Myth: People With Narcolepsy Dont Have Trouble Sleeping At Night
The truth is that many people with narcolepsy also have trouble falling asleep, says Malhotra. In fact, they often also have sleep apnea, another common sleep disorder. Sleep apnea and narcolepsy commonly coexist, says Stevens.
The myth that I see the most is that people with narcolepsy are always sleepy and they never have insomnia or problems sleeping at night, but thats actually not the case, says Malhotra. Ive even seen some people with narcolepsy come into my clinic and their main complaint is actually insomnia, which you would think would be the exact opposite. He notes that narcolepsy not only causes problems with being very sleepy during the day but also interferes with the ability to sleep well at night. That sleep disruption or sleep fragmentation, where the sleep doesnt go through the normal sleep stages that people without narcolepsy go through, can cause people with narcolepsy to feel like theyre not sleeping well at night, says Malhotra. Theyll and feel like they cant stay asleep at night.
What Are Sleep Disorders
Sleep disorders are conditions that impair your sleep or prevent you from getting restful sleep and, as a result, can cause daytime sleepiness and other symptoms. Everyone can experience problems with sleep from time to time. However, you might have a sleep disorder if:
- You regularly experience difficulty sleeping.
- You are often tired during the day even though you slept for at least seven hours the night before.
- You have a reduced or impaired ability to perform regular daytime activities.
There are more than 100 million Americans of all ages who are not getting an adequate amount of sleep. Sleep is very important. Not getting enough sleep can have untoward consequences on school and work performance, interpersonal relationships, health and safety.
Limitations And Future Directions
Future research should focus on the systematic and thorough evaluation of daytime impairments associated with the combined impacts of ADHD and sleep disturbances on individuals with both conditions. Such research should clearly define outcomes that take into consideration the manners in which cognitive, emotional, and physical impairment may manifest at different ages, and should apply those definitions systematically across disorders. Ideally, these studies would compare individuals with ADHD and each of the primary sleep disorders known to be associated with ADHD to individuals with ADHD alone and to healthy controls. Results of these studies are needed to better appreciate patient needs and to inform clinical management.
Additional studies should also be conducted to capture the clinical characteristics and daytime impairments of all age groups, in particular adolescents and elderly patients . In addition, longitudinal studies are needed that evaluate changes in sleep, ADHD, and potential impairment over time, and that track the impacts of interventions on the sleep and daytime functioning of individuals with ADHD and comorbid sleep disorders.
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What Are Narcolepsy And Cataplexy
Narcolepsy is a long-term problem. The name comes from the Greek ‘seized by somnolence’ . Your sleep is affected so that you feel excessively tired and drowsy during the daytime but have disturbed night-time sleep. You can also have sleep attacks where you fall asleep during the day without any warning.
Many people with narcolepsy also have cataplexy. This name comes from the Greek ‘down’. In cataplexy you have sudden loss of control over some of your muscles. There are other symptoms of narcolepsy including seeing, hearing or feeling something that is not really there as you are falling off to sleep or waking up from sleep.
How Common Is Narcolepsy
Narcolepsy is relatively rare. NT1 affects between 20 and 67 people per 100,000 in the United States. According to a population based study in Olmstead county Minnesota, NT1 is two to three times more common than NT2, which is estimated to affect between 20 to 67 people per 100,000.
Calculating the prevalence of narcolepsy is challenging because of underdiagnosis and delays in diagnosis. Many patients are not diagnosed with narcolepsy until years after their first symptoms. As a result, some estimates place the prevalence of narcolepsy as high as 180 per 100,000.
Narcolepsy occurs roughly equally in men and women and can affect both children and adults. It can occur at any age, but onset has been found to peak at around age 15 and again around age 35.
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What Happens During Sleep
You don’t notice it, of course, but while you’re asleep, your brain is still active. As people sleep, their brains pass through five stages of sleep. Together, stages 1, 2, 3, 4, and REM sleep make up a sleep cycle. One complete sleep cycle lasts about 90 to 100 minutes. So during an average night’s sleep, a person will experience about four or five cycles of sleep.
Stages 1 and 2 are periods of light sleep from which a person can wake up easily. During these stages, eye movements slow down and eventually stop, heart and breathing rates slow down, and body temperature decreases. Stages 3 and 4 are deep sleep stages. It’s more difficult to awaken someone during these stages, and when awakened, a person will often feel groggy and confused for a few minutes. Stages 3 and 4 are the most refreshing of the sleep stages â it is this type of sleep that we crave when we are very tired.
The final stage of the sleep cycle is known as REM sleep because of the rapid eye movements that occur during this stage. During REM sleep, other physical changes take place â breathing becomes rapid, the heart beats faster, and the limb muscles don’t move. This is the stage of sleep when a person has the most vivid dreams.
How Do Doctors Determine Which Condition You Have
The first step in the diagnosis of a sleeping disorder is an examination with your doctor, who will review your symptoms and medical history while ruling out other neurological problems. Cataplexy, for instance, is narcolepsyâs most unique symptom which occurs in virtually no other disorders.
A multiple sleep latency test can be used to help diagnose narcolepsy. This test measures how quickly you fall asleep and how fast you enter the deep stage of sleep called rapid eye movement sleep. According to the National Institute of Neurological Disorders and Stroke, people with narcolepsy enter REM sleep abnormally earlyâtypically within 15 minutes of falling asleep.
Polysomnography, or a sleep study, is the current standard for diagnosing sleep disorders like sleep apnea. This in-lab diagnostic testing measures your blood oxygen levels, breathing, and brain and muscle activity during sleep to determine if your airflow is being blocked. There are also simplified versions of this test available via telemedicine for at-home sleep apnea testing.
âThough they are different entities, it is not uncommon for sleep apnea and narcolepsy to occur together, making the management of such patients potentially quite challenging,â Katznelson adds.
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Myth: Everyone With Narcolepsy Suddenly Passes Out Right In The Middle Of Doing Something Such As Laughing Or Talking
Thanks in no small part to exaggerated and inaccurate depictions of narcolepsy in movies and TV shows, there are persistent misconceptions about common symptoms of this sleep disorder. Actual symptoms include:
- Excessive daytime sleepiness
- Sleep paralysis when falling asleep or waking up
- Hallucinations when falling asleep or waking up
- Disrupted nighttime sleep and insomnia
- Automatic behavior
When someone with narcolepsy is depicted as doing something like laughing or walking and then suddenly falling completely asleep, thats not quite accurate. For one thing, says Chervin, people sometimes confuse narcolepsy with cataplexy.
With narcolepsy, the part of the brain thats in charge of keeping you awake for sustained periods of time … isnt functioning properly, explains Malhotra. Instead of moving gradually through stages of nonrapid eye movement sleep into rapid eye movement sleep the stage when dreams most likely occur people with narcolepsy zoom right into REM within minutes of falling asleep.
Because the brain naturally keeps our muscles limp during the REM stage of sleep to prevent us from acting out dreams someone with narcolepsy, according to NINDS, may experience a sudden loss of motor strength when theyre awake or paralysis or dreamlike hallucinations when theyre not yet asleep. This is part of whats happening when someone with narcolepsy experiences sleep paralysis or hallucinations, explains Malhotra.
Getting Back To Normal
If youâre living with a sleep disorder, keep calm. Sleep disorders are common and can be treated with a specialistâs care and a few lifestyle changes. For those who are struggling with weight management, consider starting a well-balanced, nutritious diet accompanied by daily physical exercises. Remember to take note of any abnormal sleep patterns. Contact your primary care physician or a sleep specialist who can assess you and help optimize your sleep health.
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Sleepy All The Time: What Sleep Apnea And Narcolepsy Feel Like
With some sleep disorders, such as sleep apnea, narcolepsy, or periodic limb movement disorder, patients may not realize why or even if their sleep is disturbed throughout the night. They might blame their frequent waking on another issuebad dreams or a weak bladder, for exampleor may not even arouse from slumber long enough to realize they’re awake.
Chances are, however, they’re not staying asleep for the time it takes to go through the deep, restorative stages of sleep needed to feel refreshed in the morning. That’s why, in many cases, how you feel during the day is the best indicator of whether you might have a problem.
“I’ve learned not to rely on the question, ‘How do you sleep,'” says Ralph Downey III, PhD, director of the Sleep Disorders Center at Loma Linda University Medical Center in Loma Linda, Calif. “Because the group that has the real problemthe ones who nod off whenever they’re sedentarythey always say they sleep great. Well, it’s just that they sleep everywhere, including at work and behind the wheel.”
This was the case with Virginia Arguello, 44, a medical transcriptionist in Hayward, Calif. In her mid-30s, Arguello began falling asleep during her morning drive to work, even after a full night’s sleep.
Luckily something else tipped off her doctor: Arguello had recurring nightmares of being underwater, unable to swim up and reach the surface. “I would wake up gasping,” she says. “My husband complained that I snored and gasped for air.”
You Have Chronic Insomnia
Insomnia means that you have trouble falling asleep at night. You may also have problems staying asleep, meaning that you wake up frequently throughout the night. Some people with insomnia might also wake up earlier than needed in the morning and are unable to get back to sleep.
What can make insomnia so frustrating is that youre likely tired and want to get some shut-eye. But for some reason, you just cant seem to fall asleep.
Occasional insomnia can be annoying, but not being able to sleep once in a while isnt usually a health concern. If you find yourself managing insomnia on a regular basis, it may be time to see a doctor. This could be a sign of chronic insomnia, which is a common type of sleep disorder.
Insomnia itself may be related to other underlying conditions, including:
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Treatment For Sleep Apnea
CPAP : When the patient has moderate to severe kind of sleep apnea, he/she may benefit from CPAP, in this a machine is used to deliver air while you are asleep via a mask. While using CPAP, the pressure of air is kept on the higher side as compared to the pressure of air in the room, this helps to keep the airways open and hence prevents snoring and apnea. Many people find CPAP uncomfortable, but when used on a regular basis, the patient gets used to it. The mask used must be comfortable for the patient. You must contact your doctor immediately if you still snore at night even after using CPAP.
BPAP : If CPAP does not help, then BPAP can be used for such patients. This device delivers high-pressure air while inhalation and low-pressure while exhaling.
Auto-CPAP. This is a type of CPAP device the only difference between this and CPAP is that this device adjusts the air pressure automatically on its own while you remain asleep while in CPAP you have to adjust the air pressure.
Oral Appliances. Oral appliances are available when you wear these appliances they keep your throat open. These are easy to use as compared to CPAP. But CPAP is a more reliable option than these. There are many devices available you just need to find the one that suits you the best.
Other Sleep Disorders And Excessive Sleepiness
Some other sleep disorders that may cause excessive sleepiness include:
- Circadian rhythm sleep disorders, a group of conditions caused by problems with your body’s internal “clock.” This might cause you to fall asleep too late, wake up too early, or have a hard time adjusting to a sleep schedule. These conditions can be mild, like jetlag, or more serious.
- Periodic limb movement disorder. In this rare illness, your legs and feet, and sometimes your arms, jerk or twitch as you sleep. You may not even be aware this is happening. It’s not the same as restless legs syndrome, although some people have it along with RLS.
A sleep doctor can diagnose and treat these conditions. Depending on how serious your disorder is, they may treat it with lifestyle changes, medication, or both.
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What Treatments Are Available
Although there is no cure for narcolepsy, some of the symptoms can be treated with medicines and lifestyle changes. When cataplexy is present, the loss of hypocretin is believed to be irreversible and lifelong. Excessive daytime sleepiness and cataplexy can be controlled in most individuals with medications.
Comorbid Obstructive Sleep Apnea Can Interfere With Narcolepsy Diagnosis
Some people diagnosed with obstructive sleep apnea also have narcolepsy, but soldier on for years without knowing that they have both sleep disorders, studies show, leaving these patients unsure as to why they continue to feel excessive sleepiness during the day even after their apnea is treated.
The knowledge gap that occurs due to a delayed diagnosis of narcolepsy was highlighted recently by researchers who studied how the presence of OSA can interfere with the diagnosis of narcolepsy.
According to a study that surveyed almost 1,700 people with narcolepsy, two-thirds had multiple health problems and about 24% had OSA as a comorbid condition. Overall, those who were surveyed revealed that they were often treated for OSA and other common comorbid symptoms for up to 10 years or more before receiving a proper narcolepsy diagnosis.
In fact, the presence of OSA is often a key contributor to this delayed diagnosis, the research shows. In their study, those with OSA found that a narcolepsy diagnosis was delayed by 6 to 7 years.
Our recent study on delayed diagnosis in narcolepsy showed that children and adolescents have double the odds of having a delayed diagnosis than adultsthis could be because of low awareness of narcolepsy among pediatric health care providers but also because of misdiagnoses as other conditions such a mood disorders and ADHD, says Maski.
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Questions To Expect From Your Doctor If You Suspect You Have Narcolepsy
If you are experiencing symptoms that might be narcolepsy, the first step is telling your primary care doctor. He or she will likely ask any or all of the following questions to understand more about what you are experiencing and whether or not you should see a sleep medicine specialist:
- What does your typical sleep schedule look like?
- Do you have trouble falling asleep or staying asleep?
- Do you feel fatigued or experience sleepiness during the day?
- Have you experienced other narcolepsy symptoms, such as cataplexy, hallucinations, or sleep paralysis?
- What medication are you taking? Some medications, such as pain relievers containing caffeine, antidepressants, or antihistamines, can disrupt your sleep and cause daytime drowsiness.
- Do you use drugs or alcohol? How much? How often?
- Have you recently suffered an infection or brain injury? Do you have an autoimmune disorder? These are factors that could potentially lead to narcolepsy.
- Do you have any relatives who have narcolepsy, or who had symptoms that could have possibly been narcolepsy but were never diagnosed?
Its important to know that your doctor may not ask about daytime fatigue or your sleep during a regular checkup, but its not normal to not be getting restful, restorative sleep on a regular basis. You should bring up sleep complaints with your doctor.
How Are Sleep Disorders Treated
There are a variety of treatments recommended by healthcare providers:
- Counseling: Some sleep specialists recommend cognitive behavior therapy. Such counseling helps you recognize, challenge and change stress-inducing thoughts that can keep you awake at night.
- Medications and/or supplements.
- Practice sleep hygiene such as keeping a regular sleep schedule.
- Get regular exercise.
- Manage the temperature so that youre comfortable.
Your healthcare provider will recommend treatments based on your unique situation.
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Narcolepsy Vs Sleep Apnea: How Do I Know Which One I Have
If you find yourself falling asleep or feeling excessively tired and drowsy during the day, you may have a sleeping disorder. These symptoms alone wonât tell you which disorder you have, though. Daytime sleepiness is a shared symptom of both sleep apnea and narcolepsy, for example. Read on for more details about how narcolepsy and sleep apnea differ, and what tests can help determine which one you might have.