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Narcolepsy

Narco
Nicholazk
9 KEY FACTS
CHARACTERISTICS
Daytime Sleepiness
Monkey with sleep-hat and daytime picture

Narcolepsy is characterized by daytime sleepiness. Excessive daytime sleepiness with recurrent episodes of rapid-onset, overwhelming sleepiness at least three times a week for at least three months is required for the diagnosis. It is important to note that nocturnal and narcoleptic sleep episodes start off with REM sleep, and patients cannot physically avoid falling asleep.

Hallucinations
Halloween-hallucination

Patients with narcolepsy can have dream-like hallucinations just as they are falling asleep or waking up. Hallucinations that happen when the patient is falling asleep are known as hypnagogic;  hallucinations that happen when the patient is waking up are known as hypnopompic.

PATHOPHYSIOLOGY
Cataplexy
Cat-Flexing

Cataplexy is a medical condition in which strong emotions (e.g., laughter) cause a person to suffer sudden physical collapse due to loss of all muscle tone; it is important to note that consciousness remains intact.

Low Orexin
Ox-down-arrow

Dysregulated sleep-wake cycles are caused by decreased orexin (hypocretin) production from neurons in the lateral hypothalamus. An orexin A level less than 110 g/mL in the CSF supports the diagnosis of narcolepsy.

Lateral Hypothalamus
Ladder-hipo-thor

Dysregulated sleep-wake cycles are caused by decreased orexin (hypocretin) production. Synthesis of orexin takes place in the lateral hypothalamus.

TREATMENT
Good Sleep Hygiene
Hygiene-guy with sleep-hat

Good sleep hygiene is a necessary component of narcolepsy treatment. These patients should have a regular sleep schedule; they should take scheduled naps and avoid watching TV or eating just before going to bed.

Amphetamines
Amp-feet

Stimulants such as amphetamines are frequently used to help these patients stay awake throughout the day.

Modafinil
Monitor-filling

Modafinil is one of the first-line medications for narcolepsy. This medication helps patients stay awake throughout the day.

Sodium Oxybate
Sodium on ox

Sodium oxybate is given to these patients at nighttime due to its sedative effects. Sodium oxybate is effective in reducing cataplexy. It also reduces REM phenomena such as sleep paralysis and hypnagogic hallucinations.

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