narcolepsy cataplexy syndrome
Narcolepsy Medication
Narcolepsy is seen in both women and men of all ages. The initial signs of narcolepsy commonly appear during your teenage years, or early twenties, however cases can appear in children as well as in adults in later life. A particular characteristic of this sleep disorder it that it is often some years after the onset of the disease (typically about fifteen years) before it is diagnosed. It is also one of the most frequently under-diagnosed sleep disorders today. For instance, although about 50,000 sufferers in the United States are diagnosed with narcolepsy, it is approximated that the true number of sufferers is nearer to 250,000. Right now there is no cure for narcolepsy, which is a chronic and life-long condition. In spite of this fact, doctors can treat the symptoms with a combination of behavioral therapy and narcolepsy medication. There are two main symptoms of narcolepsy: - Excessive Daytime Sleepiness (EDS).
- An abnormal pattern of rapid eye movement (REM) sleep.
In narcolepsy both the length and order of the sleep cycles are changed, with REM sleep appearing soon after falling asleep, as opposed to following a period of deep sleep. Three specific characteristics of REM sleep appear as symptoms of narcolepsy:
- Sleep paralysis. Nearly half of all narcolepsy sufferers experience sleep paralysis in which there is a brief loss of muscle control as they drift into, or out of, sleep. In this still semi-consious state between wakefulness and sleep you keep a general awareness of your surroundings, however you're not able to move or to speak.
Sleep paralysis can appear alongside hypnagogic hallucinations and, for a few sufferers, the resultant feelings of terror can be overwhelming.
- Cataplexy. Found in approximately 2 out of 3 cases of narcolepsy, cataplexy might appear to coincide with excessive daytime sleepiness, or may not come along until a number of years after the onset of the disease.
Cataplexy is a impermanent loss of muscle control that can range from quite minor symptoms, like weakness at the knees, to a total collapse with you falling to the ground. Attacks can last from merely a matter of seconds to several minutes and could take place infrequently or many times every day. You remain conscious throughout these attacks, but normally you are unable to speak.
Cataplexy attacks are commonly sparked off by events associated with strong emotions such as laughing, surprise or anger.
- Hallucinations. Roughly half of all narcolepsy sufferers experience intense dream-like images, called hypnagogic hallucinations, as they drift into sleep. Often these images can be quite frightening, especially as you are still partially conscious in this phase between wakefulness and sleep, but are not able to control these images.
The nature of the images often gives rise to a variety of feelings including fear, absolute dread and anxiety and it is common for these episodes to make you think that you are suffering from some form of mental illness.
Narcolepsy medication.Narcolepsy medication normally comes in one of two different types - the first to bring down daytime sleepiness and the other to counter the effects of hallucinations, cataplexy and sleep paralysis.
Stimulants. Stimulants are normally prescribed to counteract daytime sleepiness. The range of drugs available is too long to list them all here, but perhaps the 2 most commonly prescribed are Ritalin (Methylphenidate) and Provigil (Modafinil).
- Ritalin. Ritalin is one of various central nervous system stimulants traditionally 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, often giving rise to unwanted side effects. These include nervousness, headache, irritability, gastrointestinal problems and further disturbed nighttime sleep.
Additionally, drugs of this type can loose their effectiveness if used over extended 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 taking care of daytime sleepiness in cases of narcolepsy.
Different to other drugs, Provigil doesn't interfere with the hormones linked to sleep and therefore does not lead to disturbed nighttime sleep. It also stimulates far less nervousness and anxiety than many other alternative drugs and has fewer side-effects in general. The main 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.
- 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.
- 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.
- 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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