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Narcolepsy: the hidden sleep disorder

Narcolepsy is a disorder which affects the body’s ability to regulate sleep/wake cycles. It’s a chronic condition which has four common effects: excessive daytime sleepiness (EDS), cataplexy (sudden limpness or loss of muscle tone while a person is awake), sleep paralysis where a person becomes temporarily immobilised whilst falling asleep or waking up, and hallucinations during wakefulness similar to dream imagery. It is estimated that only 25% of narcoleptics are diagnosed.
Causes
Many people with narcolepsy have low levels of the neurotransmitter hypocretin, which tells the body to stay awake. No strong genetic component to narcolepsy has been identified, although in some families there are multiple instances of the disorder. There are also indicators that narcolepsy can relate to abnormal autoimmune function. Human leukocyte antigens (HLA) are a group of genes that regulate the immune system. Most people diagnosed with narcolepsy and cataplexy have an HLA gene variant DQB1*0602, indicating a possible link to a malfunction with this system. Traumatic brain injury or brain tumours, infections, hormonal changes and extreme stress or sleep deprivation all have the potential to impact on normal brain functioning, increasing vulnerability to brain disorders such as narcolepsy.
Solutions
Stimulants are the primary treatment of choice for narcolepsy, effectively reducing EDS and allowing for a normal level of functioning. There are drawback to these medications however, with amphetamine-type substances carrying the risk of dependence and abuse, along with unwanted side effects such as anxiety, jitters and anorexia. Certain antidepressants are also effective for some, including tricyclics and noradrenergic reuptake inhibitors. Side effects may be problematic, including high blood pressure, compromised sexual function and irregular heartbeat. Sedatives prescribed at night are sometimes used to rebalance the sleep/wake cycle by promoting sound sleep at night and greater wakefulness by day.
Facts
• Narcolepsy is defined as an autoimmune neurological disorder
• It is estimated to affect approximately 3 million people worldwide
• Narcolepsy is a serious and debilitating condition that is widely misunderstood
• People with narcolepsy have a greatly increased risk of obesity. This is thought to relate to the role of the neurotransmitter hypocretin in regulating appetite as well as promoting wakefulness
• There are higher rates of narcolepsy onset in spring and summer. Studies of newly diagnosed individuals have revealed higher levels of an antibody called ASO, indicative of recent bacterial infection
• People with untreated symptoms of narcolepsy are approximately 10 times more likely to have a motor vehicle accident
• Narcolepsy is recognised as a disability, affording sufferers protection under law in most countries
• Narcolepsy can cause terrifying hallucinations
• Narcolepsy is frequently misdiagnosed, sometimes as a mental disorder or epilepsy

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