![]() Unlike those that occur in psychotic disorders, the hallucinations tend to be associated with preserved insight that they are not real. The hallucinations are often vivid and usually visual, although other types of hallucinations are possible. ![]() Hypnopompic hallucinations, occurring upon awakening, are more common than hypnagogic hallucinations, which are experienced before falling asleep. Sleep paralysis can be associated with a sensation of fear or suffocation, especially when initially experienced. In most cases, it is manifested by inability to move the limbs or speak, lasting several seconds or, in rare cases, minutes at a time. Sleep paralysis occurs most commonly upon awakening, but sometimes just before sleep onset. Sleep paralysis and hallucinations are other features of narcolepsy that reflect this REM dissociation from sleep. 2Ĭataplexy is thought to represent intrusion of REM sleep and its associated muscle atonia during wakefulness. 8 Status cataplecticus can be spontaneous or an effect of withdrawal from anticataplectic medications. ![]() 2Ĭataplexy can worsen with stress and insufficient sleep, occasionally with “status cataplecticus,” in which repeated, persistent episodes of cataplexy occur over several hours. 9 Deep tendon reflexes disappear in cataplexy, so checking reflexes during a witnessed episode can be clinically valuable. A range of emotions can trigger cataplexy, but typically the emotion is a positive one such as laughter or excitement. 8 Episodes can last from a few seconds to 2 minutes. However, episodes can be more dramatic and, if the trunk and limb muscles are affected, can result in collapsing to the ground.Ĭataplexy usually has its onset at about the same time as the sleepiness associated with narcolepsy, but it can arise even years later. It often begins in the facial muscles and can manifest with slackening of the jaw or brief dropping of the head. 7Ĭataplexy-transient muscle weakness triggered by emotion-is a specific feature of narcolepsy type 1. 6 Napping after age 5 or 6 is considered abnormal and may reflect pathologic sleepiness. In children, sleepiness can manifest in reduced concentration and behavioral issues. Therefore, when taking a history, it is worthwhile to ask patients whether they dream during naps a yes answer supports the diagnosis of narcolepsy. Rapid eye movement (REM) latency-the interval between falling asleep and the onset of the REM sleep-is short in narcolepsy, and since the REM stage is when dreaming occurs, naps often include dreaming. Sleep attacks can come on suddenly and may be brief enough to manifest as a lapse in consciousness. Sleepiness tends to be worse with inactivity, and sleep can often be irresistible. 4 Narcolepsy is divided into type 1 (with cataplexy) and type 2 (without cataplexy). In fact, a minority of patients with narcolepsy have all these symptoms. Cataplexy, sleep paralysis, and hypnagogic or hypnopompic hallucinations can also be present, 2, 3 but they are not necessary for diagnosis. ![]() This review focuses on clinically relevant features of the disorder and proposes management strategies.Ĭlinically, narcolepsy manifests with excessive daytime sleepiness that can be personally and socially disabling. Importantly, treatments have improved and expanded, facilitating its management and thereby improving quality of life for those with the disorder. Since then, the disorder has been further characterized, and some insight into its biological underpinnings has been established. In this first description, he coined the term narcolepsie by joining the Greek words narke (numbness or stupor) and lepsis (attack). N arcolepsy was originally described in the late 1800s by the French physician Jean-Baptiste-Edouard Gélineau, who reported the case of a wine merchant suffering from somnolence. Modafinil, methylphenidate, and amphetamines are used to manage daytime sleepiness, and sodium oxybate and antidepressants are used for cataplexy. A consistent sleep schedule with good sleep hygiene is also important. Scheduled naps lasting 15 to 20 minutes can improve alertness. Total sleep time is normal, but sleep is fragmented. They go into rapid eye movement sleep soon after falling asleep. People with narcolepsy feel sleepy and can fall asleep quickly, but they do not stay asleep for long. Features of narcolepsy include daytime sleepiness, sleep attacks, cataplexy (in narcolepsy type 1), sleep paralysis, and sleep-related hallucinations. ![]()
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