Lifestyle Choices

Do you ever collapse after hearing a funny joke, or after becoming very angry? Do you have any relatives who are always sleepy? If you answer yes to these questions, you might have narcolepsy. Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations (explained below). Narcolepsy is thought to be an attack of REM sleep during the day.

A person with narcolepsy will have recurring episodes of naps, or lapses into sleep. The narcoleptic will sleep for fifteen to twenty minutes and awaken refreshed, but within the next two to three hours will begin to feel sleepy again. This pattern repeats itself throughout the day. Sudden sleep attacks can occur in situations when it is quite inappropriate to sleep, such as while eating, conversing or driving.”

A primary symptom of narcolepsy is cataplexy, a momentary loss in muscle tonus provoked by strong emotion, such as surprise, laughter, anger or elation. The patient may experience “a mild sensation of weakness with head droop, facial sagging, jaw drop, slurred speech and buckling of the knees to complete postural collapse, with a fall to the ground. The duration is short, ranging from a few seconds to several minutes, and recovery is immediate and complete.”‘

Someone who has narcolepsy may collapse into REM sleep after hearing a joke, or after hitting a good golf shot. REM sleep, lasting from several seconds to thirty minutes or more, sometimes follows a cataplectic attack.’

The narcoleptic often experiences sleep paralysis, an inability to move or speak during the transition between sleep and wakefulness. This is limited in duration to a minute or so, but can be frightening, especially when accompanied by a sensation of inability to breathe, and by hypnagogic hallucinations, which are vivid perceptual experiences at sleep onset.

Patients hallucinate the presence of someone or something, and feel fear or dread. “Hallucinatory experiences, including being caught in a fire, drowning in a bathtub, being attacked or flying through the air, are frequently reported.

The patient described above was evaluated by an all-night sleep recording and a daytime nap study. Like most narcoleptic patients, she had sleep-onset REM periods, going directly from wakefulness into REM sleep without prior slow-wave sleep. She was diagnosed with narcolepsy and was instructed not to drive because of her pathological level of daytime sleepiness until her sleepiness was brought under control.

Narcolepsy usually begins in late childhood or adolescence. Excessive daytime sleepiness is almost always the first symptom to appear.’ Patients have difficulty in school, or at work, because they are constantly falling asleep. Not surprisingly, narcolepsy impairs social activity and often leads to marital disharmony. About one in 2,000 people suffer from narcolepsy — about the same incidence as that of multiple sclerosis.” Yet 80 per cent of those with narcolepsy are undiagnosed. Narcolepsy is a genetically linked disorder. People with a relative who has narcolepsy have a sixty times higher risk for the disorder. If one parent has narcolepsy, the chances are one in 20 that a child will have the disorder.

The symptoms of narcolepsy can be lessened by taking a ten- to twenty-minute nap every two hours throughout the day, by avoiding alcohol and sleeping pills, and by getting adequate sleep on a consistent basis. Though taking frequent naps is not an ideal solution, it’s better than running the high risk of a spontaneous sleep attack. Narcolepsy is typically treated by using appropriate medication: tricyclic antidepressants for reducing cataplexy, and stimulants to counter the daytime sleepiness. Cataplexy, sleep paralysis and hypnagogic hallucinations are likely to decrease over time, but excessive daytime sleepiness is usually a lifelong problem. But with proper medical attention narcolepsy can be managed so that the patient is able to lead a satisfactory life.

Restless Legs Syndrome

Do your legs ache, tingle or itch just before you fall asleep? Does your bed partner complain of being kicked during the night? If so, you need to consult your doctor. Restless legs syndrome is a sleep disorder “characterized by disagreeable leg sensations, usually prior to sleep onset, that cause an almost irresistible urge to move the legs.”‘ The sensations may be pain, discomfort, itching, pulling, tingling or prickling. If the patient moves his legs, there is partial or complete relief of the sensation, but the symptoms return upon cessation of the leg movements. Having restless legs syndrome often leads to periodic involuntary limb movements both during sleep and during the day.” It is often accompanied by intense anxiety or depression.

Between 5 and 15 per cent of the population suffer from restless legs syndrome.’ The peak onset period is usually middle age, and it may be seen for the first time in advanced old age. It is more common in females. Pregnant women, people who suffer from rheumatoid arthritis and people who are anaemic are at higher risk.

Restless legs syndrome is usually treated with prescribed medication, such as Sinemet or Parlodel, and relaxation therapy.”

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