Narcolepsy, characterized by excessive daytime sleepiness, is a disorder believed to be caused by a deficiency in certain neuropeptides called orexins.
It is often seen in children, adolescents, and young adults. Narcolepsy may be easily confused with other childhood disorders, such as depression and insomnia, because its symptoms are often nonspecific.
Girls and boys are affected in equal numbers, and some studies show that up to 30% of patients are diagnosed before the age of 15 years.
Children with narcolepsy typically complain about feeling tired all the time, and may be aggressive and irritable periodically.
They fall asleep at unusual times, such as in the middle of their conversations, while eating, or during short drives. Their ‘sleep attacks’ negatively impact their social and academic functioning.
Cataplexy may also occur in narcoleptic children. This term refers to the abrupt and unexpected loss of muscular tone as a reaction to strong emotions. Furthermore, patients may have sleep paralysis as well as frightening hallucinations just before sleeping or when waking up.
It is critical to make sure that a child does not have any other disorders. Steps taken to rule out other conditions are a complete medical history, physical examination, and clinical workups that include blood and other laboratory tests. Next, specialists are consulted to ascertain if there is sleep dysfunction.
Two tests are used to diagnose narcolepsy. Overnight sleep studies in a specialized center are conducted. These studies are known as polysomnograms and are necessary for identifying sleep disorders. Polysomnogram is immediately followed by a multiple sleep latency test to study the excessive sleepiness during the daytime.
Narcolepsy has no known cure at the moment. However, there are several avenues that may be taken to curtail the symptoms. These include pharmacotherapy, behavioral modification, and education.
Therapy with drugs is geared towards treating the excessive sleepiness during the day as well as the cataplexy, hallucinations and associated sleep disturbances.
Stimulants like amphetamine-containing drugs may be used to modulate the daytime sleepiness. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may be employed to subdue REM sleep, whereas sodium oxybate may be prescribed for cataplexy.
Behavioral modification therapy is important for affected patients to help achieve control over narcolepsy.
Patients are advised to avoid caffeinated substances close to bedtime so that their normal sleep is not affected.
Caffeinated substances include chocolates, and drinks such as tea, coffee, and cola. Adhering to strict schedules with regards to sleeping and waking is crucial.
Patients are advised to make sure they get enough sleep at night and take one or two short and regularly scheduled naps during the daytime.
Patients, family, close friends, and even colleagues of those affected may need to receive thorough education on narcolepsy in terms of how to manage it and deal with the impact it may have on the psychosocial well-being of the affected individual.
It is important that those who are closest know something about narcolepsy so as to not jump to any conclusions about the patient.
Narcoleptic patients can be easily seen as disinterested or lazy, because of their condition. Hence, it is important that others be aware that the narcoleptic individual suffers from a recognized medical condition and is not just lazy.
Reviewed by Liji Thomas, MD