Over the past 160 years, this disease has gone from being hard to recognize and untreatable to a condition that is easily diagnosed and for which medications are available.
Sleep is a part of our lives. During sleep, we rest both physically and mentally. While we are awake, the physiological balance in the body gradually deteriorates, so sleep is necessary to restore that balance. Narcolepsy is a primary sleep disorder characterized by spontaneously falling asleep.
How is narcolepsy defined?
The most common and best-known example of excessive sleepiness is the illness known as “Narcolepsy.” The disease was first described by the French physician Dr. Jean Baptiste Edouard Gélineau in 1860. Perhaps drawing on the meaning of his middle name, he named the disease “narcolepsia” (from the Greek word “narkos,” meaning sleep, and “lepsis,” meaning seizure).
Over the past 160 years, this disease has progressed from being difficult to recognize and untreatable to a condition that is easily diagnosed and for which medications exist. These medications often significantly alleviate the symptoms of narcolepsy. On the other hand, it is one of the rare diseases whose (pathophysiological) mechanism has been largely uncovered by medicine.
What are the key symptoms of narcolepsy?
Narcolepsy consists of several elements:
Excessive daytime sleepiness – means that individuals suffering from it are constantly drowsy, with a sleep pressure so strong it feels like they haven’t slept for three days and nights, says neurologist Dr. Sci. Med. Slavko Janković for Stetoskop.
So-called sleep attacks mean that these individuals can fall asleep instantly, even in unusual situations (for example, during a business conversation, at a traffic light while driving, or during a meal – sometimes they fall asleep so suddenly that their head falls into their plate).
Patients experience cataplexy, or sudden and complete loss of muscle tone in all muscles (except for respiratory and eye muscles), usually triggered by (un)pleasant emotions.
Any strong emotion (such as a sudden appearance of a loved one, winning a hand in gambling, or even just a good joke) can cause a sudden collapse with full consciousness (unlike epilepsy).
Hallucinations during falling asleep or waking – mean that patients with narcolepsy may see dreams and real surroundings at the same time during sleep onset.
The image of reality and the dream image overlap and mix (like picture-in-picture on a TV), merging and passing through one another, causing confusion as the patient doesn’t know if they are awake or asleep.
In that state of partial wakefulness, they might attempt certain actions to draw attention or call for help, but it usually turns out that everything they did or tried was fictional – a dream.
Sleep paralysis – is the inability to move any muscles (except for respiratory and eye muscles), typically occurring upon awakening. Although awake, the patient is unable to move or alert family members. This experience is described as “creepy,” accompanied by fear of remaining paralyzed forever. Fortunately, this state usually lasts only a few seconds and ends spontaneously or with a simple touch.
Automatic behavior – means that a person with narcolepsy can start heading somewhere (e.g., to work or a store), fall asleep while walking, and suddenly “wake up” in a completely different part of the city, to their own surprise.
What is the social and psychological impact of narcolepsy on patients?
Due to constant sleepiness, people with narcolepsy are unable to meet the daily demands of life. Few employers are understanding enough to allow an employee to take a one-hour nap at noon in the middle of work so they can continue functioning.
This disease excludes its victims from everyday life and its competitive nature, either due to the depression it causes or the ridicule they face from others. Even though their mental and physical abilities are intact, these individuals often cannot progress at work or school in line with their actual potential due to excessive sleepiness.
As a result, the personality of a narcolepsy patient is often marked by:
- introversion
- difficulties with adaptation
- personality disorders
- alcoholism
- depression
A constant source of frustration is the ongoing effort to perform as well as healthy peers. On the other hand, the psychosocial stigma they face is just as burdensome as the disease itself.
What are the treatment options for narcolepsy, and how can challenges caused by the disorder be overcome?
The treatment approach for excessive sleepiness/narcolepsy must address all aspects affecting the patient.
The social aspect includes educating the public about the characteristics of the disorder (which is one of the goals of this article) to avoid the silent but persistent exclusion of patients from all social layers and activities.
The occupational aspect involves securing an appropriate status at work, based on prior agreement with the employer, who must be informed that narcolepsy is a condition that, with a little understanding, can spare the patient from social condemnation.
A non-pharmacological approach includes adequate psychological support, usually provided by a psychologist or psychiatrist.
Pharmacological treatment involves the regular use of wakefulness-promoting medications (from the “eugeroic” group), which are effective in about 80 percent of cases – reports Sombor.info.
