Sleep is an essential part of our lives. Those who do appreciate and enjoy sleep often take it for granted. Those who cannot sleep yearn for it, but realize that they will never appreciate its full capacity. Sleep is a part of the human life that also has disorders that terrorize its victims. One such sleep disorder is narcolepsy, this disorder is a bit different from most disorders that disallow sleep, and with narcolepsy you have no control of your sleep. Narcoleptics fall victim to a genetic disorder that makes it almost impossible to control the moments when you fall asleep. They live with knowing that at any time they are susceptible to an uncontrollable and personally embarrassing spell of sudden slumber. My research is aimed at identifying exactly what narcolepsy is, why it works and the certain available treatments of this disorder. The more we understand this disorder, the more equipped we are to deal with it in our lives as psychologists. The symptoms and qualifications for being a narcoleptic will be a large focus of this research only because I feel it important that we understand what qualifies someone as narcoleptic. It is often a misconception of the practitioner that the narcoleptic patient is a schizophrenic, perhaps with the information provided we will be able to avoid these misconceptions in the future.
If there is one part of the life process that we as humans have a less than average understanding of, it is the mystery of sleep. Many of us take for granted the fact that sleep is a complex process that rejuvenates and restores our minds and our bodies. However, like every aspect of the life process, sleep does not present itself to be error free. Sleep comes with a long list of disorders and problems that can affect anyone at any point in their life. Some disorders are genetic and others are developmental but they are all equally horrifying for the victim. One of the more interesting disorders is a genetic neurological disorder called narcolepsy. Narcolepsy is unique and fascinating to the psychological mind, but to the victim it is torturous. It is a disorder that brings with it much embarrassment and stress to the sufferer. Narcoleptics can take comfort however, knowing that although there is no cure for narcolepsy there are a number of successful treatments available. As this research unfolds, narcolepsy will be explained in detail as well as some of its history and treatments. Perhaps by becoming familiar and aware of it, we can better deal with and treat its patients.
Narcolepsy is a genetically based sleep disorder that deals with the mechanisms controlling sleep and waking. Narcolepsy is characterized by sudden extreme spells of sleepiness. This sleepiness is present in even the most well rested narcoleptic. However, this feature alone does not determine or delegate that a patient has narcolepsy. Aside from this sudden sleepiness, the victim must also report cataplexy, sleep paralysis and hypnogogic hallucinations. In order to be considered truly narcoleptic, all of these elements must be present in the individual (Pressman & Orr, 1997). Cataplexy is a sudden loss of muscle control, this loss usually happens while the patient sleeps, however narcoleptics experience this while awake. The cataplexy is as mild as falling to the ground briefly, to not being able to move at all. Hypnogogic and hypnopompic hallucinations are the second determinate of narcolepsy. These hallucinations are usually vivid visual or auditory hallucinations, experienced right after or before REM sleep. The narcoleptic will report seeing these images prematurely before REM sets in, or after the patient is awake the hallucination will not stop. Since these hallucinations are so real, often the patient mistakes them for something else and becomes very frightened. The third and final symptom of narcolepsy is called sleep paralysis. This occurs when the patient is waking up from REM sleep, and the normal muscle inhibition fails to end with the end of the REM stage. This leaves the patient awake but unable to move. All three of these symptoms must be present to diagnose a person with narcolepsy. It should also be kept in mind that on the same token, if an individual does possess all three symptoms of narcolepsy, that does not always meant that they are a narcoleptic. Presence of one symptom out of the possible three, will most often be treated as a singular problem not related to narcolepsy (1997).
Hypnogogic and hypnopompic hallucinations are a very interesting aspect of the narcoleptic. Aside from the previous definition and explanation of these images, it is necessity that we have a more in depth look at exactly what these hallucinations are. Hypnogogic hallucinations are nothing more than deeply vivid hallucinations that are associated with the onset of REM sleep. Narcoleptics fail to progress through the preceding stages of sleep before reaching REM sleep. This causes the narcoleptic to have these hallucinations right as wakefulness ends, leading to a string of consciousness from the real world right into the dream world (Dement & Vaughan, 1999). The difference in hallucinations is that for the narcoleptic patient these hallucinations are very terrifying and real. In fact, these hallucinations can be so real, that many narcoleptics have reported being completely awake and paralyzed. These hallucinations include such images as animal attacks, strange intruders in the home and some have even reported alien visitation. The most frightening part of these hallucinations is that the patient seems unable to distinguish from hallucination and reality (1999).
These hallucinations lead right into the second symptom of narcolepsy and that symptom is sleep paralysis. Narcoleptics have reported that while having these hallucinations, a type of temporary paralysis sweeps over them. They are unable to speak, move or even roll over (Fritz, 1993). Another part of narcolepsy that is linked to the hallucinations and paralysis is the presence of automatic behaviors. Soon after the sleep paralysis has passed, narcoleptics will often engage in simple everyday tasks such as making the bed. The task is completed but the narcoleptic has no recollection of the event ever happening. This is called an automatic behavior, and this is a problem for the narcoleptic who has images of intruders in the home or alien visitation. These automatic behaviors leave the victim to wonder if the hallucination was actually real. Some narcoleptics question the fact that if they did not do the task than surely the intruder must have completed it in order to not arouse suspicion, others believe that they are insane (1993).
Now that we know about the symptoms of narcolepsy, it is important that we further define the disorder itself and explore the roots of narcolepsy. As stated earlier narcolepsy is the dysfunction of the normal sleep mechanisms in the body. Victims are plagued by uncontrollable sleepiness throughout their day, no matter how much sleep they may have gotten on the previous night. Attacks can occur as a result of mood swings, for example a sudden burst of excitement may cause a victim to slip into a narcoleptic episode. A narcoleptic having an episode will lose all muscle function and appear to be asleep for a period of time, they usually are not easily waken and if they are awaken they are very frightened and remain paralyzed for several minutes. These episodes last between ten to twenty minutes, and they leave the patient feeling refreshed and rested. This however is a false sense of rest, sure enough an hour later the patient is once again consumed by overwhelming sleepiness (Hale, 1981).
What causes such dysfunction in a human, this question is asked over and over again with no definite answer. When narcolepsy was first being studied, many physicians and psychologist simply dismissed narcolepsy as schizophrenia, but since then research has been compiled to lead us away from this misdiagnosis. Evidence now points us to genetics and neurological explanation. In recent studies it has been found that in 99 of 100 narcoleptics, there is a shared genetic marker that is present in the blood of the victims. It is an exclusive genetic marker called DR2. DR2 is a leukocyte antigen, and while it may have a hand in other sleep disorders, it is most specific in narcolepsy (Lavie,
1996). others feel that narcolepsy is result of a biochemical imbalance of the CNS. Researches have begun to look more carefully at the at the presence of the
Neurotransmitter called acetylcholine, a chemical that plays a role in REM sleep. Blood flow in the brain has also been heavily studied as a result of the DR2 theory. After research was done on blood flow and narcolepsy, scientists have in large dismissed the DR2 theory and are focusing more on the brain stem and the increased blood flow through the brain stem that narcoleptics have been found to have (1996).
Due to the genetic nature of narcolepsy there is no cure, but treatments are available and usually successful. In order to treat narcolepsy, the patient must first complete a sleep study, this ensures a proper and accurate diagnosis of the patient. The most common treatment of narcolepsy is the use of antidepressants and stimulants. The stimulant battle the daytime sleepiness while the bulk of the work is done by antidepressants. Antidepressants are used to block the REM paralysis which leads to cataplexy (Dement & Vaughan 1999). In the past amphetamines were widely used to treat narcoleptics, but in the past few years as a result of the drug war and the information that researchers have collected about drug abuse, the use of such drugs has dwindled. The best treatment plan lies in the hands of the individual. They must set their own goals and be willing to achieve them. They must tell the practitioner what they wish to accomplish and the practitioner will draw up a plan to help treat them. They will also provide the necessary pharmaceuticals as well as moral support and help (Hales, 1981).
The knowledge that we have is amazing, but the knowledge that we do not have must be even greater. The more we search for understanding and the right answers, the closer we are to finding them for ourselves. Sleep is a huge mystery that we will only understand better as time goes on and people apply their knowledge. We do not have a cure for narcolepsy but with the proper time and the proper minds we one day could stumble upon it. Until that day, we can only try to understand the mystery of sleep and its many hidden secrets.
Dement, W. C., & Vaughan, C. (1999). The Promise of Sleep. New York, NY: Random House.
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Naperville, IL: National Sleep Alert.
Hales, D. (1981). The Complete Book of Sleep: How Your Nights Affect Your Days. London: Addison Wesley.
Lavie, P. (1996). The Enchanted World of Sleep. New Haven: Yale University Press.
Pressman, M. R., & Orr, W. C. (Eds). (1997). Understanding Sleep: The Evaluation and Treatment of Sleep Disorders. Washington D.C.: American Psychological Association.