Sleep Apnea Treatment

Narcolepsy

Narcolepsy, also called Gelineau syndrome or sleep epilepsy is a chronic neurological disorder, that presents as the main symptom daytime sleepiness. From the Greek "Närke" sleep "lepsis" possession, manifests itself in bouts of irresistible sleepiness. Narcolepsy is characterized by episodes of uncontrollable sleepiness with substrates of the features of REM sleep, dreams and muscle weakness that occur abnormally during wakefulness. It includes involuntary sleep attacks, that befall the subject causing hypnagogic cataplexy (at the beginning of the night) and hypnopompic (at the time of awakening) hallucinations, sleep paralysis, automatic behavior and disturbance of sleep at night. Uncontroled narcoleptic sleep starts directly in the REM stage. Yoss and Daly in 1957, after reviewing 241 cases of narcolepsy established a tetrad diagnosis: sleep attacks in 100% of the cases, cataplexy that appears in 70% of patients, sleep paralysis in 50%, hypnagogic hallucinations observed only 25% of the cases. The clinical picture of narcoleptic patients is completed with sleep attacks, that can last a few minutes to an hour and some or all of the following symptomatic processes.

Cataplexy
The sudden and reversible cataplexy of narcolepsy is unique and distinctive of this disorder.
It is the loss or diminution of motor functions that together causes extreme muscular paralysis, it is usually caused by sudden intense emotional stimuli (bursts of laughter, fright, fear ...). Patients experience a sudden global or partial loss of muscle tone of short duration, that can last from a few seconds to a few minutes. During the episode there is no respiratory compromise or conscience and the recovery is complete after the event.

Sleep paralysis
It is a common finding in clinical narcolepsy. Sleep paralysis is defined as the temporary inability to move the limbs, speak or open his eyes, that usually occurs when the subject is entering sleep or immediately upon waking. In these transient episodes, the person is fully conscious, and the inability to move or speak inevitably leads to feelings of distress. The episodes are easily interrupted by external stimulation.

Hypnagogic hallucinations and hypnopompic
It corresponds to very vivid visions, that occur in the hypnagogic period, the transition from wakefulness to sleep (sleep onset). They are rare in the transition from sleep to waking (waking), when hypnopompic hallucinations dominate. These experiences of dreams and hallucinatory perceptions of images and sounds are experienced in a very real and sometimes terrifying way. These visual, auditory, tactile and kinesthetic hallucinations are of short duration and its demonstration can accompany sleep paralysis.

Automatic behavior
It is the conduct of insisting on carrying on with business despite the persistent feeling of sleepiness, so that the patient has no control over what he is doing. The automatic behavior represents a dangerous situation, when the patient remains asleep doing activities like driving or everyday activities in which he loses conscious control posing a risk to himself or others (reckless driving, fallings, assault risks of walking and sleeping on the street, unattended cooking ...)

Uncontrolled sleep episodes (sleep attacks) occur regardless of place and time. This limits patients to perform their normal daily lives. After the sleep attack the person feels rested having this dream it simulates a full restorative effect.
It is a dangerous condition, cause it means "falling asleep" in any situation. If narcolepsy doesn’t show all the syptomatis the diagnosis (cataplexy and sleep attacks) can be confusing and can be difficult to distinguish with other types of hypersomnia. The diagnosis is confirmed by an overnight polysomnography test and multiple sleep latency. Epidemiological studies indicate a population prevalence of 0.26% without distinction between sexes (1 in 2000). Symptoms may begin at any age, but is common to develop at puberty, with a peak incidence between 15 and 25. Recent research points to an immune attack as the cause of narcolepsy, that causes neurological hypocretin deficits. This opens a new hope for patients, because the effects are devastating and negative impact of the disease leads to limitations in social-, family- and workarea.
Currently it deosn’t present a cure and the only alternative is treatment through medication, a proper lifestyle and proper eating habits to improve the quality of life of patients.