Narcolepsy

Tetrad of narcolepsy

• Cataplexy
• Sleep paralysis
• Hypnagogic hallucinations
• Excessive daytime sleepiness

Clinic

• Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep–wake cycles.

• Only about 20 -25 % of people with narcolepsy experience all four symptoms.

• Excessive daytime sleepiness and brief involuntary sleep episodes.
• They have episodes of sudden loss of muscle strength, known as cataplexy. (70%)
• Narcolepsy paired with cataplexy is evidenced to be an autoimmune disorder.
• Cataplexy can be brought on by strong emotions.
• Vivid hallucinations or sleep paralysis while falling asleep or waking up (Less commonly)
• Sleep quantity in narcolepsy is not changed but its quality decreased.
• Narcolepsy is a clinical syndrome of hypothalamic disorder
• Low levels of the neuropeptide orexin, which may be due to an autoimmune disorder triggered by INFL (H1N1) infection.
• Trauma, tumors or other brain diseases affecting the parts of the brain that regulate wakefulness or REM sleep.
• They are also more likely to develop RBD.

Hypnagogic hallucinations

• They are vivid, often frightening, dreamlike experiences that occur while dozing or falling asleep.
• Hypnopompic hallucinations refer to the same sensations while awakening from sleep.
• Visual or auditory hallucinations
• They may visibly fall asleep at unpredictable moments
• They fall quickly into what appears to be very deep sleep, then wake up suddenly and can be disoriented when they do (dizziness is a common occurrence).
• They have very vivid dreams, which they often remember in great detail.
• Along with vivid dreaming, people with narcolepsy are known to have audio or visual hallucinations prior to falling asleep.

Other symptoms

• Automatic behaviors
• Night-time wakefulness
• Irregular sleep–wake cycles
• Abnormal REM sleep

Irregular sleep–wake cycles

• Excessive daytime sleepiness due to irregular sleep–wake cycles.
• Decreasing amount of restorative deep.
• They have sufficient REM sleep, but do not feel refreshed / Sleep deprivation
• Excessive sleepiness esp commonly during monotonous situations
• Daytime several naps
• Vivid dreams even during very brief naps.
• Night-time sleep is fragmented with frequent awakenings.

Abnormal REM sleep

• It is a prominent symptom of narcolepsy
• They typically have higher REM sleep density
• They enter into REM in the beginnings of sleep, even during day-sleep.
• REM sleep without atonia
• Some aspects of REM sleep that normally occur only during sleep occur at other times.
  • Muscular atonia can occur during wakefulness in a cataplexy episode
  • Sleep paralysis and vivid dreams can occur while falling asleep or waking up.

Related disease

Cataplexy

Miasms

FFI