School-going children as young as seven can have narcolepsy and may keep on dozing off in class. — Freepik
Narcolepsy is actually a chronic neurological disorder.
If you are having interrupted sleep, it does not necessarily mean that you have narcolepsy.
There are very specific symptoms to narcolepsy.
However, it is estimated that one out of every 2,000 people in the United States have some degree of narcolepsy.
Most of them don’t know they have narcolepsy and have never been properly diagnosed.
Some patients can be diagnosed as early as seven years old – when they keep on falling asleep during class.
Some are diagnosed much later.
But it can sometimes take many years to diagnose narcolepsy because many patients think it is a normal part of their lives to feel very sleepy during the day.
Narcolepsy affects your brain’s ability to control your sleep-wake cycle.
It is a lifelong affliction.
Your sleep-wake cycle is your body’s circadian rhythm that enables you to fall asleep and wake up every day.
Your sleep-wake cycle typically follows a 24-hour circadian clock; every single cell, tissue, and organ in your body follows this clock.
Your central circadian clock is located in your brain.
It tells you when it is time for you to sleep.
There are other circadian clocks located throughout your organs.
Your clocks are in sync with your environment – sunlight, darkness, etc.
They determine when you feel awake and when you feel sleepy.
That is why jet lag exists – when you are in a different time zone, it takes your body some time to get used to the light and darkness of a new country.
Artificial light and caffeine may disrupt your rhythm.
If you are one of those people who need coffee to wake up (otherwise you feel sleepy), it means your circadian rhythm has already been disrupted artificially.
People who have narcolepsy may experience these:
> Uneven and interrupted sleep involving waking up frequently during the night.
Their sleep may be disrupted by insomnia, vivid dreaming, sleep apnoea, acting out while dreaming, and periodic leg movements.
You may not realise this when you sleep, but a partner can certainly tell you.
> You may feel rested after waking, but then feel very sleepy throughout much of the day.
This is called Excessive Daytime Sleepiness (EDS) – regardless of how much you have slept the night before, you can have this.
In narcoleptics, there is a sudden, overwhelming “sleep attack” of sleepiness that comes on quickly, and at any time of the day.
In between these attacks, you can feel refreshed and awake.
> Narcolepsy may significantly affect your daily activities.
Some narcoleptics unwillingly fall asleep even if they are in the middle of an activity like driving or talking.
This can be extremely dangerous for the patient and for other people.
> Cataplexy – this is a sudden loss of muscle tone when you are awake.
You feel suddenly weak when triggered by strong emotions like laughter, anger or excitement.
Some narcoleptics experience this every day, but other narcoleptics may not even have it or have the attacks only once in a lifetime.
This is commonly misdiagnosed as a seizure.
The loss of muscle tone here resembles what happens to a normal person’s muscles when they are in rapid eye movement (REM) sleep.
The cataplexy episodes only last a few seconds or minutes, but can be dangerous if the person is driving or not in a safe place.
> Sleep paralysis – this is a temporary disability where you are unable to move or speak when falling asleep or waking up.
> Hallucinations – this most often occurs when the patient is falling asleep or waking up.
They can be very vivid and frightening. The hallucinations can involve many senses.
In a normal sleep-wake cycle, you will enter REM sleep after about 60 to 90 minutes.
This is when you dream.
Your brain keeps your muscles limp during this stage so that you will not act out your dreams.
Narcoleptics frequently enter REM sleep rapidly, within 15 minutes of falling asleep.
The muscle weakness or dream activity of REM sleep may occur during wakefulness or not be present during their sleep.
Basically, their entire sleep-wake cycle and events that are supposed to occur during it have been messed up.
Narcoleptics with cataplexy have low levels of hypocretin, which is a natural chemical that we all have.
Hypocretin promotes our sleep-wake cycle and regulates REM sleep.
For narcoleptics without cataplexy, they have normal levels of this chemical, but may be affected by other factors.
It is postulated by researchers that narcolepsy is caused by multiple factors that cause a lack of hypocretin, such as a family history of narcolepsy, autoimmune disorders (that cause the body’s immune system to turn against itself) and brain injuries.
Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
