding driving.

When to See a Doctor?

You can consult a doctor if you sleep too much during the day, disrupting your daily activities. The doctor can examine you and refer you to the relevant experts. If your doctor suspects narcolepsy, you can be referred to a neurologist or psychiatrist to help you identify and treat the problem.

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