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.
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.
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.
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.
Dysregulated sleep-wake cycles are caused by decreased orexin (hypocretin) production. Synthesis of orexin takes place in the lateral hypothalamus.
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.
Stimulants such as amphetamines are frequently used to help these patients stay awake throughout the day.
Modafinil is one of the first-line medications for narcolepsy. This medication helps patients stay awake throughout the day.
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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