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Aspects of Narcolepsy

Introduction

Narcolepsy is a rare and unique condition that affects the sleep patterns of a person suffering from it, which disrupts their sleep-wake pattern. The prevalence of this condition in the western states is approximately 200-500 cases per million inhabitants. However, the highest prevalence is in Japan, where 1,600 individuals per million are diagnosed with narcolepsy (Basetti et al., 2019). Hence, narcolepsy seriously impairs the day-to-day functioning of an individual. Despite the severity of this condition, current research and pharmacological development do not fully explain the cause and ways of treating narcolepsy, and only symptomatic treatments are available. This paper will summarize five scholarly articles on the topic of narcolepsy.

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Summary of Literature on Narcolepsy

Narcolepsy is a condition characterized by daytime sleepiness and weakness during the night (Kornum et al., 2017). This means that a person with narcolepsy has a disrupted sleep pattern when compared to the norm, which is daytime activity and sleepiness at night. Basetti et al. (2019) describe this condition as a dysfunction of orexin neurons located in the lateral hypothalamus, while Mahoney et al. (2019) state that it is a result of the selective loss of orexin neurons. This dysfunction causes people to lose control ver their sleep-wake patterns and results in uncontrollable urges to fall asleep. Hence, the anger of narcolepsy is that an individual may fall asleep while performing routine tasks such as driving or cooking.

Narcolepsy has been known for a while, however, the first scholarly description of this condition dates to 1877s, where Westphal, Gélinau, and Fischer describe symptoms such as excessive sleepiness and loss of muscle tone after experiencing strong emotions (Basetti et al., 2019). Interestingly, these publications point to one characteristic of cataplexy not discussed in other scholarly resources reviewed in this paper, which is the perseverance of consciousness. Hence, during an episode, individuals with this condition cannot control their muscles, but they can think and comprehend the events and objects around them.

This condition is chronic, and no treatment that would address its development is currently available (Kornum et al., 2017; Basetti et al., 2019). Moreover, narcolepsy patients report experiencing sudden attacks of sleep, which is when an individual falls asleep randomly, regardless of their intent. In some cases, narcolepsy causes a person to experience hallucinations or cataplexy. The acronym CHESS and CRASH is used to describe all the symptoms of this condition (Kadiyala, 2020). CHESS refers to “cataplexy, hallucinations, excessive daytime sleepiness, sleep paralysis, and sleep disruption” (Kadiyala 2020, p. e100109).

Apart from the CHESS assessment, narcolepsy is diagnosed via biomarkers. Basetti et al. (2019) state that the following are usually used during diagnostics: “polysomnography findings of sleep-onset rapid eye movement (REM) sleep, periods (SOREMPs), positivity for HLA-DQB1, (refs15,16) and orexin deficiency in cerebrospinal fluid (CSF)” (p. 519). In addition, to diagnose narcolepsy, clinicians may choose to observe an individual’s behavior in a clinical setting, to prove the symptom of daytime sleepiness, as well as use “sleep-onset rapid eye movement (REM) periods during multiple sleep latency testing (MSLT)” (McCall & Watson, &, p. 1099).

Another important condition is that the clinician should ensure that other potential causes of sleepiness are rolled out. For example, they must ensure that this patient does not have sleep apnea, chronic lack of sleep or ensure that their medication is not the cause of the symptoms. Considering the need to eliminate other potential causes of sleepiness, narcolepsy may be difficult to recognize and diagnose and requires physicians to pay particular attention to other potential causes of sleepiness, apart from orexin deficiency.

Although narcolepsy itself is problematic for a patient because they cannot control their sleep patterns and adjust them to those accepted within the society, there are other issues such as social stigma that accompanies the disease (Kornum et al., 2017).

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Other issues include obtaining an education or maintaining a job, which is difficult for these patients since their sleep patterns are different. Since narcoleptic patients may suddenly fall asleep or lose muscle tone, they cannot perform the tasks that other individuals can, especially if they require strong focus and attention. Kornum et al. (2017) also report the economic effect of narcolepsy because the inability to get an education or a job due to the condition adversely affects the financial status of these individuals. Hence, patients with narcolepsy suffer from social stigma and economic difficulties as a result of their condition.

Considering the evident problem of uncontrolled weakness and sleepiness, the ability to complete routine tasks for narcoleptic patients is impaired. According to McCall and Watson (2020), driving may be dangerous for narcoleptic patients because it often triggers cataplexy, which means that the individuals lose control of their vehicles. Hence, these patients should be hyper-aware of this potential danger and avoid driving if they think it might trigger a strong emotional response. This is because cataplexy is triggered by emotions, for example, fear or anxiety due to driving (McCall & Watson, 20220).

Moreover, although there currently are no guidelines for providers on how to address driving safety issues with narcoleptic patients, McCall and Watson (2020) recommend using self-repots. For example, assessing whether an individual has fallen asleep while driving previously, the cases of near misses, and actual crashes can help a provider determine whether it is safe to allow this person to continue driving. Considering this, patients with narcolepsy should be cautious about intensive tasks that require strong focus due to the potential consequences of them experiencing cataplexy or sleepiness.

Narcolepsy is divided into two subcategories, which are narcolepsy one and narcolepsy 2 (Kornum et al., 2017). Patients with type 1 suffer from comorbid cataplexy, which is a sudden loss of muscle tone. Type 2 narcolepsy is more difficult to diagnose, and it is usually an exclusion diagnosis, which is used when other causes of symptoms were disproven. Moreover, type II narcolepsy is still not studied extensively, which means that there are many areas of the unknown with this condition. However, Basetti et al. (2019) argue that the classification should be reviewed since there are several borderland conditions that have some similarities to narcolepsy but also some distinct differences.

There are several hypotheses regarding the causes of narcolepsy. According to Kornum et al. (2017), it is the result of an “autoimmune destruction of the hypocretin-producing neurons in the hypothalamus” (p. 1). However, to this day, there is no evidence to support this hypothesis. Basetti et al. (2019) argue that the deficiency of orexin neurons is a result of environmental, genetic, and immune-related factors, a combination of which causes the deficiency of these neurons.

Mahoney et al. (2019) hypothesis that narcolepsy is an autoimmune condition that is caused by T-cells. Under this hypothesis, the T-cells attack orexin neurons, which results in their selective loss and subsequent disruption of the sleep-wake pattern. Despite having several hypotheses about the development of narcolepsy and advancements in understanding this condition made within the last twenty years, it remains to be understudied.

The treatment for narcolepsy is currently unavailable, nor can this condition be prevented. However, patients may receive medication that relieves some of the symptoms (Kornum et al., 2017). These medications adequately address the symptoms and are safe for the individuals taking them. Basetti et al. (2019) state that stimulants and anticataplectics are used to address narcolepsy symptoms. Among interventions that can reduce some risks connected to narcolepsy, McCall and Watson (2020) recommend scheduled naps and avoiding performing a task that requires concentration after alcohol, meals, or sedatives. This approach can help a patient control some of their narcolepsy symptoms, although it will not mitigate them completely.

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Conclusion

In conclusion, narcolepsy is a serious chronic condition that affects the sleep-wake pattern of a person suffering from it. Narcolepsy is rare because it impacts only from 200 to 500 individuals within a million inhabitants of a Western nation. However, its symptoms are severe, and they drastically affect the patient’s lives. For example, individuals may experience loss of muscle tone while remaining conscious or suddenly fall asleep while performing some task.

The current paper suggests that narcolepsy, its causes, and potential treatment require more research since the researchers currently do not fully comprehend the mechanism of narcolepsy’s development. Moreover, this affects the potential for treating narcolepsy because currently, patients can only use symptomatic treatment with stimulants and anticataplectics. More research is needed to determine the causes and ways of treating narcolepsy.

References

Bassetti, C., Adamantidis, A., Burdakov, D., Han, F., Gay, S., & Kallweit, U. et al. (2019). Narcolepsy—Clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nature Reviews Neurology, 15(9), 519-539. Web.

McCall, C. A., & Watson, N. F. (2020). Therapeutic strategies for mitigating driving risk in patients with narcolepsy. Therapeutics and Clinical Risk Management, 16, 1099–1108. Web.

Mahoney, C., Cogswell, A., Koralnik, I., & Scammell, T. (2018). The neurobiological basis of narcolepsy. Nature Reviews Neuroscience, 20(2), 83-93. Web.

Kadiyala P. K. (2020). Mnemonics for diagnostic criteria of DSM V mental disorders: A scoping review. General Psychiatry, 33(3), e100109. Web.

Kornum, B., Knudsen, S., Ollila, H., Pizza, F., Jennum, P., Dauvilliers, Y., & Overeem, S. (2017). Narcolepsy. Nature Reviews Disease Primers, 3(1), 1-10. Web.

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