articles on narcolepsy
Narcolepsy Medication
Narcolepsy is a relatively common sleep disorder that affects both women and men regardless of age. The symptoms of narcolepsy typically appear in your teenage years, or in your early twenties, however cases can develop in young children as well as adults later in life. A specific characteristic of this condition it that it might well be some years after the onset of the disease (typically about fifteen years) before it is diagnosed. It is also one of today's most frequently under-diagnosed sleep disorders. For instance, although about 50,000 sufferers in the USA are diagnosed as having narcolepsy, it is thought that the true number of sufferers is nearer to 250,000. Right now there is no remedy for narcolepsy, which is a chronic and life-long condition. Despite this fact, doctors can treat the symptoms with a combination of behavioral therapy and narcolepsy medication. The two most common symptoms of narcolepsy are: - Excessive Daytime Sleepiness (EDS).
- An abnormal pattern of rapid eye movement (REM) sleep.
In narcolepsy both the order and length of your sleep cycles are changed, with REM sleep appearing soon after falling asleep, instead of following a period of deep sleep. Three specific characteristics of REM sleep are seen as symptoms of narcolepsy:
- Hallucinations. Around half of all narcolepsy sufferers have vivid dream-like images, referred to as hypnagogic hallucinations, as they drift into sleep. Often these images can be quite frightening, especially so because you are still semi-consious in this stage between being awake and asleep, but are unable to control these images.
The nature of the images seen usually gives rise to several feelings including absolute dread, fear and anxiety and it is usual for these episodes to lead you to think that you are suffering from some type of mental illness.
- Sleep paralysis. Roughly half of all narcolepsy sufferers suffer from sleep paralysis in which they have a temporary 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, however you're not able to move or to speak.
Sleep paralysis can appear at the same time as hypnagogic hallucinations and, for some sufferers, the resultant feelings of terror can be overwhelming.
- Cataplexy. Seen in almost two out of three cases of narcolepsy, cataplexy can appear alongside excessive daytime sleepiness, or may not appear until several years after the onset of the disease.
Cataplexy is a temporary loss of muscle control that can range from relatively minor symptoms, like weakness at the knees, to a total collapse with you falling to the ground. Attacks can last from only a few seconds to several minutes and might occur infrequently or several times every day. You stay conscious throughout these attacks, however ordinarily you are unable to speak.
Cataplexy episodes are usually activated by events connected to strong emotions such as laughing, surprise or anger.
Narcolepsy medication.Two separate forms of narcolepsy medication are normally used - the first to cut down daytime sleepiness and the second to counteract the effects of hallucinations, cataplexy and sleep paralysis.
Stimulants. Stimulants are commonly prescribed to reduce daytime sleepiness. The number of possible drugs 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 a number of central nervous system stimulants often used in treating narcolepsy but unfortunately, in common with other drugs in its class, Ritalin also increases activity in other parts of the nervous system, usually bringing on undesirable side effects. These include irritability, headache, nervousness, gastrointestinal problems and further disturbed nighttime sleep.
In addition, drugs of this nature can loose their effectiveness if they are used for long periods of time.
- Provigil. Provigil is a reasonably new drug which is rapidly replacing Ritalin, and other central nervous system stimulants, as the drug of choice for the treatment of daytime sleepiness in narcolepsy sleep disorder.
Different to other drugs, Provigil doesn't interfere with the hormones connected to sleep and thus doesn't cause disturbed nighttime sleep. It also causes far less anxiety and nervousness than many other options and has fewer side-effects in general. The primary side-effects are nausea and headache, but these are usually short-lived.
There are five main categories of anti-cataplectic medication commonly in use today.
- 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.
- 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.
- 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.
- 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.
- 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.
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