Mental Sleep Activity In Narcolepsy And Emotional Experience
Considering all these findings , the crucial role of emotions in narcolepsy and an impairment of the limbic system in these subjects , the investigation on emotional experience during MSA for this sleep disorder deserves interest. Narcoleptic patients often report an abundant production of vivid, bizarre and frightening MSA . A high prevalence of aggressive dreams was found, including dreams with aggressive sexual themes . Furthermore, some studies revealed that narcoleptic patients, with or without cataplexy, have more negatively toned and bizarre dreams and significantly more terrifying and repetitive dreams in narcoleptic patients compared to insomnia patients . However, it should be noted that some authors also found positive emotions in narcoleptic dreams . Other authors posited that NC exaggerates the emotional aspects of REM dreams, probably because of the alteration of neurobiological systems that support cognitive-emotional functions. They investigated the emotional experience during REM sleep in these patients and observed more intense emotions especially- anxiety/fear and following joy/elation and more bizarre and vivid contents .
Narcolepsy Treatment And Pregnancy
There is limited data about the safety of most drugs used to treat narcolepsy in women who are pregnant, trying to get pregnant, or breastfeeding. A survey found that the majority of experts recommend stopping narcolepsy medications when trying to conceive as well as when pregnant and breastfeeding. Discontinuing medication may require changes to behavioral approaches and other accommodations to safely cope with symptoms without medication.
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A Help For Both Conditions: Get Better Rest
Good sleep hygiene is important whether youre dealing with fatigue or narcolepsy.
Here are some tips:
- Allow adequate time for sleep at night and keep consistent bed/wake times.
- Keep your bedroom comfortable, cool, dark and quiet.
- Arrange for a wind-down period of time before bed to calm your mind and body.
- For best results, remove electronics from your bedroom and avoid all screens for one hour before you go to sleep. TVs, phones, tablets and computers all can disrupt your sleep.
- Daily exercise can also improve sleep quality at night.
If you feel tired all the time or have trouble staying awake in meetings or at other times during the day, talk to your healthcare provider. They can help you pinpoint the cause and find a way to treat it.
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Practice Good Sleep Hygiene
While people with narcolepsy have unique challenges when it comes to sleep, practicing good sleep hygiene can help. This means sticking to a consistent sleep routine, avoiding digital screen time before bedtime and sleeping in a room thats cool, dark and comfortable.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Apr 14, 2021
Meditate Or Be Mindful
It is easier to manage narcolepsy when you can manage your own mind. Meditation and mindfulness are tools that have allowed me to quiet my mind, feel more centered and in control of myself, and even get better quality sleep!
Dawn from Going Beyond Coping has made an amazing adapted method if you are intimidated by mindfulness practices!
This paper shows that mind wandering makes us feel bad and concludes that average people mind wander 46.9% of the time! As a person with narcolepsy, I wonder if mine was even worse before discovering mindfulness techniques. The physical and mental health benefits of meditation are real and long lasting! It can increase grey matter in the brain, improve memory, and help you feel more socially connected!
Each one of these chips away at the layers of sleepiness and fog that we walk through every day. You can drop what you are doing and try any of them right now. They may not be formally recognized narcolepsy treatments, but I believe all of them help to relieve the stress that exacerbates our symptoms. Anyone you know that is not happy tends to be tired, so it makes sense that as people with narcolepsy we also have to work toward happiness to reduce our fatigue.
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Drug Treatments For Cataplexy
Sodium oxybate , also referred to as gamma-hydroxybutyrate , helps reduce the frequency of cataplexy attacks and improve daytime sleepiness. People need to take GHB for about 4 weeks before they notice significant benefits. It may take an additional 4 weeks for the drug to reach maximum effect. Food intake can affect the actions of GHB, so people are advised to take it at a regular time after the evening meal.
Xyrem is a controlled substance. The FDA has placed tight restrictions on the use of this drug. Xyrem and the generic form of sodium oxybate can only be prescribed and dispensed under an FDA program called risk evaluation and mitigation strategy . Although the drug appears to be effective and safe when used for narcolepsy, it has a history of illegal and “date-rape” use, with street names such as “Grievous Bodily Harm” or “Liquid Ecstasy.” GHB can cause dependence over time. Education through the Xyrem Success Program may be valuable to people with narcolepsy and physicians.
Very serious side effects, including seizures, coma, respiratory arrest, and death, have been reported in people who abused GHB. However, clinical trials of Xyrem have not reported these effects with the doses used in treatment for cataplexy. Patients should be monitored closely for depression and suicidal thoughts, which may be worsened by use of sodium oxybate.
Monoamine Oxidase Inhibitors
What Is The Multiple Sleep Latency Test
After waking from an overnight sleep study, you will stay in the sleep laboratory until late that afternoon. Every two hours after waking in the morning, you will be asked to return to bed for 20 minutes and try to fall asleep. There will usually be 4-5 of these nap opportunities through the day. During each of the sessions, the time taken to fall asleep and whether any REM sleep occurs are recorded. . Falling asleep quickly and experiencing REM sleep during the multiple sleep latency test are features of narcolepsy.
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Whats Behind These Disorders
For fatigue: There is often an underlying cause. Here are some possibilities:
- Medication side effects.
- Heart and lung diseases.
For narcolepsy: The exact cause is uncertain, but may relate to a loss of orexin signaling for some people. The hypothalamus in the brain releases orexin to help stimulate other brain regions to help keep you awake. If there is not enough orexin, normal sleep and wake patterns sometimes blur.
Other possible causes of narcolepsy include:
- Genetic factors.
- Rare brain lesions from tumors or strokes.
The Effects Of Narcolepsy
Physical well-being and safety. Many ordinary daily activities, such as cooking or walking, can become very dangerous if you fall asleep or lose muscle control unexpectedly.
Mental health. Narcolepsy can disrupt your life to the extent that it may lead to depression and anxiety.
Social and professional relationships. Unfortunately, sudden sleep episodes are often found humorous to those not familiar with the disorder. Some people may assume that you are lazy, rude, or even faking the sudden sleep episodes.
Intimate relationships. Your personal relationships, especially romantic relationships, can often suffer. Extreme sleepiness may also cause low sex drive and impotence.
Memory and attention. Narcolepsy may cause you to have problems remembering things and concentrating, creating more disruption to your daily activities.
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What Lifestyle Changes Can Help Better Manage Narcolepsy
Consider the following:
- Follow a regular sleep/wake schedule. Go to bed and wake up at about the same time every day. Avoid intentional sleep loss, such as staying awake late on weekends.
- Keep your bedroom quiet, dark, cool and comfortable. Do not watch TV or bring computers or phones into bed with you.
- Avoid alcohol and caffeine for several hours before bedtime.
- Avoid smoking, especially in the evening.
- Exercise at least 20 minutes per day. Do not exercise within three hours of bedtime.
- Dont eat large, heavy meals or a lot of liquids close to bedtime.
- Relax before bedtime. Take a warm bath, meditate, perform some gentle yoga moves, listen to soft music, expose yourself relaxing scents such as peppermint, eucalyptus or lavender.
- Take short naps at times when you are feeling most sleepy, if possible.
Can Stress Cause Sleep Paralysis
Have you ever felt the sensation of being awake, but you are unable to move? This might happen right as you are falling asleep or waking up. You might also feel pressure on your chest or like someone is pinning you down. This is known as sleep paralysis, and it is often accompanied by feelings of fear and can even cause hallucinations to appear.
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What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
The NINDS, along with several other NIH Institutes and Centers, supports research on narcolepsy and other sleep disorders through grants to medical institutions across the country. Additionally, the NIHs National Heart, Lung, and Blood Institute manages the National Center on Sleep Disorders Research , which coordinates Federal government sleep research activities, promotes doctoral and postdoctoral training programs, and educates the public and health care professionals about sleep disorders. For more information, visit the NCSDR website at www.nhlbi.nih.gov/about/ncsdr.
Immune systemAbnormalities in the immune system may play an important role in the development of narcolepsy. NINDS-sponsored scientists have demonstrated the presence of unusual immune system activity in people with narcolepsy. Further, strep throat and certain varieties of influenza are now thought to be triggers in some at-risk individuals. Other NINDS researchers are also working to understand why the immune system destroys hypocretin neurons in narcolepsy in the hopes of finding a way to prevent or cure the disorder.
What Is Hypersomnia Symptoms Causes Diagnosis Treatment And Prevention
Sleep paralysis Our muscles are temporarily paralyzed during REM sleep , but in people with narcolepsy it can happen at the wrong time. This symptom can leave these individuals awake and unable to move. The paralysis typically lasts only a few seconds or minutes.
Hallucinations These are vivid dream-like visions that take on an extra-real quality. They are called “hypnagogic” if they happen while someone is falling asleep, and “hypnopompic” if they occur while they are waking up.
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When Should I Call My Healthcare Provider
If you or a loved one believe you have narcolepsy, see your healthcare provider. He or she may refer you to a sleep specialist or sleep center for additional evaluation. Early diagnosis and treatment can help reduce symptoms. Also continue to share your issues and concerns with your healthcare professional. Your doctor may adjust the dose of your medication, try other medications, or make other recommendations to improve your symptoms to achieve the highest degrees of alertness and daytime functioning possible.
What Are The Types Of Narcolepsy
There are two major types of narcolepsy:
- Type 1 narcolepsy . This diagnosis is based on the individual either having low levels of a brain hormone or reporting cataplexy and having excessive daytime sleepiness on a special nap test.
- Type 2 narcolepsy . People with this condition experience excessive daytime sleepiness but usually do not have muscle weakness triggered by emotions. They usually also have less severe symptoms and have normal levels of the brain hormone hypocretin.
A condition known as secondary narcolepsy can result from an injury to the hypothalamus, a region deep in the brain that helps regulate sleep. In addition to experiencing the typical symptoms of narcolepsy, individuals may also have severe neurological problems and sleep for long periods each night.
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Primary Symptoms Of Narcolepsy
Excessive Daytime Sleepiness
All people with narcolepsy can experience excessive sleepiness during the day. Sometimes they fall asleep rapidly and inappropriately, even when fully involved in an activity. This symptom is sometimes described as an irresistible daytime need for naps, which will generally refresh the person. EDS may be characterized by the following behaviors:
- People typically have periods of drowsiness every 3 or 4 hours that usually end in short naps.
- People may sleep during the day for a few minutes, particularly if they are in an awkward position for sleep or for a few hours if they are lying down.
- People often underestimate the duration of their drowsy periods and may not recall clearly their behavior during that time.
Cataplexy is a brief and sudden loss of muscle tone or strength that results in an inability to move and always occurs during wakefulness. Symptoms of excessive daytime sleepiness may be present for years before cataplexy first occurs, although cataplexy often develops within a year. About two-thirds of people with narcolepsy have symptoms of cataplexy, and cataplexy is rarely present outside narcolepsy. The following events may be triggers for cataplexy:
- Sudden emotions, usually laughter and sometimes excitement, rage, or anger
Cataplexy may have the following characteristics:
How Is Narcolepsy Diagnosed
A clinical examination and detailed medical history are essential for diagnosis and treatment of narcolepsy. Individuals may be asked by their doctor to keep a sleep journal noting the times of sleep and symptoms over a one- to two-week period. Although none of the major symptoms are exclusive to narcolepsy, cataplexy is the most specific symptom and occurs in almost no other diseases.
A physical exam can rule out or identify other neurological conditions that may be causing the symptoms. Two specialized tests, which can be performed in a sleep disorders clinic, are required to establish a diagnosis of narcolepsy:
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How Are These Conditions Treated
For fatigue: Since it is likely a sign of another problem, your healthcare provider will focus on finding and treating that.
If a primary cause is not found, your healthcare provider may recommend:
- Cognitive behavioral therapy. It challenges beliefs and awareness of your fatigue, helping you control symptoms and change behavior that may make your condition worse.
- Graded exercise therapy. It helps with underlying deconditioning, starting with low-intensity activity like walking or stretching and building from there.
For narcolepsy: Your healthcare provider likely will recommend a sleep study, encourage changes in behavior, such as strategic napping and caffeine intake. However, you may need prescription medications to help stay awake during the day or improve sleep quality at night.
Its important to have a good psychosocial support system. Talking to your family about your condition or working with a counselor or a support group can help a lot.
What Causes Narcolepsy Symptoms
Symptoms of narcolepsy are usually related to the loss of brain cells that produce neurotransmitters called orexins. Orexins have many important roles in the body, two of which are to consolidate wakefulness and suppress REM sleep. Consolidating wakefulness is important because it allows people to maintain alertness for long periods throughout the day.
Without sufficient orexin-producing neurons, the body cannot appropriately maintain sleep-wake cycles. Sleep is less consolidated, leaving people feeling tired throughout the day and feeling a need to take frequent naps. Its common for people with narcolepsy to experience an intense need for sleep at inopportune times.
Narcolepsy also causes the body to transition rapidly between sleeping and waking states. People with narcolepsy fall asleep quickly and enter REM sleep much faster than those without this disorder. Narcoleptic patients wake up often during the night and spend time in abnormal intermediate states in which they are neither fully asleep nor fully awake manifesting as cataplexy, sleep paralysis, and hallucinations.
The connection between a lack of orexins and narcolepsy symptoms is well established, but not all people with narcolepsy have a loss of orexin-producing neurons. There are two types of narcolepsy type 1 and type 2 and orexin deficiencies are known to cause symptoms only in people with narcolepsy type 1.
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Avoiding Sleep Attack Triggers
A problem controlling the normal sleep-wake cycles in narcolepsy causes the sudden attacks of sleepiness. “We don’t believe that it is related as much to environmental factors,” Awad says. But, he adds, “There are a lot of things people can do to improve the symptoms of narcolepsy.”
One is to stick to a regular sleep schedule. Go to bed at the same time each night and wake up at the same time each morning. Try to get 7 to 8 hours of sleep a night. Make up for any sleep you miss during the day with naps. “Scheduling naps is really key,” Javaheri says. “Try to time naps during the day before you hit the wall or feel really sleepy.”
Avoid alcohol and caffeine, especially before bedtime. “Alcohol causes sleep fragmentation, which means that it breaks up our sleep,” Awad says. Alcohol interrupts the restorative REM sleep stage, which can leave you feeling sleepy the next day, even when you feel like you’ve had a full night’s sleep.
There’s some evidence that the nicotine in cigarettes improves narcolepsy symptoms. But given the other health problems linked to smoking, “the risks strongly outweigh the benefits,” Awad says. “There’s also the concern, especially when people smoke in the afternoon or evening, if they have a sleep attack it could lead to burns or fires.”