Narcolepsy - an Introduction (This text is still under work, so come by for the update.) The cardinal symptoms of narcolepsy (classical tetrad of narcolepsy) are: 1. excessive daytime sleepiness (EDS) with sleep attacks 2. cataplexy (C) 3. hypnagogic (and hypnopompic) hallucinations (HH) 4. sleep paralysis (SP) Other symptoms often reported by narcoleptics: - automatic behaviour - disturbed nocturnal sleep (sleep disruption) - visual disturbances (diplopia, blurred vision, ocular flickering) - headaches - impaired memory and concentration - depression Excessive Daytime Sleepiness (EDS) / Daytime Drowsiness The person usually experiences a more or less expressed sleepiness during the whole day, a so called vigilance-deficit, although there can be flucations in severity during the day (eg. stronger in the afternoon) which can be sometimes explained by the activites during the specific daytimes (eg. a lack of interesting/attention-consuming activites during the afternoon). There can occure sleep attacks during these periods the person cannot withstand (mostly during monotone or annoying tasks). These sleep attacks last for some minutes (up to 15 minutes, in special occasions - when the possibility is given (comfortable situation, silence) - up to an hour). These sleep episodes are easy terminated by external stimuli. The sleep usually isn't very deep and therefore the person can recall events happened in his surrounding during the sleep episode and is easy terminated by external stimuli. Even while walking sleep attacks can occur, the patient continuing walking and reawakening while running into another person or a traffic sign. Other unusual moments are: while eating, while coitus, ... As a consequence of this vigilance-deficit, the person also can experience so called automatic behaviours (mostly during monotonous or repetitive activities). These are activities without sense (putting shoes into the refrigator) and anamnesia (the person cannot remember doing so). Also walking to a place without recalling to have done so can occure (the person describes it as beeing at a place not knowing how to have gotten there). Other consquence of EDS commonly reported by narcoleptics are concentration problems and visual disturbances (diplopia, blurred vision, ocular flickering). The sleepiness can be as allready noted above overhelming (a sleep attack follows). Sometimes though the person is able to fight against the propensity to get asleep. In this phase (of fighting) there can occur the various aspects of lowered vigilance (automatic behaviour, concentration-problems and visual disturbances). After some time (usually 30 to 60 minutes) the sleepiness suddenly disappears (just to reemerge eventually after ~3 hours). This implies some phasic nature of the sleepiness (a biorhythm?) which can be reseted by a short sleep (e.g. the refreshing character of sleep attacks). Cataplexy Cataplexy means a sudden wakeness of the muscles, usually of the limbs, the jaw (falling down), the head (falling ahead) and even the whole body (which results in falling to the ground). In the beginning of an attack there can occure phasic movements (e.g. opening and closing of the jaw, raising and lowering of the arms). Typically these attacks last only for seconds and the consciousness remains intact. It even happens that in the process of falling to the ground the person regains his muscle-tone and thus is able to prevent reaching the floor. Sometimes the wakeness represents a less intense character, still enabling the person to do minimal activites (e.g. whispering phraese difficult to understand). These attacks usually last for a longer time (up to 15? minutes). The start of these attacks also can be of a milder nature, enabling the person to go for some retreat to sit down. Triggers for these attacks are sudden and unexpected emotions / events with an emotional component (e.g. hearing or wanting to tell the point of a joke, sudden arousals (even by suddenly seeing a long not seen friend over the street)) but also a sudden (physical) exertion/effort (e.g. the intention of running for a parting train triggers a blockade to start running). So the two aspects unexpected event/surprise and emotionally rising character are the two pillers in triggering cataplexy. Especially laughing poses a big problem to narcoleptics: they even can't laugh without experiencing a sudden muscle weakness. As a consquence this can induce the person to avoid social gatherings and to isolate itself in the process. Hallucinations Hallucinations are most often experienced while falling asleep (hypnagogic H) or awakening (hypnompompic H). Even healthy individuals sometimes experience these hallucinations (reference?). It is characterized by dream-like experiences in the surrounding the person laid down (e.g. a person is in the sleeping-room and somebody (unknown, often a child) comes in and touches the person). Often the irreality of the experience is recognised, the person perhaps trying to awake. Sleep paralysis This symptom also occures while falling asleep or awakening. It is characterized by paralysis of the whole body (person is unable to move) but whith intact consciousness (hearing everything and realizing the situation). Usually this state can be interrupted by an external stimuli (e.g. calling or touching), though sometimes strong shaking is necessary to terminate the paralysis. 1998-99 by Christian Sturzenegger Update 03-01-99 contact webmaster@orangemind.ch