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Narcolepsy Medication
Narcolepsy afflicts both women and men young and old alike. Narcolepsy symptoms commonly appear during your teenage years, or early twenties, but cases can appear in young children as well as in adults later in life. One specific characteristic of this sleep disorder it that it may well be a number of years after the onset of the disease (generally about 15 years) before it is diagnosed. It is also one of the most frequently under-diagnosed sleep disorders today. Thus, although about 50,000 sufferers in north America are diagnosed with narcolepsy, it is estimated that the true number of sufferers is closer to 250,000. Today there is no remedy for narcolepsy, which is a chronic and life-long condition. Nevertheless, it is possible to treat the symptoms with a mixture of narcolepsy medication and behavioral therapy. Two common symptoms of narcolepsy are: - Excessive Daytime Sleepiness (EDS).
- An abnormal pattern of rapid eye movement (REM) sleep.
In cases of narcolepsy both the order and length of your sleep cycles are altered, with REM sleep appearing soon after falling asleep, instead of following a period of deep sleep. In particular three particular characteristics of REM sleep appear as symptoms of narcolepsy:
- Sleep paralysis. An estimated half of all narcolepsy sufferers suffer from sleep paralysis in which they have a brief loss of muscle control as they drift into, or out of, sleep. In this still semi-consious state between being awake and asleep you retain a general awareness of your surroundings, but you're not able to speak or to move.
Sleep paralysis can be seen together with hypnagogic hallucinations and, for a few sufferers, the resulting feelings of terror may appear overwhelming.
- Hallucinations. About 50% of all narcolepsy sufferers will experience vivid dream-like images, known as hypnagogic hallucinations, as they drift into sleep. Commonly these images are quite frightening, especially as you are still partially conscious in this stage between wakefulness and sleep, but are unable to control these images.
The nature of the images seen Commonly gives rise to several feelings including fear, anxiety and absolute dread and it is common for these episodes to make you believe that you are suffering from some type of mental illness.
- Cataplexy. Encountered in nearly two out of three cases of narcolepsy, cataplexy may appear alongside excessive daytime sleepiness, or might not come out until a few years after the onset of the condition.
Cataplexy is a temporary loss of muscle control that can range from comparatively minor symptoms, like weakness at the knees, to a complete collapse causing you to fall to the ground. Episodes can last from just a few seconds to many minutes and might happen infrequently or several times each day. You stay conscious throughout these episodes, although normally you are unable to speak.
Cataplexy attacks are commonly triggered by events connected to strong emotions such as surprise, laughing or anger.
Narcolepsy medication.Two separate types of narcolepsy medication are usually used - the first to keep down daytime sleepiness and the other to lower the effects of sleep paralysis, cataplexy and hallucinations.
Stimulants. Stimulants are often prescribed to counteract daytime sleepiness. The number of drugs used is far too long to list them all here, however perhaps the two most commonly prescribed are Ritalin (Methylphenidate) and Provigil (Modafinil).
- Ritalin. Ritalin is one of various central nervous system stimulants frequently used to treat narcolepsy but unfortunately, along with other drugs in its class, Ritalin also raises activity in other parts of the nervous system, typically producing undesirable side effects. These include nervousness, irritability, headache, gastrointestinal problems and further disturbed nighttime sleep.
Additionally, drugs of this type can loose their effectiveness if they are used for long periods of time.
- Provigil. Provigil is a comparatively new drug which is quickly replacing Ritalin, as well as other central nervous system stimulants, as the drug of choice for the treatment of daytime sleepiness in narcolepsy.
Unlike other drugs, Provigil does not interfere with the hormones connected to sleep and thus does not result in disturbed nighttime sleep. It also causes far less anxiety and nervousness than many other options and has fewer side-effects in general. The central side-effects are nausea and headache, but these tend to be short-lived.
There are five main categories of anti-cataplectic medication commonly in use today.
- Selective Serotonin Reuptake Inhibitors (SSRIs). These are again designed to slow down the central nervous system and include such drugs as Prozac (Fluoxetine). SSRIs display fewer side-effects than tricyclic antidepressants.
- Gamma hydroxybutyrate (GHB). This particular drug, commonly referred to as Xyrem (Sodium oxybate), has been in use in Europe for some time now, but has only recently gained FDA approval for use in the United States (July 2002). Side effects, which tend to be mild, include nausea, headache, dizziness, urine leakage, and sleepwalking.
- Monoamine Oxidase Inhibitors (MAOIs). These drugs, which include Eldepryl (Selegiline), block monoamine oxidase B, an enzyme that degrades dopamine and is believed to play a role in narcolepsy. There can be some serious side-effects associated with these drugs, especially if used in conjunction with other antidepressant drugs. Further complications can arise from the interaction with certain foods.
- New Antidepressants. Two relatively new antidepressants are also being prescribed for cases of narcolepsy. The first, Edronax (Reboxetine) is known as a selective noradrenaline reuptake inhibitor (NARI) which is a unique form of antidepressant showing encouraging results in early use. The second, Effexor (Venlafaxine), is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) that has again shown promising results in early use.
- Tricyclic Antidepressants. These are used to slow down the central nervous system and include such drugs as Tofranil (Imipramine) and Anafranil (Clomipramine). There are a range of side effects associated with this class of drugs, some of which can be extremely serious, and care should be exercised if using this form of medication.
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