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Narcolepsy is a neurological disorder that is primarily believed to be related to disruptions in the sleep cycle, particularly with the rapid eye movement sleep cycles that many people refer to as REM sleep.
This disorder can be diagnosed in nearly anyone, but is it typically diagnosed between the ages of 7 and 25.
The most commonly documented symptoms that are associated with narcolepsy are:
Narcolepsy is often divided up into two subtypes. Narcolepsy type I is often labeled in individuals who have narcolepsy with cataplexy, whereas narcolepsy type II is often the label use for individuals who have narcolepsy but do not experience cataplexy. Narcolepsy is relatively rare, and the prevalence rate for narcolepsy is often reported as being around 1:2000. It appears equally common in men and women. There is no known cause for this disorder and it is believed that there is a strong genetic component associated with the disorder, even though a large number of individuals diagnosed with narcolepsy have no family history of the disorder.
There is ongoing research that has suggested that low levels of a neurotransmitter known as orexin or hypocretin may be associated with the disorder, and some forms of narcolepsy may be associated with the loss of neurons in the brain that produce this neurotransmitter. This research indicates that at least some cases of narcolepsy may result from an autoimmune disorder that results in the loss of these neurons and that this autoimmune disorder may have a genetic component. In rare cases, individuals who experience traumatic brain injuries may develop narcolepsy, further suggesting that disruption of specific categories of neurons may be one potential cause of the disorder.
Since narcolepsy is a neurological disorder, it can only be diagnosed by a physician, preferably a neurologist. Some of the assessments used to assist in the diagnosis of narcolepsy include:
It appears that a large number of individuals with narcolepsy may develop depression, and individuals who develop major depressive disorder are at risk for the development of substance use disorders. However, individuals diagnosed with narcolepsy without a co-occurring psychological/psychiatric disorder do not appear to be considered to be at high risk for the development of a substance use disorder.
There is research that looks at the associations between impulsiveness and the symptoms of narcolepsy that has indicated that individuals with narcolepsy with cataplexy were found to be significantly more impulsive under certain cognitive tests than individuals with narcolepsy without cataplexy. Increased impulsivity is associated with an increased risk to develop substance abuse.
There is also research that indicates that a small number of individuals with sleep disorders also develop substance use disorders, such as alcohol use disorders, or abuse other substances to help them induce sleep; however, this research does not specifically apply to individuals with narcolepsy. Unless individuals diagnosed with narcolepsy also have depression or some other psychological/psychiatric disorder, these individuals as a group are probably not at a significantly increased risk to develop a substance use disorder; however, some individuals with narcolepsy may abuse alcohol and other medications in an effort to induce sleep.
There is no known cure for narcolepsy, and most individuals diagnosed with the disorder will get involved in lifetime pharmacological management for their symptoms as well as a behavioral management program designed to help them sleep. Medications commonly used in the treatment of narcolepsy include:
Antidepressant medications: These are often newer antidepressant medications but can also include older antidepressant medication, such as tricyclic antidepressants. They are commonly used to control cataplexy and sleep paralysis issues.
Stimulants: A number of different stimulant medications can be used to treat EDS, including Ritalin and Adderall (but typically not time-released forms of these drugs), Provigil, Nuvigil, and a number of others.
Individuals with narcolepsy can also benefit from therapy, particularly a sleep maintenance schedule where they learn the productive sleep habits that can reduce the issues they have with nighttime insomnia.
Some of the medications that are used in the treatment of narcolepsy, such as amphetamines (particularly stronger amphetamines like dextroamphetamine or methamphetamine) and sodium oxybate, do have the potential for abuse, and these drugs would need to be administered under the strict supervision of a physician.
Individuals who have narcolepsy and are diagnosed with a co-occurring substance use disorder require that both of these disorders be treated concurrently. These individuals require the traditional approach to substance abuse treatment that would include placement in a withdrawal management program if they have developed physical dependence on alcohol or some other drug, therapy for substance abuse, social support for substance abuse, family support, and other supports and long-term aftercare programs that assist them in coping with stress, engaging in a positive program of relapse prevention, and maintaining an ongoing program of sobriety. If these individuals are diagnosed with any other comorbid psychological condition, such as depression, that also needs to be addressed along with the narcolepsy and substance use disorder. A complicated treatment program such as this requires a multidisciplinary approach that includes a number of different physicians, psychologists, counselors, other therapists, and specialists, and a strong program of peer support.