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SIGNS AND SYMPTOMSPeople with narcolepsy have various day and night sleep problems associated with disturbances in REM sleep. These disturbances can begin subtly and may change over time. Symptoms usually appear between the ages of 7 and 25.Daytime sleepiness is usually the first clinical sign of narcolepsy. It interferes with normal, daily activities even if the person has had an adequate night sleep. People with narcolepsy usually describe having a mental fogginess, depression, lack of energy and extreme exhaustion throughout the day. Some people experience memory lapses and the inability to concentrate at work or school. These involuntary daytime sleep episodes usually only last a few seconds. However, the person can still perform tasks while asleep but they have no recollection of their activity during this time. For example, they may continue to take notes in class but have no memory of doing so and their handwriting may have become illegible. The most common sign, other than daytime sleepiness is cataplexy. This is a sudden weakness of the muscles in the body, generally involving the legs and drooping eyelids. This sudden loss of muscle tone can lead to feeling weak and losing voluntary muscle control. The most severe cases involve complete loss of voluntary muscle tone resulting in collapse and being unable to move or speak. However, most people remain fully aware of their surroundings during these episodes. Often these symptoms are misdiagnosed as epilepsy. Cataplexy is most often initiated by sudden, strong emotions such as laughing, stress, fear or excitement. Approximately 70% of people with narcolepsy experience cataplexy. Narcolepsy also affects energy levels, balance, metabolism and appetite.

DIAGNOSIS Diagnosing narcolepsy is a challenge because there is no standard of diagnosis that exists. The signs and symptoms vary widely among patients and can often lead to a misdiagnosis. Recent research tried to help alleviate this situation and categorized recurring symptoms into two groups:Excessive daytime sleepiness, cataplexy and automatic behaviorsSleep paralysis, hallucinations, and parasomniasSeveral clinical procedures are used to correctly diagnose the disorder including: Nocturnal polysomnogramMultiple sleep latency testsCerebrospinal fluid hypocretin levelsGenetic testing Epsworth sleepiness scale TREATMENTSAdvances in the medical management of narcolepsy has been apparent in recent years. Narcolepsy has been treated by two groups of drugs: stimulants and tricyclic antidepressants. Current available medications are the following: Modafinil which promotes wakefulness Sodium oxybate which responds well with cataplexy and positively affect daytime functioning Ritanserin which have been shown to improve sleep quality Melatonin which regulates the rhythms of the body by increasing REM sleep continuity 1REFERENCESCook, N. (2008). Understanding narcolepsy, part 1: epidemiology and neurophysiology. British Journal Of Neuroscience Nursing, 4(3), 108.Cook, N. (2008). Understanding narcolepsy, part 2: accurate diagnosis and effective management. British Journal Of Neuroscience Nursing, 4(4), 170-176.Sleep Foundation.org. (2011). Narcolepsy Fact Sheet. Bethesda, MD: National Institute of Neurological Disorders.

. NON-PHARMOCOLOGICAL MANAGEMENTRecent research has shown that a low-carbohydrate, ketogenic diet (such as Atkins Diet) improved the symptoms of narcolepsy by 18%. Carbohydrates in a diet can also help produce serotonin which influences a persons degree of sleepiness. Behavioral practices and lifestyle changes also help manage narcolepsy. EPIDEMIOLOGYStatistics on narcolepsy indicated that the disorder affect as many as 200,000 Americans, although fewer than 50,000 have been diagnosed. About 8 to 12 percent of people with narcolepsy have a family history of the disorder. Data on narcolepsy indicate that occurrence rates vary among populations but is estimated to affect about 3 million people worldwide. It can affect any gender at any age. The onset of symptoms usually occur during the teenage years and reaches its peak at around 30 years of age. It can also develop during the early years of childhood but is rare and not often diagnosed. A smaller number of people also develop narcolepsy at ages 50 to 65.

NARCOLEPSYCAUSES AND RISK FACTORS

Narcolepsy is a neurological disorder sleep disorder caused by low levels of hypocretin (also called orexin). This chemical regulates the bodys sleep and wakefulness patterns. The hypothalamus is the part of the brain responsible for producing hypocretin, but in narcolepsy, the cells are destroyed leading to a lack of hypocretin. Certain factors like heredity, infections, brain injuries, autoimmune disease, level changes in hormones and neurotransmitters, and environmental toxins may play a role in triggering the damage of hypocretin cells. Narcolepsy has a strong familial association. A person with a family history of narcolepsy is 20 to 40 times more likely to develop it. The risk goes higher for first degree relatives. It also occur more in men than in women.

SLEEP HYGIENE: FUNDAMENTAL PRINCIPLESAvoid late afternoon napsAvoid alcohol, tobacco, and caffeineImplement and adhere to a strict bedtime routine and timetableAvoid bedtime activities that stimulate physiologically, cognitively or emotionallySleep alone if possibleMaintain bedroom as an environment solely for sleepEnsure sleeping environment is comfortale, quiet, and toxin-freeFACTORS THAT CONTRIBUTE TO THE DAMAGE OF HYPOCRETIN CELLSLow levels of histamineLow levels of epinephrineLow levels of leptinLow levels of the enzyme monoamine oxidaseIncrease levels of dopamineIncrease levels of acetylcholinePROGNOSISCurrently, none of the available treatments for narcolepsy can maintain a full level of alertness but certain medications and a healthy lifestyle can help manage the symptoms. Treatments are modified as symptoms changes. Symptoms could get worse thirty years after the onset. Many older patients reported a decrease in severity after the age of 60.1