Narcolepsy Essay, Research Paper
Miranda was walking down the street and she came to a stoplight, it was red. While she was waiting, somehow she had fallen asleep standing up. This was not the first time for Miranda or others like her, Miranda suffered from a disorder called narcolepsy. Narcolepsy is a disorder that causes excessive daytime sleepiness(EDS) and affects more than 200,000 Americans, but can be helped with scheduled naps and drugs such as Provigil and Yohimbine. Those with Narcolepsy experience excessive daytime sleepiness as one of many symptoms. Narcoleptics may fall asleep while watching television, driving, eating, or even walking down the street (Dement). Research on narcolepsy shows that the disorder seems to be a chemical imbalance of the sleep-wake cycle in the brain (Newman). Sleep in mammals is categorized into two stages: REM sleep (Rapid Eye Movement, the stage in which people dream) and NREM sleep (Non Rapid Eye Movement, where the sleeping don t dream) REM is usually occurs sixty to ninety minutes after sleep onset, but with Narcoleptics, this process is reversed and REM occurs right away, sometimes causing hallucinations (Dement). Although narcolepsy does not kill, it is worst in middle-aged persons and seems to run in families, primary family members run a risk sixty times greater than the rest of the population. Albeit doctors can easily distinguish narcolepsy from regular excessive daytime sleepiness, polysomnograms are helpful. Polysomnograms are machines that record brain waves, eye movements, and muscle tension (Dement). Narcolepsy usually begins in the teen years, but is usually not diagnosed for ten to fifteen years because it is not very well known, even though it affects as many people as Multiple Sclerosis (Alger B17). During those endless years, narcoleptics suffer through loss of jobs, endless doctor appointments, and the embarrassment of falling asleep all the time and not knowing why. Likewise, they have a higher rate of divorces and marital troubles. When a young child falls asleep in class, most teachers commonly assume that it is the parent s fault for not sending the child to bed early enough. When a teen falls asleep in class, it is thought that the kid is bored, on drugs, or just plain lazy. Self-blame and denial are a big part of narcolepsy (Smith). Narcolepsy has many symptoms. Excessive daytime sleepiness is the most common and by far the most troublesome. People with narcolepsy say that EDS is very troublesome and interferes with their lives. said Helen Temple, assistant Director of the National Narcolepsy Registry. Patients may fall asleep at all times during the day. They might fall asleep while eating, watching TV, and driving down the street. More than sixty-five percent of narcoleptics report falling asleep behind the wheel (Smith). Narcolepsy patients do not sleep any more or less than average persons, but their sleep during the night is not very good. Temple explains that they must play catch up during the day. They may take up to ten naps per day. Patients often complain about insomnia, but the disorder isn t due to lack of sleep during the night, but the chemistry in the brain s sleep-wake cycle. There is only one animal that can be studied for narcolepsy: the Doberman pincer, though they are almost as hard to study as humans noted Helen Temple. Another common and cardinal symptom of narcolepsy is cataplexy. Cataplexy is a very common and very troublesome symptom of narcolepsy. It is a muscle weakness or paralysis that occurs when a patient experiences a strong emotion. Sometimes the loss of muscle tone is very mild: drooping eyes, quivering lips, or dropped jaw. The person may not even notice it. Sometimes it is more than that, a Narcoleptic may be crying and raging and just drop to the ground (Dement). It is similar in a way when something makes a person laugh really hard, they laugh and laugh and then can t stand up any more. Temple explains that not much is known about cataplexy, it occurs only with narcolepsy, and the antonia is thought to be alot like what is seen in REM sleep and is an interruption of being awake with a feature like REM sleep. Cataplexy is often mistaken for epilepsy, but in fact is very different. Subjects are fully conscious during attacks and EEG s show no signs of epileptic activity (Dement). Temple also explains that although most patients complain that EDS is the most bothersome of the symptoms, some people with severe cases find that the cataplexy is more of a problem than EDS, but is usually treatable with antidepressants. Alas, the antidepressants don t work so well with another symptom: hypnogogic hallucinations. Hypnogogic hallucinations are hallucinations that occur when the person is between asleep and awake. These false sightings of things that are not there are very vivid; it is like dreaming while awake. Hallucinations are so vivid because the person is awake; but they are only a dream. Since one of the symptoms of narcolepsy is reversed REM sleep these hallucinations usually occur directly upon awakening. They involve many sensations and are usually rather frightening. A good example of a normal hallucination would be a person awakening to think they heard someone creep into another room, and then seeing a dark figure looming over their bed (Dement). Not always does this happen in bed, it will sometimes occur in the middle of the day. REM sleep takes over instantly and the person will begin to dream while awake. Hypnogogic hallucinations are not associated with narcolepsy alone, they occur with other disorders and alone as well. The hallucinations are not the only symptom of narcolepsy that can occur alone, sleep paralysis does as well. Sleep paralysis occurs during REM sleep and no matter how hard the person tries, he or she cannot move or speak. It is just like when a normal person is having a nightmare and they try to run, and they try to scream, bur cannot. It only lasts a few minutes, and then normal sleep takes over again (Dement).
Other symptoms include: arousals during the night and blackouts where the person with the disorder will do very repetitive tasks and then not remember that they did them. Narcoleptics usually have very high levels of anxiety, memory problems, lethargy, depressive episodes and are many times introverted (Alger B17). Although this disorder is as mysterious as it is troublesome, there is a way to get help. “Medicine is certainly the most satisfactory means of treating narcolepsy.” says Temple. The most common type of drugs are amphetamines such as Methylphenidate-HCl, D-Amphetamine-Sulfate, Methamphetamine-HCL, Pemoline and Mazindol. These drugs are have a wide range of effectiveness. The Mazindol is weakly capable of alleviating the symptoms, where as the Pemoline, which is not as potent, has a longer duration of action (Stanford). These drugs are fairly effective, but there are problems. They are addictive and do not always properly control symptoms. Amphetamines leave narcoleptics with insomnia at night, and then come back with rebound sleep the next day (Laurence 8). There is a stimulant that is not an amphetamine. It is a new drug called Modifinil. This new wonder drug for narcolepsy is not yet on the market, but is being tested by the military in the United States, Great Britain, and France to help keep soldiers alive during war; which could help save their lives. It is the first new drug for narcolepsy in more than forty years. It works to keep people awake differently that any other drug around. Modifinil does not cause aggression like the amphetmines do. Instead of being a stimulant, rather, this drug is sleep preventing. With most drugs on the market, there is the nasty side-effect of rebound sleep. This is something that is not believed to occur with Modifinil. Although this drug is not an amphetamine, there is the possibility that it may be abused. The promoters of this new product reject the idea, but researchers are not opposed to it. [The idea that Modifinil is not addictive] seems to be stretching appoint. Uppers and downers are often abused , and since Modifinil is not on the market yet we cannot know whether it will be abused. said DR Meryl Dahlits a researcher on narcolepsy at Kings College Hospital. The only other real drawback is the price: fourty-eight hundred dollars a year (Laurence 8). Another possible drug to help alleviate the symptoms of narcolepsy is a natural drug called Yohimbine. Yohimbine is a natural non-addictive drug that is still being tested. Yohimbine comes from the bark of the Pausinystalisa Yohimbe tree in West Africa. The discovery of Yohimbine was purely accidental. A man was being treated for sexual dysfunction, and it helped his narcolepsy recede. Patients treated with Yohimbine were able to stay awake for a full eight-hour work period, and were still able to keep it up, even after a few weeks of treatment. Unlike the amphetmines and Modifinil, Yohimbine does not just stimulate, it is believed to counteract the chemicals in the brain that disrupt the sleep-wake cycle. The side effects include sour stomach and flushing, it has also not been tested on women. Other than the side effects mentioned, the only problem is that patients could get used to the drug and may need larger doses, and it could be harmful to those with heart disease, and high blood pressure (Munson 45). Although medication is the best way to treat the symptoms of narcolepsy, there are other ways to help. Setting scheduled times for bed and short ten to fifteen minute naps is very helpful. Narcoleptics are usually refreshed by these naps and can keep going for two to three hours before another nap is needed. Temple explains. Persons with narcolepsy have a tendency to lose their jobs because they cannot stay awake during their shift. Tasks that require extreme concentration seem to help some people as well. The more technical it is [the work] the better, the less problems I have with narcolepsy. said Brian Hunter, a narcolepsy patient (Laurence 8). Narcolepsy is a crippling disease that affects as many people as Multiple Sclerosis, but is not nearly as well-known. Despite this fact there are still ways to help the EDS, the cataplexy, the blackouts, and the hallucinations by scheduling naps and taking drugs. BibliographyNewman, Kevin, and Elizabeth Vargas. Narcolepsy Treatment Good Morning America Dec 29, 1998. Electric Library.Smith, Stephen, and Edwards, Bob. Narcolepsy. Morning Edition (NPR) Oct. 13, 1997. Electric Library.Alger, Derek. A Real Eye Opening Experience. Newsday May 6, 1994: pp B17. Electric Library.Dement, William C. Narcolepsy. CD Colliers Encyclopedia. Feb 28, 1996Munson, Marty, and Therese Walsh. Wake Up: Can natural medicine decrease dozing? Prevention Ocy. 1, 1995: pp. 45(2). Electric Library.Laurance, Jeremy. Wake-up Call for New Drug. Independant June 10, 1997: pp 8,9. Electric Library. Medications The Stanford University Center for Narcolepsy. June 16, 1998. April 5,1999. http://www.med.stanford.edu./school/psychiatry/narcolepsy/ medications.html.Temple, Helen. e-mail response. April 7, 1999.
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