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Sleep attacks and narcolepsy, when to worry
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Sleep attacks and narcolepsy, when to worry
Narcolepsy is a sleep disorder that is characterised by excessive daytime sleepiness, with sudden sleep attacks occurring several times during the day. The causes certainly lie in a disturbance of the brain areas that regulate the sleep-wake rhythm. It is a largely disabling problem, as many daily activities are precluded (driving, for example, is out of the question if one is subject to sudden, unmotivated sleep attacks).
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How many people suffer from narcolepsy?
The latest available data indicate that narcolepsy affects roughly 1 in 2000 people (0.05% of the population) with practically identical distribution in both genders. It is therefore very important to know first of all the causes, but also the specific symptoms and possible treatments.
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When narcolepsy strikes
Sleep involves two phases of sleep: NREM (non-rapid eye movement) sleep, which is divided into 'light' and 'deep' sleep, and REM (rapid eye movement) sleep, which is characterised by the presence of 'rapid eye movements' and the absence of muscle tone on the antigravity muscles (this is the phase where one dreams). In subjects with narcolepsy, the regular sequencing between NREM and REM sleep is instead altered, with intrusion of REM sleep either a few minutes after falling asleep or during wakefulness.
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The main symptoms of narcolepsy
The symptoms were defined in 1957 by Yoss and Daly. The criteria on which the diagnosis must be based are: the occurrence of daytime sleep attacks; cataplexy; so-called 'sleep paralysis'; hypnagogic and hypnopompic hallucinations.
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Sleep attacks are the most characteristic symptoms
They are episodes of excessive sleepiness with a marked tendency to fall asleep, usually of short duration (10-20 minutes) recurring throughout the day (5-10 episodes per day). What is really dangerous is that they can come at the most diverse times, regardless of the activity being performed, such as driving or waiting for public transport or cooking. This is why it is an enormously disabling symptom for everyday life.
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What causes narcolepsy
Despite numerous studies on the subject, the cause of narcolepsy is still unknown. Numerous hypotheses have been put forward, such as an autoimmune reaction, correlations with multiple sclerosis, and the action of certain molecules in the brain, such as hypocreatine, is also being studied. However, the real reason behind the pathology is currently unknown.
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Disabling disease?
It depends on the case, as the severity and potency of daytime sleep attacks varies from person to person, and therefore individual cases need to be assessed. Certainly, being a chronic disease, which develops over the years and then lasts a lifetime, it is debilitating and above all increases the risk of accidents at home, at school, on the road or in the workplace. This disease, in severe cases, could even lead to the recognition of civil invalidity.
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The diagnosis of narcolepsy
The only way to get an accurate diagnosis is to visit a sleep centre. The conditions for the diagnosis are to present hypersomnia during the day almost every day for at least three months, not justified by other causes such as taking sedative drugs, chronic sleep deprivation, depressive syndrome, other sleep pathologies responsible for poor night rest. For narcolepsy in older age, one looks more at previous and pre-existing causes in the subject.
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The MLST test
Any preliminary considerations must however be confirmed by the so-called MLST (Multiple Sleep Latency) test. It takes place during the day, and the patient is asked to attempt to fall asleep several times. The finding, during MSLT, of an average falling asleep latency of less than 8 minutes and the appearance of REM sleep in at least two of the sessions is considered indicative of the presence of the pathology.
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How is narcolepsy treated
To date, there is no real complete cure for narcolepsy, but there are techniques, strategies and drugs that can keep symptoms under control and help improve quality of life. Any therapy, however, whether behavioural or pharmacological, must be administered by a specialised physician.
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