Narcolepsy: The Most Misdiagnosed Sleep Disorder

Narcolepsy

Narcolepsy is a sleep disorder that affects the nervous system of the body and it makes people sleep so much that their sleep interferes with their daily life.

It is considered to be a rare condition that is often chronic and most people may not even be aware that they are suffering from a sleep disorder as they may be passing off their sleep as a sign of laziness.

This is often a lifelong condition and the symptoms begin to manifest around the age of 10 and they will develop fully around the age of 25 years. But it is so difficult to recognize the symptoms of this condition that in the early years it can be passed off as laziness or tiredness and in the later years’ people simply assume that it is just their lifestyle or their own laziness that is making them sleep so much.

This nervous system condition causes extreme sleepiness and drowsiness, accompanied by a consistent and overpowering need to sleep no matter where you are. 

Some people have “sleep attacks”, during which they fall asleep almost instantly when these attacks happen and it can be while they are driving, or even eating.

It may come as a shock, but the poor quality of sleep at night or even insomnia are symptoms of narcolepsy.

Patients with narcolepsy have cataplexy, which is a sudden and short-term loss of muscle control, and this happens in the majority of cases of narcolepsy.

Due to the presence of cataplexy, narcolepsy has often been misdiagnosed as seizures, especially in young children.

This condition may not seem like a big deal, and it is often treated with humor and as a comedic device in popular media, but it is a serious condition that can prove to be fatal without proper precautions and treatments.

Now, being a sleep disorder, it may not harm you or cause your vital organs to stop working, but it can interfere with your day to day life and affect your productivity at work, it will show its effects on your academic life and it can even cause problems in your interpersonal relationships.

Types of Narcolepsy:

Type 1 Narcolepsy:

Type 1 Narcolepsy was previously termed as Narcolepsy with Cataplexy, and it involved a major defining symptom which is an abrupt short-term loss of muscle control. 

People who are diagnosed with Type 1 Narcolepsy have sudden episodes where they lose muscle control and feel extremely drowsy or sleepy during the day. While more evidence is needed to establish the root cause of narcolepsy, some studies indicate that a low amount of orexin or Hypocretin protein can be a cause of Type 1 Narcolepsy.

Type 2 Narcolepsy:

Type 2 Narcolepsy, is less common than Type 1 Narcolepsy, and it was previously known as Narcolepsy without cataplexy. As the name suggests, there is an absence of cataplexy in this type of narcolepsy, but the person suffering from Type 2 Narcolepsy will still have daytime sleepiness, having trouble getting proper sleep at night, and even have sleep attacks during the day. Interestingly, people with Type 2 Narcolepsy have nearly balanced or normal levels of orexin (Hypocretin) protein.

Symptoms:

Cataplexy

Cataplexy in Narcolepsy is a defining symptom as it helps in differentiating the type of Narcolepsy that a person may be suffering from. Narcolepsy with Cataplexy involves unforeseen loss of control on voluntary muscles which can be triggered by strong emotions such as laughter, fear, and even excitement. It only happens when a person is awake, and most of the time it is not easy to notice that a person is having a cataplexy attack as the muscle weakness may be extremely mild. But if it is a severe cataplexy attack, a person may collapse, the symptoms may look similar to that of seizure disorder.

Excessive Day-Time Sleepiness

Excessive Daytime Sleepiness in Narcolepsy is a common symptom in both Type 1 and Type 2 Narcolepsy and it involves feeling extremely sleepy or drowsy during the day even if the person has slept fairly well during the night. It can severely interfere with day-to-day activities, and the most impact can be seen in performance at school or college or at work and it is often seen as laziness or lack of professionalism than a symptom of a medical condition.

Insomnia

People often find it contradictory that insomnia, a sleeping disorder that includes difficulty in falling asleep can be a symptom of narcolepsy.

But people suffering from Narcolepsy often have symptoms of insomnia, such as inability to fall asleep quickly, or frequent waking up during the night or waking up too early in the morning.

Disrupted Sleep

Disrupted sleep can be a part of insomnia, or can also occur as a stand-alone symptom of Narcolepsy. The person suffering from this disorder may not have a good quality of sleep at night which can make day-time sleepiness even worse for them.

Sleep Paralysis

When people who suffer from Narcolepsy fall asleep or wake-up, in those few seconds or minutes, they may not be able to move or speak, and such episodes are termed as sleep paralysis.

Hallucinations

People who suffer from sleep paralysis as a part of narcolepsy condition may also suffer from hallucinations that are vivid and as they often happen around the time of waking up or falling asleep, a person may feel that they are having nightmares.

Lack of Control over Sleeping

The most common symptom of narcolepsy is the lack of control a person has over their sleeping pattern. They may fall asleep while they are eating, out on a romantic date, or even when they are driving, and it happens so quickly that most of the time, the person does not have any idea that it will happen in the next moment. This symptom can cause severe injuries and fatal accidents for the person suffering from this condition as well as other people who are around that person when such a sleep attack occurs.

Conditions which are Associated with Narcolepsy:

Narcolepsy is a condition that can occur to anyone but its occurrence is closely associated with a few conditions.

Obstructive Sleep Apnea:

Obstructive Sleep Apnea is a type of Sleep Apnea during which a person stops breathing for a brief while during his or her sleeping hours at night. Narcolepsy is often found in people who suffer from this sleep disorder.

Insomnia:

Insomnia and Narcolepsy are often linked together and difficulty in sleeping well at night, or poor quality of sleep at night can cause excessive daytime sleepiness.

Restless Leg Syndrome:

Restless leg syndrome involves an involuntary moment of legs for a brief period or an unexplainable yet strong need to keep moving your legs while you are sitting or resting, especially at night or in the evening, symptoms of narcolepsy are also found in people suffering from this disorder.

What are the Major Causes of Narcolepsy?

As Narcolepsy is a rare disorder, and it is often misdiagnosed or ignored, there have been very limited studies offering any substantial information regarding the cause of Narcolepsy.

A low amount of Hypocretin protein can be attributed to Type 1 Narcolepsy, which has the symptom of cataplexy, but further studies are required for better understanding the causes of this condition.

Stress can be a major factor that can cause excessive daytime sleepiness in people but it is yet not proven that it may be a potential cause of chronic narcolepsy.

People between the ages of 10-25 are more likely to suffer from narcolepsy, but these are years when a person has daunting school work, the pressure to do well in college and excel at their first jobs, so the symptoms are often passed as laziness, or result of work-stress & burnout.

A person may be at risk of narcolepsy if someone in their family is suffering from this sleep disorder, so it can even have genetic causes.

Other Significant Complications Associated With Narcolepsy:

Social Assumptions Regarding Narcolepsy

Due to lack of awareness, as well as multiple cases of misdiagnosed narcolepsy, there is a negative stigma attached to this condition.

Most people do not recognize excessive daytime sleepiness as a medical disorder and if a child is sleeping a lot then he or she may be termed as lazy or unwilling to learn by the adults around them such as teachers or even parents.

An employer is more likely to see day-time sleepiness as unprofessional behavior than as a recognized symptom of a medical disorder and most people do not want to accept that excessive daytime sleepiness due to narcolepsy cannot be controlled.

Difficulty in Maintaining Interpersonal Relationships

Having absolutely no control over when you may fall asleep during the day does a considerable amount of damage to your social life as well as your interpersonal relationships.

You may fall asleep while you are out having a lunch date with your partner which may offend them or at least make them feel embarrassed in a public setting. You may fall asleep at parties or social gatherings or strong emotions such as excitement, laugher and happiness can trigger a loss of muscle control which may make people avoid having you over for the fear of risking an accident.

Unless people accept and support that you have narcolepsy and it has certain symptoms it will be hard to maintain and thrive in your social life with this sleep disorder.

Increases Risk of Physical Harm for Self as Well as Others

People with narcolepsy may have sudden sleep attacks and they can occur anywhere and at any time of the day, which can be quite a risk for themselves as well as others. For instance, if a person has one of these sleep attacks or catalepsy attacks while driving, it can cause some serious accidents and harm them as well as people who are in the vehicle with them.

A person who is suffering from this disorder may fall asleep while operating a piece of heavy machinery at work and cause physical injuries for themselves as well as their co-workers.

High Risk of Obesity and Related Conditions:

A person who suffers from narcolepsy tends to spend more time in a sedentary state when they are either sleepy or drowsy and thus there is a lack of adequate physical activity. The metabolism rate is thus low in people who suffer from this excessive sleep-related disorder and thus a person suffering from this sleep disorder is more likely to become overweight or obese and also be at a higher risk of heart diseases.

 Narcolepsy and Mental Health

Narcolepsy is often a chronic but rare sleep disorder so a person who suffers from this condition may not be able to get support from other people. Few people recognize the severity of this condition, so they don’t get proper social acceptance and their school life, as well as their work-life, suffers as a result. 

As it is difficult to maintain a social life with narcolepsy, someone with this Sleep disorder may feel cut-off or isolated from other people which can trigger the symptoms of depression.

If they have narcolepsy with cataplexy, they may feel anxious when they are in social settings due to the fear of having a cataplexy attack or of having a sleep attack at crucial moments which can result in full-blown social anxiety.

Apart from depression and anxiety, they may also feel less sure of themselves and may develop an inferiority complex over a span of time.

Available Treatments for Narcolepsy

Narcolepsy cannot be cured, but it can be managed with various types of treatments as well as lifestyle changes so that the person can enjoy a better quality of life.

The most common medications used for the treatment of narcolepsy are stimulants like caffeine, but there is a risk of addiction associated with them.

Modafinil is an effective treatment for excessive daytime sleepiness in narcolepsy as it has wakefulness boosting properties but is not a stimulant so there is a lower risk of developing an addiction.

Armodafinil can also be used for excessive daytime sleepiness as it is an enantiopure compound of this very drug.

The brand name medication Provigil prescribed for the effective treatment of narcolepsy also has generic equivalents such as Modalert and Modvigil, similarly, the enantiopure compound can be found in Waklert.

It is true that oral medications such as Modafresh and Modaheal will make a significant positive impact on the quality of life you live with narcolepsy, but making lifestyle changes will be equally vital for you.

Regular day-time naps, informing people at work and school about your condition, and having realistic expectations from yourself will make it easier for you to manage your daily life with narcolepsy.