Monday, October 4, 2010
1:55 PM James Manuel 9 comments
Some estimate that the United States alone may be home to tens of thousands of narcoleptics. And while the disease itself is not life threatening, the danger of accidental injury is quite serious.
For many years doctors brushed off narcolepsy as a purely psychological problem. Psychiatrists called it an escape mechanism, a form of hysteria, a withdrawal of ego. However, evidence began to accumulate that narcolepsy is physical in nature. It was learned, for example, that the illness seemed to run in families and that the malady afflicts even certain breeds of dogs. The American Journal of Psychiatry thus concludes: “At the present time narcolepsy is considered to be primarily an organic neurologic [brain] disorder rather than a psychogenic [originating in the mind] disorder.”
Still, being branded as “lazy” or even “insane” by friends and family members may very well cause psychological damage. In one study of 24 sufferers of narcolepsy, fully two thirds had psychiatric problems, such as depression or alcoholism. The disease also dramatically disrupted their lives in other ways. Of the 24 men studied, 18 proved to be “unemployable.”
What Causes the Symptoms
If you have a normal sleep pattern, within 60 to 90 minutes after you fall asleep, you will reach the dream stage called REM (Rapid Eye Movement) sleep. Although you don’t realize it, your muscles go perfectly limp during REM sleep. This apparently serves to protect us from acting out our dreams.
Narcolepsy, however, disrupts the normal REM pattern. A narcoleptic patient plunges into the dreamy REM condition almost the instant he falls asleep. And during the day—virtually without warning—he will get that urge to sleep and again be shifted almost instantly into the REM state. Some doctors would thus define narcolepsy as a “REM dysfunction disorder.”
Narcolepsy can also cause the normal states of the mind and the body to become out of phase. A patient may awaken from sleep with his body still in the REM state and discover to his horror that he is unable to move a muscle! Or his body is thrust into REM sleep while he is wide awake and going about his daily routine. For no apparent reason, his muscles suddenly grow weak or so limp (muscle paralysis called cataplexy) that he collapses into a heap. From about two thirds to three fourths of narcoleptic patients experience these frightening symptoms.
Almost any emotional stimulus—laughter, anger, fear—can trigger cataplexy. The book Sleep, by Gay Gaer Luce and Julius Segal, says: “They cannot laugh at a joke, spank their children in anger, mourn, or exhibit certain strong feelings without becoming literally weak with emotion and collapsing like jelly.”
REM sleep features may even intrude on a patient’s waking thoughts and superimpose a vivid dream—or a terrifying nightmare—on reality. He may awaken in bed, his body paralyzed in the REM state, and hear voices and see frightening things. Such waking dreams (called hypnagogic hallucinations) may also occur during the day, and about half of all narcoleptics experience them.
It is thus understandable that some narcoleptics tend to withdraw from others for fear of being stigmatized as “lazy,” “mentally ill,” or “possessed by demons.”
Coping With the Illness
Far too often narcoleptics explain away their symptoms as fatigue or chronic tiredness and fail to seek medical help. Even when they do, narcolepsy is not always easily diagnosed, especially in its early stages. Says the American Family Physician: “Patients with narcolepsy experience symptoms for an average of 15 years before receiving a correct diagnosis.” Still, if you suffer from chronic daytime sleepiness, you are wise to consult a physician and not try to diagnose yourself. A thorough examination may identify a medical problem that needs attention.
What, though, if a doctor confirms your condition to be narcolepsy? While the disease is incurable, doctors claim that there are a number of medications that can help the sufferer to lead a reasonably normal life. Central-nervous-system stimulants are often prescribed to help a patient stay awake during the day. Antidepressants are used to control problems with cataplexy.