Narcolepsy
Could you imagine standing around chatting with friends, and then suddenly you see someone drop to the floor and fall asleep. Most people would laugh, but narcolepsy is not a laughing matter; it is a severe, life changing illness. Narcolepsy is classified as a chronic sleep disorder that is characterized by three groups of symptoms: cataplexy, which is an unexpected failure of muscle tone set off by strong emotions, excessive daytime sleepiness, and abnormal rapid eye movement sleep manifestations, such as parasomnias (Billiard, 2008). According to the DSM-IV, in order for a person to become diagnosed with narcolepsy, they must have irresistible attacks of refreshing sleep that occur daily over at least three months. The person must also have either repeated disruptions of rapid eye movement (REM ) sleep into the transition between wakefulness and sleep, which is manifested by either hypnagogic hallucinations, sleep paralysis, or hypnopompic at the beginning or end of sleep episodes, or cataplexy. Also the disturbance of sleep must not be due to any direct physiological effects of a substance (BehaveNet.)
Patients who suffer from this disorder typically present different types of behaviors depending on the symptoms that they have. People who have the symptom cataplexy normally show signs of slurred speech and sometimes their body will totally collapse which may cause them to fall to the ground and lye there for a few seconds. This is known as a sleep episode and is due to the sudden loss of muscle tone. These episodes can last for 20 minutes or less and can be brought on by strong emotions such as laughter, anger, or surprise. Patients with narcolepsy can experience up to six episodes a day. Other behaviors that might be observed would be a person showing signs of sleepiness, lack of energy and concentration, or exhaustion due to EDS. About 40 percent of the people who have been diagnosed with narcolepsy also show signs of another DSM disorder, most commonly anxiety, substance use conditions, and mood (Lyons & Martin 2009).
According to Lyons and Martin (2009), a reported 1 in 2000 people in the United States are diagnosed with the condition, and it is equally common in males and females and has an onset beginning before the age of 40. Also about one half of first degree relatives of patients with narcolepsy show symptoms of sleepiness, and about 15% of them have the disorder. Most patients who have the condition do not sleep regularly, meaning the person does not progress through a series of stages into slow wave sleep followed by a periodic rapid eye movement or REM sleep. Patients who have narcolepsy go into REM sleep more quickly than usual. This can sometimes happen immediately after the patient fall asleep (Robinson & Keating, 2007). There is no cure for narcolepsy, but for patients suffering from this condition, treatment is available in the form of medication that treats its three cardinal symptoms.
Conventional treatments, such as amphetamines, methylphenidate, mazindol, selegiline, pemoline, and behavioral treatment, have been used to treat the three cardinal symptoms of narcolepsy. In a study conducted by Billiard (2008), he discusses these types of treatments and how they are used. For the treatment of excessive daytime sleepiness and sleep attacks, Billiard first suggested the drug mazindol, but later found out that the drug modafinil was best to use to treat EDS. This was based on a double blind with placebo controlled trials, which showed that the drug was significantly effective on EDS at a dose of 300 mg. Modafinil also replaced amphetamines and methylphenidate as the first line treatment of EDS. For the treatment of cataplexy and other REM sleep manifestations, Billiard illustrates how these symptoms were primarily treated using a tricyclic antidepressant called imipramine, which are norepinephrine uptake inhibitors. These days’ mazindol, selefiline, SSRS, and behavior treatments