narcolepsy

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More about Narcolepsy: Causes and symptoms Diagnosis Treatment Prognosis Resources

Definition

Narcolepsy is a disorder marked by excessive daytime sleepiness, uncontrollable sleep attacks, and cataplexy (a sudden loss of muscle tone, usually lasting up to half an hour).

Description

Narcolepsy is the second-leading cause of excessive daytime sleepiness (after obstructive sleep apnea). Persintent sleepiness and sleep attacks are the hallmarks of this condition. The sleepiness has been compared to the feeling of trying to stay awake after not sleeping for two or three days.

People with narcolepsy fall asleep suddenly—anywhere, at any time, maybe even in the middle of a conversation. These sleep attacks can last from a few seconds to more than an hour. Depending on where they occur, they may be mildly inconvenient or even dangerous to the individual. Some people continue to function outwardly during the sleep episodes, such as talking or putting things away. But when they wake up, they have no memory of the event.

Narcolepsy is related to the deep, dreaming part of sleep known as rapid eye movement (REM) sleep. Normally when people fall asleep, they experience 90 minutes of non-REM sleep, which is then followed by REM sleep. People with narcolepsy, however, enter REM sleep immediately. In addition, REM sleep occurs inappropriately throughout the day.

There has been debate over the incidence of narcolepsy. It is thought to affect between one in every 1, 000 to 2, 000 Americans. The known prevalence in other countries varies, from one in 600 in Japan to one in 500, 000 in Israel. Reasons for these differences are not clear.

— Michelle Lee Brandt

A disorder characterized by sudden and uncontrollable, though often brief, attacks of deep sleep, sometimes accompanied by paralysis and hallucinations.

Definition

Narcolepsy is a disorder marked by excessive daytime sleepiness, uncontrollable sleep attacks, and cataplexy (a sudden loss of muscle tone, usually lasting up to half an hour).

Description

Narcolepsy is the second-leading cause of excessive daytime sleepiness (after obstructive sleep apnea). Persistent sleepiness and sleep attacks are the hallmarks of this condition. The sleepiness has been compared to the feeling of trying to stay awake after not sleeping for two or three days.

People with narcolepsy fall asleep suddenly—any-where, at any time, even in the middle of a conversation. These sleep attacks can last from a few seconds to more than an hour. Depending on where the sleep attacks occur, they may be mildly inconvenient or even dangerous to the person, particularly if they occur while driving. Some people continue to function outwardly during the sleep episodes, such as continuing a conversation or putting things away. But when they wake up, they have no memory of the event.

Sleep researchers have identified several different types of sleep in humans. One type of sleep is called rapid eye movement (REM) sleep, because the person's eyes move rapidly back and forth underneath the closed eyelids. REM sleep is associated with dreaming. Normally, when people fall asleep, they experience 90 minutes of non-REM sleep, which is then followed by a phase of REM sleep. People with narcolepsy, however, enter REM sleep immediately. In addition, REM sleep occurs inappropriately throughout the day in patients with narcolepsy.

Demographics

There has been debate over the incidence of narcolepsy. It is thought to affect between one in every 1,000–2,000 Americans. The known prevalence in other countries varies, from one in 600 in Japan to one in 500,000 in Israel. The reasons for these demographic differences are not clear. In about 8–12% of cases, people diagnosed with narcolepsy know of other family members with similar symptoms.

Causes and symptoms

One of the causes of narcolepsy is a genetic mutation. In 1999, researchers identified the gene that causes the disorder. The narcolepsy gene allows cells in the hypothalamus (the part of the brain that regulates sleep behavior) to receive messages from other cells. As a result of the mutation, the cells cannot communicate properly, and abnormal sleeping patterns develop.

Researchers are also looking into the possibility that narcolepsy may be caused by some kind of autoimmune disorder. This theory suggests that the person's immune system accidentally turns against the specific area of the brain that controls alertness and sleep, injuring or destroying it.

The disorder sometimes runs in families, but most people with narcolepsy have no family members with the disorder. Researchers believe that the inheritance of narcolepsy is similar to that of heart disease, in which several genes play a role in being susceptible to the disorder. But heart disease does not usually develop without an environmental trigger of some sort.

While the symptoms of narcolepsy usually appear during a person's late teens or early 20s, the disease may not be diagnosed for many years. Most often, the first symptom is an overwhelming feeling of fatigue. After several months or years, cataplexy and other symptoms of the disorder appear.

Cataplexy is the most dramatic symptom of narcolepsy, affecting 75% of people with the disorder. During attacks, the knees buckle and the neck muscles go slack. In extreme cases, the person may become paralyzed and fall to the floor. This loss of muscle tone is temporary, lasting from a few seconds to half an hour, but it is frightening.

The attacks can occur at any time, but are often triggered by strong emotions such as anger, joy, or surprise.

Other symptoms of narcolepsy include:

• sleep attacks: short, uncontrollable sleep episodes throughout the day
• sleep paralysis: a frightening inability to move shortly after awakening or dozing off
• auditory or visual hallucinations: intense, sometimes terrifying experiences at the beginning or end of a sleep period
• disturbed nighttime sleep: tossing and turning, nightmares, and frequent awakenings during the night

Diagnosis

The diagnosis of narcolepsy can be made by a general practitioner familiar with the disorder as well as by a psychiatrist. If a person comes to the doctor with reports of both excessive daytime sleepiness and cataplexy, a diagnosis may be made on the patient's history alone. Laboratory tests, however, can confirm a diagnosis of narcolepsy. These tests may include an overnight polysomnogram, which is a test in which sleep is monitored with a variety of electrodes that record information about heart rate, eye movements, brain waves, muscle activity, breathing, changes in blood oxygen concentration, and body position. A multiple sleep latency test, which measures sleep latency (onset) and how quickly REM sleep occurs, may also be used. People who have narcolepsy usually fall asleep in less than five minutes.

If the diagnosis is still open to question, a genetic blood test can reveal the existence of certain substances in people who have a tendency to develop narcolepsy. Positive test results suggest, but do not prove, that the patient has narcolepsy.

Narcolepsy is a complex disorder, and it is often misdiagnosed. Many people with the disorder struggle with symptoms for an average of 14 years before being correctly diagnosed.

Treatment team

Sleep disorder specialists are experts in management of narcolepsy. Other team members may include neurologists, psychiatrists, or psychologists.

Treatment

There is no cure for narcolepsy. It is not progressive, and it is not fatal, but it is a chronic disorder. The symptoms can be managed with lifestyle adjustments and/or medication.

People with narcolepsy must plan their days carefully. Scheduling regular naps (either several short, 15-minute naps or one long nap in the afternoon) can help boost alertness and wakefulness. A full eight hours of nighttime sleep should also be a goal. Exercise can often help people with narcolepsy feel more alert and energetic, although they should avoid exercising within a few hours of bedtime. Substances that contain alcohol, nicotine, and caffeine should be avoided because they can interfere with refreshing sleep and with daytime alertness.

Medications for narcolepsy may include the use of antidepressants (tricyclic antidepressants or selective serotonin-reuptake inhibitors [SSRIs]) to treat such symptoms of the disorder as cataplexy, hypnagogic hallucinations, and/or sleep paralysis.

Stimulants (amphetamines) may also be used to help individuals with narcolepsy stay awake and alert.

With the recent discovery of the gene that causes narcolepsy, researchers are hopeful that other treatments can be designed to relieve the symptoms of the disorder.

Clinical trials

A number of clinical trials are underway to investigate a number of drugs that may help improve daytime sleepiness in narcolepsy patients. For more information visit .

Prognosis

Narcolepsy is not a degenerative disease, and patients do not develop other neurologic symptoms. Narcolepsy can, however, interfere with a person's ability to work, play, drive, socialize, and perform other daily activities. In severe cases, the disorder prevents people from living a normal life, leading to depression and a loss of independence.

Resources

PERIODICALS

Mignot, E. "Genetics of Narcolepsy and Other Sleep Disorders." American Journal of Human Genetics 60 (1997): 1289–1302.

Siegel, Jeremy M. "Narcolepsy." Scientific American (January 2000).

ORGANIZATIONS

American Academy of Sleep Medicine. 6301 Bandel Rd. NW, Suite 101, Rochester, MN 55901. (507) 287-6008. (March 23, 2004). http://www.aasmnet.org.

American Sleep Disorders Association. 1610 14th St. NW, Suite 300, Rochester, MN 55901. (507) 287-6006.

Narcolepsy Network. P. O. Box 42460, Cincinnati, OH 45242. (973) 276-0115.

National Center on Sleep Disorders Research. Two Rockledge Centre, 6701 Rockledge Drive, Bethesda, MD 20892. (301) 435-0199.

National Sleep Foundation. 1522 K St., NW, Suite 500, Washington, DC 20005. (202) 785-2300. (March 23, 2004). http://www.sleepfoundation.org.

Stanford Center for Narcolepsy. 1201 Welch Road, Room P-112, Stanford, CA 94305. (415) 725-6517.

University of Illinois Center for Narcolepsy Research. 845 S. Damen Ave., Chicago, IL 60612. (312) 996-5176.

OTHER

Stanford Researchers Nab Narcolepsy Gene For Sleep Disorders. Stanford University Medical Center. Cited August 5, 1999 (March 23, 2004). http://www.stanford.edu/%7Edement/ngene.html.

Rosalyn Carson-DeWitt, MD

A disease in which the patient is unable to stay awake.

Definition

Narcolepsy is a neurological disorder characterized by uncontrollable episodes of sleepiness during the day. Episodes can last from a few seconds to more than an hour and can significantly interfere with daily activities.

Description

People with narcolepsy often fall asleep suddenly, anywhere at any time, even in the middle of a conversation. They may sleep for just a few seconds or for up to a half hour, and then reawaken feeling alert until they fall asleep again. The condition affects one of every 2,000 Americans. Sleep apnea (difficulty in breathing while sleeping) is the leading cause of excessive daytime sleepiness. Narcolepsy is the second leading cause.

The attacks of sleepiness that are the hallmark of this condition may be mildly inconvenient or deeply disturbing. Some people continue to function during the sleep episodes, even talking and putting things away, but will reawaken with no memory of what they had been doing while briefly asleep.

Narcolepsy is related to the dreaming part of sleep known as REM (rapid eye movement) sleep. Normally, people fall asleep for about 90 minutes of non-REM sleep followed by REM sleep. However, people with narcolepsy enter REM sleep immediately; upon awakening, REM sleep recurs inappropriately throughout the day.

Causes & Symptoms

Recent research suggests that the development of narcolepsy probably involves a combination of environmental factors and several genes, most likely those that are involved with the immune system. The exact gene pattern has not been identified as of 2002.

Cross-ethnic studies indicate significant variations in the prevalence of narcolepsy in different countries, with the Japanese having a very high rate and Israeli Jews one of the lowest in the world. A recent study of five European countries found that the prevalence of narcolepsy is higher in the United Kingdom and Germany than in Italy, Portugal, and Spain.

In the late 1990s, three independent research groups discovered a neuropeptide system in the hypothalamus, the part of the brain that regulates body temperature and appetite. The newly discovered system, which has been called the hypocretinergic system, regulates sleep and wakefulness. The nerve cells, or neurons, in this part of the hypothalamus secrete substances known as hypocretins or orexins, which regulate the sleep/wake cycle in humans. There are two of these compounds, known as orexin-A and orexin-B, or as hypocretin-1 and hypocretin-2. As of 2002, narcolepsy is thought to be an orexin deficiency syndrome; that is, it develops when a person's hypothalamus does not secrete enough orexins to keep the person from falling asleep at inappropriate times. Samples of cerebrospinal fluid taken from patients with narcolepsy contain little or no orexins. MRI scans of these patients indicate that there is some loss of brain tissue in the hypothalamus itself, suggesting that the neurons responsible for secreting orexins have died.

Symptoms of narcolepsy typically appear during adolescence; however, studies have shown that they may also begin in childhood. The disorder itself may not be diagnosed for many years after the first appearance of symptoms. The primary symptom is an overwhelming feeling of fatigue, together with sleep attacks that may occur with or without warning. About 75% of patients also experience cataplexy, a sudden loss of muscle control lasting a few seconds to 30 minutes resulting in physical collapse without any loss of consciousness. Episodes of narcolepsy can be triggered by emotions such as laughter, fear, or anger. Other symptoms include sleep paralysis and hypnogogic (vivid) hallucinations as the person wakes up or falls asleep. Some patients may also have trouble staying asleep at night.

Diagnosis

If a person has both excessive daytime sleepiness and cataplexy, narcolepsy can be diagnosed on the basis of patient history alone. Lab tests, however, can confirm a diagnosis. Tests at a sleep disorders clinic include an overnight polysomnogram (sleep is monitored with electrocardiography, video and respiratory parameters) followed by a Multiple Sleep Latency Test, which measures sleep onset and how quickly REM sleep occurs. In narcolepsy, sleep latency is usually less than five minutes. First REM period latency is also abnormally short.

A genetic blood test can reveal certain antigens in people who have a tendency to develop narcolepsy. Positive blood test results suggest, but do not prove, the existence of narcolepsy.

As of 2002, the diagnosis of narcolepsy can be confirmed by taking a sample of the patient's cerebrospinal fluid by a spinal tap, and testing it for the presence of hypocretin-1. Patients with narcolepsy have no hypocretin-1 in their spinal fluid.

Treatment

Several short naps scheduled throughout the day may help relieve some of the sleepiness associated with narcolepsy. The botanical remedy yohimbe (Pausinystalia yohimbe) may also be useful in promoting alertness. As with any herbal preparation or medication, individuals should check with their healthcare professional before taking the remedy to treat narcolepsy.

Allopathic Treatment

Patients can be treated with amphetamine-like stimulant drugs (Dexedrine) to control drowsiness and sleep attacks. The symptoms of abnormal REM sleep (cataplexy, sleep paralysis, and hypnagogic hallucinations) are treated with antidepressants.

Newer nonamphetamine wake-promoting drugs are now available to treat narcolepsy. These medications lack the unpleasant side effects of amphetamines, particularly jitteriness and anxiety. Modafinil (Provigil) is the most commonly prescribed of the newer psychostimulants. As of 2002, however, researchers do not know exactly how modafinil prevents the drowsiness associated with narcolepsy.

Patients who do not like taking high doses of stimulants may choose to nap every couple of hours to relieve daytime sleepiness and take smaller doses of stimulants.

Expected Results

Narcolepsy can be a devastating disease that impairs a person's ability to work, play, and engage in meaningful activities. In severe cases, an inability to work and drive can interfere with daily life, leading to depression and a loss of independence. Drug treatments can ease symptoms but will not cure the disease. Narcolepsy is not a degenerative disease, and patients are not expected to develop new neurologic symptoms. Life span is normal if common sense is exercised regarding such hazards as automobile accidents.

Resources

Periodicals

Beuckmann, C. T., and M. Yanagisawa. "Orexins: From Neuropeptides to Energy Homeostasis and Sleep/Wake Regulation." Journal of Molecular Medicine 80 (June 2002): 329-342.

Kaufmann, C., A. Schuld, T. Pollmacher, and D. P. Auer. "Reduced Cortical Gray Matter in Narcolepsy: Preliminary Findings with Voxel-Based Morphometry." Neurology 58 (June 25, 2002): 1852-1855.

Mazza, M., V. Faia, N. Paciello, et al. "Sleep Disorders in Childhood: A Review." La Clinica Terapeutica 153 (May-June 2002): 189-193.

Ohayon, M. M., R. G. Priest, J. Zulley, et al. "Prevalence of Narcolepsy Symptomatology and Diagnosis in the European General Population." Neurology 58 (June 25, 2002): 1826-1833.

Silvestri, A. J., L. D. Sanford, R. J. Ross, et al. "The Central Nucleus of the Amygdala and the Wake-Promoting Effects of Modafinil." Brain Research 941 (June 21, 2002): 43-52.

Smart, D., and J. Jerman. "The Physiology and Pharmacology of the Orexins." Pharmacology and Therapeutics 94 (April-May 2002): 51.

Stahl, S. M. "Awakening to the Psychopharmacology of Sleep and Arousal: Novel Neurotransmitters and Wake-Promoting Drugs." Journal of Clinical Psychiatry 63 (June 2002): 467-468.

Sutcliffe, J. G., and L. de Lecea. "The Hypocretins: Setting the Arousal Threshold." Nature Reviews. Neuroscience 3 (May 2002): 339-349.

Wing, Y. K., R. H. Li, C. W. Lam, et al. "The Prevalence of Narcolepsy Among Chinese in Hong Kong." Annals of Neurology 51 (May 2002): 578-584.

Organizations

Narcolepsy Network. 10921 Reed Hartman Highway, Cincinnati, OH 45242. (513) 891-3522. http://www.websciences.org/narnet/.

National Sleep Foundation. 1522 K Street, NW, Suite 500, Washington, DC 20005. (202) 347-3471. nsf@sleepfoundation.org. http://www.sleepfoundation.org.

Stanford Center for Narcolepsy. Stanford University School of Medicine, 701-B Welch Road, Room 146. Palo Alto, CA 94304. (650) 725-6517. http://www-med.stanford.edu/school/Psychiatry/narcolepsy.

[Article by: Paula Ford-Martin; Rebecca J. Frey, PhD]

Definition

Narcolepsy is a disorder of the nervous system marked by excessive daytime sleepiness, uncontrollable sleep attacks, and cataplexy (a sudden loss of muscle tone, usually lasting up to half an hour). The American Psychiatric Association (APA) classifies narcolepsy as a sleep disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. The National Institute of Neurological Disorders and Stroke (NINDS) defines narcolepsy as a "disorder caused by the brain's inability to regulate sleep-wake cycles normally." The disorder is sometimes called Gélineau's syndrome because it was first identified in 1880 by the French neurologist Jean-Baptiste Gélineau. The word narcolepsy itself comes from two Greek words that together mean "seized by sleepiness."

Description

Narcolepsy is the second-leading cause of excessive daytime sleepiness (after obstructive sleep apnea). Persistent sleepiness and sleep attacks are the hallmarks of this condition. The sleepiness has been compared to the feeling of trying to stay awake after not sleeping for two or three days. It is not correct, however, to describe people with narcolepsy as sleeping longer or spending more time asleep in a 24-hour period than people without the disorder. Although patients with narcolepsy experience drowsiness and sleep attacks during the daytime, they also wake up frequently during the nighttime hours. For this reason, narcolepsy is more accurately described as a disorder of the normal boundaries between sleep and wakefulness.

People with narcolepsy fall asleep suddenly—anywhere, at any time, maybe even in the middle of a conversation. These sleep attacks can last from a few seconds to more than an hour. Depending on where they occur, they may be mildly inconvenient or even dangerous. Some people continue to function outwardly during the sleep episodes, such as talking or putting things away. But when they wake up, they have no memory of the event.

Narcolepsy is related to the deep, dreaming part of sleep known as rapid eye movement (REM) sleep. Normally when people fall asleep, they experience 80 to 100 minutes of non-REM sleep, which is then followed by about 20 minutes of REM sleep. People with narcolepsy, however, enter REM sleep immediately. In addition, REM sleep occurs inappropriately throughout the day in patients with narcolepsy.

Demographics

There has been considerable debate in the early 2000s over the incidence of narcolepsy. Some researchers think the disorder is underdiagnosed. According to NINDS, the disorder affects one American in every 2000, or about 135,000 people in the general United States population. However, the rates in other countries vary considerably, from one in 600 people in Japan to one in 500,000 in Israel. The reasons for these variations in different ethnic groups are not yet fully understood.

Males and females seem to experience this disorder at about the same rate.

Narcolepsy is a somewhat unusual disorder in terms of age distribution. Although the disorder has been identified in children as young as three years of age, most patients with narcolepsy are diagnosed either between the ages of ten and 25 or between the ages of 40 and 45. It is uncommon for a person to develop the signs of narcolepsy for the first time after age 55.

Causes and Symptoms

Causes

In 1999 researchers identified the gene that causes narcolepsy on chromosome 12. The gene allows cells in the hypothalamus (the part of the brain that regulates sleep behavior) to receive messages from other cells. When this gene is abnormal, cells cannot communicate properly, and abnormal sleeping patterns develop. However, not everyone who has the gene develops narcolepsy; between 12 percent and 35 percent of the United States population is thought to carry the gene but only 0.02 percent develop the disorder. Narcolepsy sometimes clusters in families; first-degree relatives of a person diagnosed with the disorder have a 1 percent to 2 percent risk of developing narcolepsy themselves, or about 10 to 40 times the risk of a person in the general population.

In the late 1990s, three independent research groups discovered a neuropeptide system in the hypothalamus, the part of the brain that regulates body temperature and appetite. The newly discovered system, which has been called the hypocretinergic system, regulates sleep and wakefulness. The nerve cells, or neurons, in this part of the hypothalamus secrete substances known as hypocretins or orexins, which regulate the sleep/wake cycle in humans. There are two of these compounds, known as orexin-A and orexin-B, or as hypocretin-1 and hypocretin-2. As of the early 2000s, narcolepsy is thought to be an orexin deficiency syndrome; that is, it develops when a person's hypothalamus does not secrete enough orexins to keep the person from falling asleep at inappropriate times. Samples of cerebrospinal fluid taken from patients with narcolepsy contain little or no orexins. MRI scans of these patients indicate that there is some loss of brain tissue in the hypothalamus itself, suggesting that the neurons responsible for secreting orexins have died.

In a few cases, the first signs of narcolepsy are triggered by traumatic damage to the part of the brain that governs REM sleep or from a rapidly growing tumor that puts pressure on this region of the brain. It is also thought that the hormonal changes of puberty may affect this region of the brain in some people.

Symptoms

Narcolepsy is defined by four major symptoms:

• Excessive daytime sleepiness (EDS).
• Cataplexy, the most dramatic symptom of narcolepsy, affecting 75 percent of people with the disorder. During an attack of cataplexy, the person's knees buckle and the neck muscles go slack. In extreme cases, the person may become paralyzed and fall to the floor. This loss of muscle tone is temporary, lasting from a few seconds to half an hour, but it is frightening to other family members or friends. Attacks of cataplexy can occur at any time but are often triggered by such strong emotions as anger, joy, or surprise.
• Hypnagogic hallucinations, intense and sometimes terrifying experiences that occur as the person is falling asleep. The hallucinations may be either visual or auditory. They are thought to represent an intrusion of REM sleep/dreaming into the wakeful state.
• Sleep paralysis, a frightening inability to move shortly after awakening or dozing off.

When to Call the Doctor

The symptoms of narcolepsy in children below the age of ten are somewhat different from the classical signs of the disorder in adolescents and adults. They may include the following (in addition to cataplexy and daytime sleepiness):

• unexplained falls or dropping of objects
• night terrors
• moodiness and abrupt episodes of irritability
• restlessness and hyperactivity
• difficulty waking up in the morning

Children between the ages of ten and 12 frequently report falling asleep in school or being unable to pay attention during class. In some cases a sudden drop in the child's academic performance is the first indication of narcolepsy.

Parents who suspect that their child may have narcolepsy should consult a specialist (usually a pediatric neurologist) and have the child tested in a sleep clinic. Children with narcolepsy have often been misdiagnosed as having attention-deficit hyperactivity disorder, while adolescents have sometimes been misdiagnosed as having substance abuse or personality disorders. The sooner narcolepsy is correctly identified, the better the child's chances of maintaining normal academic and social development.

Diagnosis

Narcolepsy is a complex disorder, and it is not always easy to identify. It takes ten years on average for an individual to be correctly diagnosed. The diagnosis of younger patients is additionally complicated by the fact that children with narcolepsy rarely have all four of the classical symptoms of the disorder as described in adults. Most often, the first symptom in children is an overwhelming feeling of fatigue. After several months or years, cataplexy and the other classical symptoms of the disorder may appear.

The child's doctor will not be able to diagnose narcolepsy on the basis of a routine physical examination. If the child has experienced both excessive daytime sleepiness and cataplexy, a tentative diagnosis may be made on the basis of the patient's history. In addition, the doctor may give the child or adolescent a short self-administered list of eight questions known as the Epworth Sleepiness Scale (ESS). First published by an Australian doctor in 1991, the ESS asks the person to rate how likely they are to doze off or fall asleep in eight different situations from everyday life. A score above ten (maximum score is 24) generally indicates that the doctor should consider laboratory testing for narcolepsy.

Imaging studies are not helpful in diagnosing narcolepsy, although in some cases the doctor may order an MRI or CT scan to rule out a brain tumor or other abnormality in brain structure. Laboratory tests used to evaluate a person for narcolepsy include an overnight polysomnogram (a test in which sleep is monitored with electrocardiography, a video camera, and respiratory parameters). A multiple sleep latency test, which measures sleep latency (onset) and how quickly REM sleep occurs, may also be used. People who have narcolepsy usually fall asleep much more rapidly that people without the disorder, often in less than five minutes.

If the diagnosis is still questionable, a genetic blood test can reveal the existence of certain substances in people who have a tendency to develop narcolepsy. Positive test results suggest but do not prove that the person has narcolepsy. As of the early 2000s, the diagnosis of narcolepsy also can be confirmed by taking a sample of the patient's cerebrospinal fluid by a spinal tap and testing it for the presence of hypocretin-1. Patients with narcolepsy have no hypocretin-1 in their spinal fluid.

Treatment

There is no cure for narcolepsy. The disorder is neither progressive nor fatal, but it is chronic. The symptoms, however, can be managed with a combination of medications and lifestyle adjustments. Amphetamine-like stimulant drugs are often prescribed to control drowsiness and sleep attacks. Patients who do not like taking high doses of stimulants may choose to take smaller doses and make adjustments in their lifestyles, such as napping every couple of hours, to relieve daytime sleepiness. Antidepressants are also often effective in treating symptoms of abnormal REM sleep.

Newer nonamphetamine wake-promoting drugs are available to treat narcolepsy. These medications lack the unpleasant side effects of amphetamines, particularly jitteriness and anxiety. Modafinil (Provigil) is the most commonly prescribed of the newer psychostimulants. As of 2004, however, researchers do not know exactly how modafinil prevents the drowsiness associated with narcolepsy. Its most common side effect is headache. A study published in 2003 reported that modafinil appears to be safe for use in children.

With discovery of the gene that causes narcolepsy, researchers are hopeful that therapies can eventually be designed to relieve the symptoms of the disorder.

Alternative Treatment

The botanical remedy yohimbe (Pausinystalia yohimbe) may be useful in promoting alertness. As with any herbal preparation or medication, however, individuals should check with their healthcare professional before taking the remedy to treat narcolepsy.

Nutritional Concerns

Children with narcolepsy sometimes fall asleep while eating, but the disorder itself does not cause or lead to malnutrition. Adolescents should be advised to avoid tobacco, caffeine, and alcoholic beverages, as these substances can increase daytime sleepiness in patients with narcolepsy.

Prognosis

The symptoms of narcolepsy are more severe when they develop in children than when they emerge in adult life. Narcolepsy is not a degenerative disease, however, and patients do not develop other neurologic symptoms. In fact, older patients often report that their symptoms decrease in severity after age 60. Apart from falls or other accidents, narcolepsy does not affect a person's life expectancy. It can, however, severely interfere with a young person's ability to study, play, participate in sports and other social activities, and develop close relationships with others. The sooner it is diagnosed and treated, the better the child's outlook for a happy and productive adult life.

Prevention

There is no way to prevent narcolepsy as of the early 2000s.

Parental Concerns

Narcolepsy can affect a family in a number of ways before it is diagnosed. Younger children are at risk of injuring themselves by falling, and adolescents with driving privileges are at high risk of automobile accidents. Poor performance in school and difficulty making friends as a result of irritability or embarrassment over sleep attacks can have a lasting impact on a child's chances of preparation for college or the choice of a challenging and satisfying line of work. In many cases the child is accused of being lazy or stupid, which can have devastating effects on his or her self-esteem. Misdiagnoses can lead to inappropriate treatment and psychological depression for the affected child. In addition, sleep attacks and cataplexy can be frightening to other family members who witness them.

Narcolepsy can be particularly stressful for a family when the affected child reaches adolescence, because of peer pressure to experiment with smoking and recreational drugs, and because of resentment about restrictions on learning to drive or use of the family car. Families with a child diagnosed with narcolepsy should consider joining a support group for people affected by the disorder.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington, DC: American Psychiatric Association, 2000.

"Sleep Disorders: Narcolepsy." Section 14, Chapter 173 in The Merck Manual of Diagnosis and Therapy. Edited by Mark H. Beers, and Robert Berkow. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Periodicals

Beuckmann, C. T., and M. Yanagisawa. "Orexins: From Neuropeptides to Energy Homeostasis and Sleep/Wake Regulation." Journal of Molecular Medicine 80 (June 2002): 329–42.

Ivanenko, A., R. Tauman, and D. Gozal. "Modafinil in the Treatment of Excessive Daytime Sleepiness in Children." Sleep Medicine 4 (November 2003): 579–82.

Kotagal, S. "Sleep Disorders in Childhood." Neurologic Clinics 21 (November 2003): 961–81.

Ohayon, M. M., et al. "Prevalence of Narcolepsy Symptomatology and Diagnosis in the European General Population." Neurology 58 (June 25, 2002): 1826–33.

Silvestri, A. J., et al. "The Central Nucleus of the Amygdala and the Wake-Promoting Effects of Modafinil." Brain Research 941 (June 21, 2002): 43–52.

Organizations

American Sleep Disorders Association. 1610 14th St. NW, Suite 300, Rochester, MN 55901. Web site: www.sleepapnea.org.

Narcolepsy Network. PO Box 42460, Cincinnati, OH 45242. Web site: www.narcolepsynetwork.org.

National Center on Sleep Disorders Research. Two Rockledge Centre, 6701 Rockledge Dr., Bethesda, MD 20892. Web site: www.nhlbi.nih.gov/health/public/sleep.

National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health. 9000 Rockville Pike, Bethesda, MD 20892. Web site: .

National Sleep Foundation. 1522 K St., NW, Suite 500, Washington, DC 20005. Web site: www.sleepfoundation.org.

Stanford Center for Narcolepsy. 1201 Welch Rd-Rm P-112, Stanford, CA 94305. Web site: .

University of Illinois Center for Narcolepsy Research. 845S. Damen Ave., Chicago, IL 60612. Web site: www.uic.edu/depts./cnr/

Web Sites

Baker, Matthew J., and Selim R. Benbadis. "Narcolepsy." eMedicine, October 4, 2004. Available online at www.emedicine.com/neuro/topic522.htm (accessed January 14, 2005).

Other

National Institute of Neurological Disorders and Stroke (NINDS). Narcolepsy Fact Sheet. Bethesda, MD: NINDS, 2003.

[Article by: Michelle Lee Brandt]

For more information on narcolepsy, visit Britannica.com.

Although most people think of a narcoleptic as a person who falls asleep at inappropriate times, victims of narcolepsy also share other symptoms, including excessive daytime sleepiness, hallucinations, and cataplexy (a sudden loss of muscle strength following an emotional event). Persons with narcolepsy experience an uncontrollable desire to sleep, sometimes many times in one day. Episodes may last from a few minutes to several hours.

Cataplectic episodes, often precipitated by exercise or excitement, with partial to complete flaccid paralysis. It occurs in dogs and rarely cats and is thought to be inherited in Shetland ponies, miniature horses and Suffolk horses.

Tutor's tip: This was the final winning word in the 1976 National Spelling Bee.

For other uses, see Narcolepsy (disambiguation).

Narcolepsy
Classification and external resources
ICD-10	G47.4
ICD-9	347
OMIM	161400
DiseasesDB	8801
eMedicine	neuro/522
MeSH	D009290

Narcolepsy is a chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as whilst at work or at school. A narcoleptic will most probably experience disturbed nocturnal sleep and also abnormal daytime sleep pattern,which is often confused with insomnia. When a person with narcolepsy falls asleep or goes to bed they will generally experience the 4th stage of sleep REM (rapid eye movement/dreamings state), within 10 minutes; whereas for most people, this shouldn't occur until generally 30 minutes of slumber.

Cataplexy, a sudden muscular weakness brought on by strong emotions (in most cases, there are many people who will experience cataplexy without having a emotional trigger), is known to be one of the other problems that some narcoleptics will experience. Often manifesting as muscular weaknesses ranging from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually only speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. In some rare cases, an individual's body becomes paralyzed and muscles will become stiff.

The term narcolepsy derives from the French word narcolepsie created by the French physician Jean-Baptiste-Édouard Gélineau by combining the Greek narke numbness, stupor and lepsis attack, seizure. ^[1]

Contents 1 Symptoms 2 Causes 3 Epidemiology 4 Diagnosis 5 Treatment 6 Popular culture references 6.1 Films and television 6.2 Music 7 See also 8 References 9 Sources 10 External links

Symptoms

The main characteristic of narcolepsy is excessive daytime sleepiness (EDS), even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or fall asleep, often at inappropriate times and places. Daytime naps may occur with little warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only for a few hours. Drowsiness may persist for prolonged periods of time. In addition, night time sleep may be fragmented with frequent awakenings.

Four other classic symptoms of the disorder, often referred to as the "tetrad of narcolepsy," are cataplexy, sleep paralysis, hypnagogic hallucinations, and automatic behavior.^[2]. These symptoms may not occur in all patients. Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. In some cases, cataplexy may resemble epileptic seizures.^[3] Sleep paralysis is the temporary inability to talk or move when waking (or less often, falling asleep). It may last a few seconds to minutes. This is often frightening but is not dangerous. Hypnagogic hallucinations are vivid, often frightening, dreamlike experiences that occur while dozing, falling asleep and/or while awakening.

Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. Sleep paralysis and hypnagogic hallucinations also occur in people who do not have narcolepsy, but more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in rapid eye movement behavior disorder.

In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not.

Although these are the common symptoms of narcolepsy, many people with narcolepsy also suffer from insomnia for extended periods of time. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious problems in a person's social, personal, and professional life. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again. This sleep state, called REM sleep (rapid eye movement sleep), is when most remembered dreaming occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present (called REM atonia).

In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep — lack of muscular control, sleep paralysis, and vivid dreams — occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up. Simply put, the brain does not pass through the normal stages of dozing and deep sleep but goes directly into (and out of) rapid eye movement (REM) sleep.

This has several consequences. Night time sleep does not include as much deep sleep, so the brain tries to "catch up" during the day, hence EDS. People with narcolepsy may visibly fall asleep at unpredicted moments (such motions as head bobbing are common). People with narcolepsy fall quickly into what appears to be very deep sleep, and they wake up suddenly and can be disoriented when they do (dizziness is a common occurrence). They have very vivid dreams, which they often remember in great detail. People with narcolepsy may dream even when they only fall asleep for a few seconds.

Causes

Although the cause of narcolepsy was not determined for many years after its discovery, scientists had discovered conditions that seemed to be associated with an increase in an individual's risk of having the disorder. Specifically, there appeared to be a strong link between narcoleptic individuals and certain genetic conditions. One factor that seemed to predispose an individual to narcolepsy involved an area of Chromosome 6 known as the HLA complex.^[4] There appeared to be a correlation between narcoleptic individuals and certain variations in HLA genes, although it was not required for the condition to occur. Certain variations in the HLA complex were thought to increase the risk of an auto-immune response to protein-producing neurons in the brain. The protein produced, called hypocretin or orexin, is responsible for controlling appetite and sleep patterns. Individuals with narcolepsy often have reduced numbers of these protein-producing neurons in their brains. In 2009 the autoimmune hypothesis was supported by research carried out at Stanford University School of Medicine.^[5][6]

The neural control of normal sleep states and the relationship to narcolepsy are only partially understood. In humans, narcoleptic sleep is characterized by a tendency to go abruptly from a waking state to REM sleep with little or no intervening non-REM sleep. The changes in the motor and proprioceptive systems during REM sleep have been studied in both human and animal models. During normal REM sleep, spinal and brainstem alpha motor neuron depolarization produces almost complete atonia of skeletal muscles via an inhibitory descending reticulospinal pathway. Acetylcholine may be one of the neurotransmitters involved in this pathway. In narcolepsy, the reflex inhibition of the motor system seen in cataplexy is believed identical to that seen in normal REM sleep.^{[citation needed]}

In 2004 researchers in Australia induced narcolepsy-like symptoms in mice by injecting them with antibodies from narcoleptic humans. The research has been published in the Lancet providing strong evidence suggesting that some cases of narcolepsy might be caused by autoimmune disease.^[7] Narcolepsy is strongly associated with HLA DQB1*0602 genotype.^[8] There is also an association with HLA DR2 and HLA DQ1. This may represent linkage disequilibrium. Despite the experimental evidence in human narcolepsy that there may be an inherited basis for at least some forms of narcolepsy, the mode of inheritance remains unknown. Some cases are associated with genetic diseases such as Niemann-Pick disease^[9] or Prader-Willi syndrome.^[10]

Epidemiology

It is estimated that as many as 3 million people worldwide are affected by narcolepsy. In the United States, it is estimated that this condition afflicts as many as 200,000 Americans, ^[11] but fewer than 50,000 are diagnosed. It is as widespread as Parkinson's disease or multiple sclerosis and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medications. It can also be mistaken for poor sleeping habits, recreational drug use, or laziness. Narcolepsy can occur in both men and women at any age, although its symptoms are usually first noticed in teenagers or young adults. There is strong evidence that narcolepsy may run in families; 8 to 12 percent of people with narcolepsy have a close relative with this neurologic disorder.

Narcolepsy has its typical onset in adolescence and young adulthood. There is an average 15-year delay between onset and correct diagnosis which may contribute substantially to the disabling features of the disorder. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of narcolepsy have been documented. For these to occur in the crucial teen years when education, development of self-image, and development of occupational choice are taking place is especially damaging. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence.

The prevalence of narcolepsy is about 1 per 2,000 persons.^[12] It is a reason for patient visits to sleep disorder centers, and with its onset in adolescence, it is also a major cause of learning difficulty and absenteeism from school. Normal teenagers often already experience excessive daytime sleepiness because of a maturational increase in physiological sleep tendency accentuated by multiple educational and social pressures; this may be disabling with the addition of narcolepsy symptoms in susceptible teenagers. In clinical practice, the differentiation between narcolepsy and other conditions characterized by excessive somnolence may be difficult. Treatment options are currently limited. There is a paucity in the literature of controlled double-blind studies of possible effective drugs or other forms of therapy. Mechanisms of action of some of the few available therapeutic agents have been explored but detailed studies of mechanisms of action are needed before new classes of therapeutic agents can be developed. Narcolepsy is an underdiagnosed condition in the general population. This is partly because its severity varies from obvious to barely noticeable. Some people with narcolepsy do not suffer from loss of muscle control. Others may only feel sleepy in the evenings.

Diagnosis

Diagnosis is relatively easy when all the symptoms of narcolepsy are present, but if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. It is also possible for cataplexy to occur in isolation. Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test (MSLT). These tests are usually performed by a sleep specialist. The polysomnogram involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders that could cause daytime sleepiness.

For the multiple sleep latency test, a person is given a chance to sleep every 2 hours during normal wake times. Observations are made of the time taken to reach various stages of sleep (sleep onset latency). This test measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep early.

Treatment

Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are also frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important.

The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants such as methylphenidate, racemic - amphetamine, dextroamphetamine, and methamphetamine, or modafinil, a new stimulant with a different pharmacologic mechanism. In Fall 2007 an alert for severe adverse skin reactions to modafinil was issued by the FDA. ^[13] Other medications used are codeine^[14] and selegiline. Another drug that is used is atomoxetine^[15] (Strattera), a non-stimulant and Norepinephrine reuptake inhibitor (NRI), that has little or no abuse potential.^[16] In many cases, planned regular short naps can reduce the need for pharmacological treatment of the EDS to a low or non-existent level.

Cataplexy and other REM-sleep symptoms are frequently treated with tricyclic antidepressants such as clomipramine, imipramine, or protriptyline, as well as other drugs that suppress REM sleep. Venlafaxine, a newer antidepressant which blocks the reuptake of serotonin and norepinephrine, has shown usefulness in managing symptoms of cataplexy^{[citation needed]}. Gamma-hydroxybutyrate (GHB), a medication recently approved by the FDA, is the only medication specifically indicated for cataplexy. Gamma-hydroxybutyrate has also been shown to reduce symptoms of EDS associated with narcolepsy. While the exact mechanism of action is unknown, GHB is thought to improve the quality of nocturnal sleep.

In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep. Ongoing communication between the health care provider, patient, and the patient's family members is important for optimal management of narcolepsy. Finally, a recent study reported that transplantation of hypocretin neurons into the pontine reticular formation in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions.^[17]

This article is missing citations or needs footnotes. Please help add inline citations to guard against copyright violations and factual inaccuracies. (October 2008)

Learning as much about narcolepsy as possible and developing a support system or finding a support group may help patients and families deal with the practical and emotional effects of the disorder, possible occupational limitations, and situations that might cause injury. Individuals with narcolepsy should avoid jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods. They may find it helps to take a nap before driving if possible or have a scheduled nap break during a long driving trip.

The National Sleep Foundation, University at Buffalo, and Mayo Clinic suggest it may help sufferers if they alert their employers, co-workers and friends in the hope that others will accommodate their condition and help when needed. The foundation say it may help if the sufferer breaks up larger tasks into small pieces and focuses on one small thing at a time, and if they carry a tape recorder, if possible, to record important conversations and meetings. The clinics say taking several short walks during the day may help sufferers.

Popular culture references

It has been suggested that this section be split into a new article. (Discuss)

Depictions of the disorder in fiction and pop culture can range greatly in the accuracy of how they depict the symptoms. Narcolepsy is often depicted in an exaggerated fashion in comedy films or TV shows. In his book How to Talk Dirty and Influence People, comedian Lenny Bruce claimed to have struggled with the condition. In Thomas E Sniegoski's "The Sleeper Conspiracy" book series, a teen named Tom Lovett has narcolepsy. In the alien-invasion-themed video game Destroy All Humans!, the scientist Sleepy Ernst has narcolepsy. "The Little Sleep", a detective novel by Paul Tremblay, was released Spring of 2009. The main charater, Mark G. has narcolepsy. In relating Mark's thoughts and experiences the author captures many esoteric nuances of the experience of narcolepsy. As narcolepsy is an “invisible” disease, most people don’t really understand how pervasive the symptoms are-how the symptoms alter your perception of events, time and may at times blur the boundaries between what is experienced when awake, and what was experienced in sleep. The character deals with daily, even hourly frustrations due to the general cognitive fog, not being able to trust his own memory and even not being able to drive. Many of these situtions are presented as humorous, but you are always laughing with Mark not at him. Mark shares the frustration felt by many with narcolepsy, that his disease isn’t taken seriously and that he is “the punch line in a joke”. A sequel to this book is planned for release next year.

Films and television

The French movie Narco portrays the disease.

The character 'Muki' in Nimród Antal's surrealistic film about Budapest Metro's Ticket Control Agents, Kontroll suffers from narcolepsy.

The lead character in Gus Van Sant's film about young gay hustlers, My Own Private Idaho, played by River Phoenix, has narcolepsy. A dictionary definition of the condition is presented in the opening sequence. The acceptance and support he receives through these episodes by Keanu Reeves' character illustrates their humanity and counterpoints their dehumanizing work.

In the movie Rat Race, one of the main characters (Enrico Pollini, played by Rowan Atkinson) has narcolepsy and is very eccentric. This portrayal has been criticized for its inaccuracy and insensitivity to the disorder.

In the movie Moulin Rouge!, the Argentine has narcolepsy and falls through Christian's roof. This is how he is introduced to the Bohemians that will later take him to the Moulin Rouge.

In the movie Death Race 2000, the navigator Joe Seasly was later diagnosed with narcolepsy at age 29

In the movie Deuce Bigalow: Male Gigolo, a woman with narcolepsy was shown as the cause of several slap-stick accidents.

In the animated children's film Shrek the Third, Sleeping Beauty has narcolepsy, hence her name.

In the episode "Best Man for the GOB" of the quirky comedy Arrested Development, George Sr. hires a narcoleptic stripper in order to convince his accountant Ira Gilligan that he has killed the stripper in order to get him to leave town. A recurring guest character on the HBO crime drama The Sopranos was Aaron Arkaway, a devout fundamentalist Christian who has narcolepsy. He was dating Janice Soprano, who explained to her bemused family (when Aaron fell asleep at the dinner table) that "narcolepsy is an AMA-recognized dyssomnia."

In Ruby Gloom, Misery's cousin Malaise from the episode "Misery Loves Company" suffers from narcolepsy, causing her to fall asleep in the most untimely situations throughout the episode. In the novel Swindle, Character Ben admits to having Narcolepsy.

In the film Austin Powers: International Man of Mystery, Dr. Evil describes his father as having "low grade narcolepsy and a penchant for buggery".

In the animated series Galactic Football gatekeeper Ahito has narcolepsy - he often falls asleep in the field during matches.

In the American sitcom Frasier, Frasier Crane's brother Niles develops narcolepsy brought about by the stress of speaking to his ex-wife Maris's lawyers.

Cesare, the main character from The Cabinet of Doctor Caligari, a sonambulist, suffers from Narcolepsy, as told by Dr. Caligari in one dialogue in the movie.

In one episode of the American series Scrubs, J.D., Turk, Carla, Elliot, and Laverne go to "laugh at the narcoleptic guy", who passes out upon becoming sexually aroused. This most likely isn't a legitimate portrayal of the disorder.

Music

In the song "Girls, Girls, Girls", Jay-Z mentions "Mami's a narcolyptic, always sleepin on Hov".

Singer and pianist Ben Folds wrote and performed a song called "Narcolepsy". The song was a metaphor for people's tendency to be emotionally numb during large life events. ^[18]

The band Placebo wrote a song called "Narcoleptic", on their album Black Market Music.

The band R.E.M., named for Rapid Eye Movement, has many lyrics about sleep, including "I don't sleep, I dream" and "Call me when you want to wake her up."

The band Third Eye Blind wrote a song called "Narcolepsy", describing the narcoleptic narrator's uncontrollable nightmares and sleep paralysis.

The Westchester punk band Plow United's third and final full length album was entitled Narcolepsy. The name of Australian band The Sleepy Jackson was inspired by a former drummer who has narcolepsy.

In the group, The Wiggles, the character Jeff possibly has narcolepsy as he sleeps far too much causing the others to constantly use the phrase, "Wake up, Jeff!"

The band 7 Car Pile-Up has a song called Narcoleptic Mime.

Canadian musician Dan Mangan has a song called Journal Of A Narcoleptic.

See also

• Cataplexy
• Dyssomnia
• Orexin
• Microsleep
• List of people with narcolepsy
• Sleep medicine

References

1. ^ Entry Narcolepsy. in the Online Etymology Dictionary. Douglas Harper, Historian. 18 Sep 2007.
2. ^ "tetrad of narcolepsy". lifehugger. http://mc.lifehugger.com/moc/608/tetrad-narcolepsy. Retrieved on 2009-05-09. 
3. ^ http://www.taumed.com/content/adam/browse.jsp?pid=10&cid=000098
4. ^ Klein J, Sato A (September 2000). "The HLA system. Second of two parts". N. Engl. J. Med. 343 (11): 782–6. PMID 10984567. 
5. ^ Hallmayer J, Faraco J, Lin L, et al. (June 2009). "Narcolepsy is strongly associated with the T-cell receptor alpha locus". Nat. Genet. 41 (6): 708–11. doi:10.1038/ng.372. PMID 19412176. 
6. ^ "Narcolepsy is an autoimmune disorder, Stanford researcher says". EurekAlert. American Association for the Advancement of Science. 2009-05-03. http://www.eurekalert.org/pub_releases/2009-05/sumc-nia042809.php. Retrieved on 2009-05-31. 
7. ^ "BBC News article". http://news.bbc.co.uk/1/hi/health/4081225.stm. 
8. ^ Maret, S; Tafti M (November 2005). "Genetics of narcolepsy and other major sleep disorders" (PDF). Swiss Medical Weekly (EMH Swiss Medical Publishers Ltd.) 135 (45-46): 662–665. PMID 16453205. http://www.smw.ch/docs/pdf200x/2005/45/smw-11162.pdf. Retrieved on 2008-03-07. 
9. ^ "Sleep disturbances and hypocretin deficiency in Niemann-Pick disease type C". http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12841368&query_hl=3&itool=pubmed_docsum. 
10. ^ "Hypersomnia in the Prader Willi syndrome". http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11336895&query_hl=1&itool=pubmed_docsum. 
11. ^ "Who Is At Risk for Narcolepsy?". http://www.nhlbi.nih.gov/health/dci/Diseases/nar/nar_who.html. 
12. ^ "Who Is At Risk for Narcolepsy?". http://www.nhlbi.nih.gov/health/dci/Diseases/nar/nar_who.html. 
13. ^ Modafinil (marketed as Provigil): Serious Skin Reactions; FDA Drug Safety Newsletter
14. ^ "Codeine treatment". http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?md=search&db=pubmed&term=codeine+narcolepsy. 
15. ^ "Stanford Center for Narcolepsy article". http://med.stanford.edu/school/Psychiatry/narcolepsy/medications.html. 
16. ^ "Curtin University of Technology Article" (PDF). http://adhdproject.curtin.edu.au/forms/STRATTERA%20PI%20(marketed%20products).pdf. 
17. ^ Arias-Carrión O, Murillo-Rodriguez E, Xu M et al. (2004). "Transplantation of hypocretin neurons into the pontine reticular formation: preliminary results". Sleep 27 (8): 1465–1470. PMID : 15683135. 
18. ^ Ben Folds Song Explanations http://www.benfoldsfive.com/thesongs.html

Sources

• Mitler, M M (June 1991). "Relative Efficacy of Drugs for the treatment of Sleepiness in Narcolepsy". Sleep 14 (3): 218. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1680245&query_hl=4&itool=pubmed_docsum. 
• Mayer, G (August 1995). "Selegiline Treatment in Narcolepsy". Clinical Neuropharmacology 18 (4): 306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8665543&query_hl=5&itool=pubmed_docsum. 
• Chabas, D (October 2003). "The Genetics of Narcolepsy". Annual Review of Genomics & Human Genetics 4: 459. doi:10.1146/annurev.genom.4.070802.110432. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14527309&query_hl=1&itool=pubmed_DocSum. 
• Smith, et al., A J (June 2004). "A functional autoantibody in narcolepsy". Lancet 364: 2122 – 2124. doi:10.1016/S0140-6736(04)17553-3. 

External links

• Stanford University: Center for Narcolepsy
• Narcolepsy Network Organization
• Narcolepsy Fact Sheet: National Institute of Neurological Disorders and Stroke
• http://www.narcolepsy.org.uk/index_html
• Read about Narcolepsy in the Sleeptionary
• What is Narcolepsy
• Narcolepsy: Symptoms, Causes, Diagnosis and Treatment
• Narcolepsy & Cataplexy videos and case study
• Transplantation of hypocretin neurons into the pontine reticular formation: preliminary results
• Living With Narcolepsy
• Narcolepsy Linked to Immune System Problem
• Video explaining that narcolepsy is an autoimmune disorder.

v • d • e Pathology of the nervous system, primarily CNS (G00–G47, 320–349) Brain/ encephalopathy Inflammatory Encephalitis (Viral encephalitis, Herpesviral encephalitis) · Cavernous sinus thrombosis · Brain abscess (Amoebic) Degenerative Extrapyramidal and movement disorders Basal ganglia disease: Parkinsonism (Parkinson's disease, Postencephalitic parkinsonism)  · Neuroleptic malignant syndrome  · Pantothenate kinase-associated neurodegeneration · Progressive supranuclear palsy · Striatonigral degeneration · Hemiballismus · Huntington's disease · Olivopontocerebellar atrophy Dyskinesia: Dystonia (Spasmodic torticollis, Meige's, Blepharospasm) · Chorea (Choreoathetosis)  · Myoclonus (Myoclonic epilepsy) Essential tremor  · Restless legs  · Stiff person Dementia Alzheimer's (Early-onset)  · Frontotemporal dementia/Frontotemporal lobar degeneration (Pick's, Dementia with Lewy bodies) · Multi-infarct dementia Mitochondrial disease Leigh's Demyelinating autoimmune (Multiple sclerosis, Neuromyelitis optica, Schilder's disease) · hereditary (Adrenoleukodystrophy, Alexander, Canavan, Krabbe, ML, Pelizaeus-Merzbacher, VWM, MFC, CAMFAK syndrome) · Central pontine myelinolysis · Marchiafava-Bignami disease  · Alpers' Episodic/ paroxysmal Seizure/epilepsy Focal  · Generalised  · Status epilepticus  · Myoclonic epilepsy Headache Migraine (Familial hemiplegic)  · Cluster  · Vascular  · Tension Vascular Transient ischemic attack (Amaurosis fugax, Transient global amnesia) Cerebrovascular disease  · Stroke (MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke) Sleep disorders Insomnia  · Hypersomnia  · Sleep apnea (Obstructive, Ondine's curse)  · Narcolepsy  · Cataplexy  · Kleine-Levin  · Circadian rhythm sleep  · Delayed sleep phase  · Advanced sleep phase CSF Intracranial hypertension (Hydrocephalus/Normal pressure, Idiopathic intracranial hypertension) · Cerebral edema · Intracranial hypotension Other Brain herniation · Reye's  · Hepatic encephalopathy  · Toxic encephalopathy Spinal cord/ myelopathy Inflammatory Myelitis: Poliomyelitis · Demyelinating disease (Transverse myelitis) · Tropical spastic paraparesis Other Syringomyelia · Syringobulbia · Morvan's syndrome · Vascular myelopathy (Foix-Alajouanine syndrome) · Spinal cord compression Both/either Inflammatory Encephalomyelitis (Acute disseminated) Meningitis/Arachnoiditis: Bacterial (Tuberculous, Haemophilus, Pneumococcal) · Viral (Herpesviral) · Fungal (Cryptococcal) · Aseptic (Drug-induced) Meningoencephalitis Systemic atrophies SA Friedreich's ataxia · Ataxia telangiectasia MND UMN only: PLS · PP · HSP LMN only: PMA · PBP (Fazio-Londe, Infantile progressive bulbar palsy) · SMA (SMN-linked, Kennedy disease, SMAX2, DSMA1) both: ALS see also congenital, tumors

v • d • e Sleep Sleep stages Rapid eye movement sleep · Non-rapid eye movement sleep · Slow-wave sleep Brain waves Alpha wave · Beta wave · Gamma wave · Delta wave · Theta rhythm · K-complex Sleep disorders Advanced sleep phase syndrome · Automatic behavior · Circadian rhythm sleep disorder · Delayed sleep phase syndrome · Dyssomnia · Hypersomnia · Insomnia · Narcolepsy · Night eating syndrome · Night terror · Nocturia · Nocturnal myoclonus · Non-24-hour sleep-wake syndrome · Obesity hypoventilation syndrome · Ondine's curse · Parasomnia · Sleep apnea · Sleep deprivation · Sleeping sickness · Sleepwalking · Somniloquy Benign phenomena Dream · Exploding head syndrome · False awakening · Hypnagogia · Hypnic jerk · Lucid dream · Nightmare · Nocturnal emission · Sleep paralysis · Somnolence Related topics Bed (Bunk bed, Four poster bed, Futon, Hammock, Mattress) · Bed bug · Bedding · Bedroom · Bedtime · Bedtime toy · Bedtime story · Caffeine nap · Chronotype · Dream journal · Jet lag · Lullaby · Nap · Nightwear · Polyphasic sleep · Polysomnography · Power nap · Siesta · Sleep and creativity · Sleep and learning · Sleep debt · Sleep diary · Sleep inertia · Sleep medicine · Sleeping while on duty · Sleepover · Snoring · Excessive daytime sleepiness

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Dansk (Danish)
n. - narkolepsi

Nederlands (Dutch)
narcolepsie (slaapziekte)

Français (French)
n. - narcolepsie

Deutsch (German)
n. - Narkolepsie (völlige Muskelerschlaffung)

Ελληνική (Greek)
n. - (ιατρ.) ναρκοληψία

Italiano (Italian)
narcolessia

Português (Portuguese)
n. - narcolepsia (f) (Med.)

Русский (Russian)
нарколепсия

Español (Spanish)
n. - narcolepsia

Svenska (Swedish)
n. - narkolepsi (med.)

中文（简体）(Chinese (Simplified))
嗜眠发作

中文（繁體）(Chinese (Traditional))
n. - 嗜眠發作

한국어 (Korean)
n. - (간질병의)발작

日本語 (Japanese)
n. - 睡眠発作

العربيه (Arabic)
‏(الاسم) الخدار : حاله مرضيه تتميز بنوبات نوم عميق قصيرة‏

עברית (Hebrew)
n. - ‮רדמת (מחלה)‬

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