Sleep Problems: Report

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Narcolepsy is a relatively common but unknown sleep disorder that has many symptoms, including

excessive sleepiness and automatic sleep attacks. Afflicted may have strange sleep schedules and

intruding feelings of drowsiness throughout the day, even after an adequate amount of sleep. These

individuals are also typically able to fall into the REM stage of sleep much quicker than the averagepopulation.

Many individuals that suffer from narcolepsy also have another disease called cataplexy.

Cataplexy is defined as the sudden loss of muscle tone. This sudden loss is often triggered by strongemotions like laughing or crying. The weakness of muscle ranges anywhere from a small loosening of

the facial muscles to a full collapse. While those with cataplexy could potentially fall asleep during

these attacks, those episodes of sleep are not related to narcoleptic ones.There are many tests to see if one has narcolepsy. The most used test is the Multiple Sleep

Latency Test (MSLT). In this test, the patient sleeps in increments of 20 minutes with two hours

between each sleep event. Data is monitored during this test, including brain waves, eye movements,and brain activity. Periodically, it is difficult to discern if a patient has narcolepsy or not from the

MSLT. In this case, it is more wise to do a repeat (or repeats, if needed) than to attempt other tests, as

they are not nearly as accurate. In a study by the University of Toronto, Canada, it was discovered that

just a single repeat MSLT would confirm a diagnosis of narcolepsy that a first test had not completelyconfirmed.

Another common test is the polysomnogram, which is a recording of brain waves as well as

muscle and nerve functions taken while the patient is asleep. It can quickly confirm if a patient hasentered REM, which, depending on how long it takes to get to the REM stage, can be a good indicator

on whether or not the patient has narcolepsy.

Recent studies have uncovered a link between narcolepsy and to a produced protein calledhypocretin. Hypocretin, also called orexin, is responsible for managing sleep patterns. Sufferers are

usually found to have less of the neurons that produce this protein. When hypocretin levels are low,

sleep balance is hard to maintain and people may face irregular sleep patterns. This is simply because

there are too little hypocretin proteins to properly keep the schedule intact.Another, more recent, study suggests that there may be a link with the influenza virus,

specifically H1N1. There was a large increase in the number of narcoleptic children in Finland

following the H1N1 scare of 2009. In 2010, 54 children were diagnosed with narcolepsy. Out of these54, 50 of them had been vaccinated up to 242 days before symptoms began showing. They had been

vaccinated by a popular H1N1 vaccination at the time.

In China, also at the same time, was a growth of the number of narcoleptics. This group isdifferent from the Finland group in that only a few had gone in for a vaccination. Out of 142 patients

that had developed narcolepsy, only eight had received an H1N1 vaccination. This is explained by the

fact that many of these Chinese had been victims of H1N1 previously. The onset of narcolepsy hadpositively correlated with the H1N1 infection (as well as other, lesser known upper airway infections).

The other large link between H1N1 and narcolepsy is one of the respiratory system. Any upper

airway infection, which includes H1N1, has been shown to lead to a immune response that will cause

the brain to lose hypocretin-producing neurons. Following this, it is also believed that breathingproblems that narcoleptics have are linked to a hypocretin deficiency.

Narcolepsy can not only introduce, but also tend to, other sleep-related problems. Narcoleptics

commonly suffer from sleep paralysis, which is when the body is asleep but the mind is awake.Typically, sufferers are fully aware of their surroundings and are conscious, but their bodies are unable

to move. These episodes can last anywhere from seconds to hours and can be extremely frightening to

those that experience them. Narcoleptics are also able to have more believable dreams. For many,hallucinations are a normal part of life simply because dreams and the real world are difficult to

distinguish. Many narcoleptics can use all of their senses in dreams similar to how they could be used

in real life. For example, smelling a flower would not just evoke a similar smell and emotion like it


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would to a normal person. Smelling a flower would be the full experience of doing so in real life to a

narcoleptic, complete with the smell and physical feelings that smelling something would introduce.

Physically, there are other problems that can be serious to narcoleptics. There is a large

correlation between having narcolepsy and having some sort of sleep-disordered breathing problem.Since there are studies that show a link between upper airway problems and narcolepsy, it is easy to see

the parallel between two of these disorders. Out of 102 narcoleptics, 29 were sufferers of an obstructive

sleep breathing disorder.This disease is one that, if not properly attended to, can lead to serious problems, not only

physically, but mentally as well. Narcolepsy typically appears during adolescence, which is a difficult

time for many people. Common side effects to narcoleptics include seemingly uncontrollable weightgain, social difficulties, irritability, frustration, and overall difficulties in concentration. Due to these

problems, many afflicted adolescents turn to substance use. Many use illegal substances just to keep

them awake, unaware of the problems associated with them. Recently, though, there has been evidenceto support that nicotine may somehow lower the incidence of sleep attacks or other narcoleptic

episodes.

Recent work has introduced the role of hypocretin in drug addiction. Hypocretin could have a

link to quite a few aspects of addiction, including reinstatement and dependence. Hypocretin couldquite possibly influence the states that influence addiction, which could help explain why so many

narcoleptics turn to drugs in the first place. Even so, it is difficult to tell exactly how much of an

influence hypocretin has on drug addiction to a narcoleptic, especially with the amount of hypocretinbeing so small compared to a healthy person.

Narcoleptic social difficulties can be destructive to a personality, since they, on average, face a

harsher world than the unaffected. Narcoleptics have higher health-related costs (including doctor visitsand insurance costs), a higher chance of dabbling in medications, and an overall higher cost of living.

They also have to deal with lower employment rates, lower income, and less actual on-the-job hours.

These problems can exist long before a narcoleptic is actually ever diagnosed. According to one study,

these consequences had been found 11 years prior to the first diagnosis. The situations only worsenedor became more prevalent as time went on.

There are only a limited number of treatments available, and the majority of these do not target

the problem directly. Most are just stimulants that activate the transmission of dopamine in the brain.Anti-depressant medication and therapies are also effective in the treatment of symptoms, as the

constant transmission of adrenaline keeps users awake and alert to the point where sleep attacks and

drowsiness episodes are much less likely to happen. Behavioral and schedule therapies are alsocommon approaches to helping the problem, and, much of the time, are paired together. Trying to do

studies in aversive conditioning showed disheartening results. Unmedicated narcolepsy patients had no

response in the amygdala to the conditioned stimuli.More recently, studies in using GHB (Gamma-hydroxybutyrate) to treat symptoms have

happened. These studies show that using GHB is a decent treatment for sleep attacks, but not for other

symptoms. Daytime sleepiness and sleep attacks were removed for many sufferers, but overall sleep

times, length of night sleeping, and length of sleep cycles had no changes. A barrier to treatment is thefact adult and child research does not have much in common. Since children are still developing, brains

are tougher to gauge in their possible potential. As far as the future holds, hypocretin replacement is a

very popular therapy idea that could have the potential to cure most, if not all, problems related to thisdisease.

Works Cited

DiLeone, R., Sarhan, M., and Sharf, R. 2011. Orexin/Hypocretin, Drug Addiction, and Narcolepsy.


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Partinen, Markku, Outi Saarenp-Heikkila, Ismo Ilveskoski, Christer Hublin, Miika Linna, Pivi

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Sleep Problems: Report