Narcolepsy – causes, symptoms, diagnosis, treatment & pathology

At one time or another you’ve probably had
to force yourself to stay awake, maybe while driving or when you’re in a looong lecture. In these situations, you were exerting control
over your sleep-wake cycles. Narcolepsy is a disorder in which individuals
lose the ability to regulate these sleep-wake cycles, so the normal boundary between sleeping
and being awake is blurred, and that leads to characteristics of sleeping happening while
a person is awake. In the brain, there are a special group of
neurons that help increase the state of wakefulness, and they extend from the lateral hypothalamus
to various parts of the brain like the reticular activating system (or RAS). In individuals with narcolepsy, there are
fewer of these excitatory neurons, and each neuron carries less of the neuropeptides orexin
A and B (also called hypocretin 1 and hypocretin 2). These orexins increasing the activity of wake-promoting
regions of the brain, thereby tipping the scales in favor of wakefulness and preventing
inappropriate transitions into a sleeping state. with narcolepsy, it’s thought that an autoimmune
process might damage the neurons delivering orexin or that there may be some other direct
injury to those neurons. Either way, when that happens, less orexin
is sent out and sleep-related symptoms begin to intrude into wakefulness. The onset of narcolepsy often happens during
adolescence and young adulthood, and is classically associated with four key symptoms. The first is daytime sleepiness, where people
chronically feel sleepy. They can get sleep attacks where they doze
off with little warning, sometimes inappropriately, but they generally don’t sleep more than
healthy people in a given 24 hour period. Most individuals with narcolepsy find that
a short, 15-minute nap substantially improves their alertness for a few hours, which suggests
that the sleepiness of narcolepsy is caused by a problem with the brain circuits that
normally promote full alertness, rather than poor quality or insufficient sleep. Normally when a healthy person goes to bed,
they go through a sleep cycle lasting an hour or more before they reach REM sleep, which
is the stage of sleep that is characterized by dreaming. People with narcolepsy fall asleep very quickly,
in as little as five minutes, and they often go directly into REM sleep. This results in their having very vivid dreams,
even when they fall asleep for brief periods of time. Alright the second symptom that often develops
over time is cataplexy which is when some strong emotion, which can be a positive one
like laughter or a negative one like anger, triggers a transient muscle weakness. That muscle weakness is often partial, affecting
the face, neck, and knees, but severe episodes can cause total body weakness or paralysis,
causing the person to collapse. These people are usually conscious during
cataplexy, and the weakness they feel usually resolves within minutes. Understandably, this symptom can have a severe
impact on the lives of people with narcolepsy, both from a physical (since they could get
hurt when they collapse) as well as a psychological perspective. The fear of cataplexy and having an episode
in public can lead to extreme anxiety, and will often lead to these people to avoid situations
that they believe might elicit an episode. The third symptom is having hypnagogic hallucinations
which are vivid, often frightening visual, tactile, or auditory hallucinations that occur
as the patient is falling asleep. They probably result from a mixture of wakefulness
and the dreaming of REM sleep. Hypnopompic hallucinations are similar except
that they occur upon awakening; although these are less common, they can happen in narcolepsy. Okay so the final key symptom is sleep paralysis,
which is the complete inability to move for a few moments to a few minutes immediately
after awakening or just before falling asleep. This is because during REM sleep the brain
is very active, but the voluntary muscles of the body are generally paralyzed, probably
to prevent an injury related to a dream about running or flying. This paralysis generally subsides as we start
to wake up, but occasionally we regain consciousness before the paralysis has worn off. Episodes of sleep paralysis can be even more
frightening because the immobility might be accompanied by hypnopompic hallucinations
or a sensation of suffocation. Interestingly, only a minority of people with
narcolepsy experience all four symptoms, which can make diagnosis difficult or make it easy
to get confused with other sleeping disorders. Evaluations like polysomnography or a multiple
sleep latency test, both of which take physiologic measurements like EEG and ECG tracings, while
a person is sleeping, can be used to help diagnose narcolepsy. For treatment, while there is no cure for
narcolepsy, there are a number of medications including specific stimulants and antidepressants
that can be used to help manage many of the symptoms. Alright, so to recap, in narcolepsy there
is a lack of orexin which is a neuropeptide that normally helps maintain a state of wakefulness. In its absence, many phenomena normally associated
with sleep begin to affect the waking state causing symptoms like daytime sleepiness,
cataplexy, hypnagogic hallucinations, and sleep paralysis. Thanks for watching, you can help support
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  1. The addition of Xyrem to the list of medications I feel is important. This is the only medication at this time that treats the underlying cause of the symptoms of narcolepsy. The medications listed only help you move through the symptoms. Please consider making this edit.

  2. I think I have partial narcolepsy(you will understand better once I describe it).

    I fall asleep fast. I don't know my starting phase of sleep or my normal phases over time, just that I fall asleep fast(in less than an hour)

    But I have control over the sleep-wake cycle and my sleep-wake cycle is normal and unless I truly am tired(lack of sleep or lack of quality of sleep) I don't dose off(I do daydream though but that is involuntary and actually helps me with 1 of my hobbies, writing(specifically thinking of ideas and building a fictional world)). I have fallen unconscious from seizures and then in a few minutes got into a state similar to waking up.

    So from a doctor's perspective, I am a normal variant just like how being nocturnal but still having control over the sleep wake cycle is a normal variant.

    But would my condition be partial narcolepsy since the only characteristic of narcolepsy I have is falling asleep fast? Or am just a variant of normal?

  3. Interesting how they didn't mention Xyrem as one of the main treatments for narcolepsy. The drug Xyrem is ghb, which has been spun by the media only for use as a date rape drug.

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  5. Weird that you didn't include disrupted nighttime sleep as a key symptom, as this is what most people miss in understanding narcolepsy. We do not just have periods of sleep during the day, we have periods of wakefulness during the night. Our sleep consists of too much REM and not enough deep sleep, so our sleep is not restful like it is for someone without narcolepsy. This is why Xyrem is the first line treatment, it solves this key issue by helping us to get the restful sleep we need.

    The video is otherwise great, but I think this is a really big point to just miss entirely!!

  6. If your father has this condition, have studies shown a link of vastly increased chances in his offspring of having it? My father developed this in his mid 30s along with sleep apnea. and low and behold in my mid 30s I begin the same, even with a lot of sleep I can be walk or sitting, or talking and go to sleep in half a second, sometimes I keep trying to talk while asleep and boom awake again…. it is starting to effect my life, before I think I did not notice it as much because I was taking stimulants for my ADHD, anyways, anyone know if it is genetic or have a link to material about that being possible?

  7. Does anyone with narcolepsy also have more energy in the even and night compared through morning and day? I'm on xyrem 4.5 twice a night and I still have trouble through the day. I can't take stimulants because they have all caused Major migraines when taken for me. I've started sleeping through the daytime and wake around 10pm at night and I'm a night person and I go bed around 10am. It's helped sooooo much.

  8. Couldn't agree more on the "difficult to diagnose" point. I have had all symptoms but some occur less often than others so I don't even bother telling the doctor. I know they'll be like, "oh, yeah, the sleep paralysis is due to your restless legs 'cause we noticed you move them a lot during sleep n shiz." Or like, "yeah, we didn't notice anything weird in the data we've collected over the overwhelming 8 HOURS, so we're gonna assume you don't experience these symptoms, call it a day, a say you have nothing"……

  9. Can insomnia cause narcolepsy? I'm often kept awake by Restless Leg Syndrome, I am sleepy all the time, and, even though I have a very active job, I keep nodding off for split seconds while working.

  10. Im 21 years old and i firgued out through watching several videos like these and research that i have Narcolepsy with the Cataplexy. Seems that the Cataplexy didnt it start until after highschool. Feeling weak to where i have to catch myself from falling when laughing or getting excited. This is beginning to effect my life more and more as I begin to get older and time seems to fly by faster. I sleep at least 10 hours every night but miss out on a few hours due to the restless sleep. Seems like a 5 min nap does me better than a full nights sleep. So i take several of those a day to try avoid falling asleep at the wrong time. I often do fall asleep at the wrong times like in class , while driving, and even working. Wish i could go throughout my day without falling asleep. Im now in college and falling asleep in every class. It’s affecting my grades like it has my whole early years & i miss out on alot because of it.

  11. I've always had trouble staying awake when sitting. It was way worse when I was still in school and I'd just doze off during class or in the middle of quizzes and exams. Then when I started working I fell asleep whenever I'm crouched over the microscope or when typing, even fell asleep standing while waiting for other people on a few occasions. It was only recently that I began to start dozing off while driving and it freaked me out so much that I haven't been behind the wheel for a few months. I occasionally have sleep paralysis, woken up in the middle of the night for no reason, thought I've seen or hear things moving around me as I fall asleep, and more recently have vivid dreams even if I sleep for less than 10 minutes. I've never called it narcolepsy because I have insane insomnia that I find it hard to fall asleep at night but doze off quickly during the morning or afternoon. So, is this narcolepsy or are the symptoms just alike with people suffering from insomnia?

  12. I have a friend who takes adderall for narcolepsy. But, even when she doesn’t take it she is still fine. Is Adderall a common drug to treat narcolepsy? I think my sister might have it, but she doesn’t want to take that medicine. Just looking around for some info to try and help her. Thanks so much 🙂

  13. It should probably be better to replace the Neuro chemicals you're lacking rather than try to take stimulants? Over the long term I suppose so. So what neurochemichals are narcoleptics lacking? Guessing vitamins, B, C, D and minerals magnesium and iodene just for a start. I am narcoleptic myself. I currently take 400mg of Modafinil per day just to stay awake in meetings or when I'm driving. A long-term cure, natural, would be really neat.

  14. So if you have trouble falling asleep (at night) you don’t have narcolepsy? I have to take 3-4 naps a day and fall asleep instantly but at night it takes me awhile. I also have the hallucinations before falling completely asleep, and lots of sleep paralysis.

  15. I was going to use this to educate people, but then you left out one of the MAJOR symptoms. Disrupted Nighttime Sleep. Fragmented sleep at night, plus vivid dreams, lead to overall sleep deprivation. Your reviewing doctor is obviously somewhat behind the times (and he is in good company- he did do better than most, sadly). Please add Disrupted Nighttime Sleep to this video, or take it down.

  16. Well this is worrying. I thought narcolepsy was basically just random uncontrollable sleep attacks during the day, but many of these are symptoms that A LOT of people have… including me? I always dream even when taking very short 1-hour naps, and when falling asleep I often have those dreams where I'm trying to move but I'm stuck in bed, and even when in the dream I do manage to get up I realise I'm actually still sleeping…

  17. I need help from anyone whom may know of online sources of information that I cannot find. I have a few of these symptoms… well, several of these symptoms, but not to the full extent as described. I also have a very hard time falling asleep at all. I'm not sure if I may have narcolepsy or insomnia or both if that is even possible. If I'm awake, I'm usually tired, but cannot fall asleep when it is time, and if I am asleep I have a very hard time waking up. I start dreaming before I fall asleep and almost always wake up while dreaming. If there is any medical professional out there that can direct me to more information which would help me describe my symptoms to my doctor then please do so. Send me a link to the information in a message, not in a reply, as I rarely read replies to my comments. The worst part of dreaming for me is that almost all my dreams are vivid and lucid, and I can sometimes mistake a dream for a memory.

  18. My sleep study and multiple sleep latency test gave me the most convincing narcolepsy diagnosis according to my doctor

  19. Do what you have to U will survive.To Share For every Narc. is Different. I thank God for more information about it .Root cause of terror by night.23 plan 91

  20. I have narcolepsy and have all the wonderful crazy things that's go with it. This video was very good for explaining everything. Thank you

  21. I don’t want to self diagnose myself but ever since early childhood, I never had a regular sleeping schedule. Everyone would go to sleep and I would just stay up all night crying about not being able to sleep. I’m in college now and it got so much worse. I can stay up for 3 days with no sleeping at all specially at night. But then in the morning I always feel super tired and lazy, I even sleep in lectures and I lost marks because I had no control over it. Everyone calls me sleeping beauty but I don’t even get half of the hours they get of sleep. It’s so hard I tried everything! But my inability to sleep is so hard and no one ever understands. I need help and when my parents knew about it they told me you’re too young to get sleeping pills and therapy isn’t the case. Idk what to do, I literally look like a drug addict Because of my eyes. Help me please. Plus at night it’s when I get creative I start writing, singing, painting, shooting. In the morning I’m the most useless person ever I can’t even focus on one thing.

  22. I always sleep during 3-5:00 after school and it’s so hard to stay awake. It lessens my study time and ive been trying to find ways to stay awake such as sniffing peppermint.

  23. Makes sense.. I have sleep paralysis, I hallucinate whilst awake in day as well as sleep during night. I feel light headed and have no control. I also fall asleep on bus, in car, at home, If I need sleep I will be in a zombie like state. Walking slowly or talking slow. I also have bipolar and it's common to get angry at the least little things. Iv been diagnosed with depression & my condition is never clock set thing it can occur Amy time. Any where.

  24. "help" is pretty loose here. I can take 90mg of Adderall per day and I can feel as if sandbags are on my shoulders. Hell, I've taken 30mg and went right to sleep and never felt it upon awakening. Problem is no one cares about us, hence why there are no real meds to help us. This video is great at explaining the issue but like so many… That's all that gets shown. It's life ending for us, can't work if you can't show up. Can't drive in some states and forget commercial driving, as guidelines seem to prevent it. Worst part, people have looked at my life as if I am a danger. An EMT asked me after a car accident how I had a license… Even though my crash was clearly due to poor conditions. This is the reason we take the antidepressants, cause without them we would probably off ourselves just so we don't have to hear incorrect comments on how "lazy" we are, even when I worked circles around guys in 100 degree heat. Nothing is stronger than a narcoleptic with a job.

  25. While I applaud your concise presentation of Narcolepsy, you are not entirely correct in your data. There are two points you failed to mention or properly explain.
    1. You stated that due to the low levels of orexin a Person With Narcolepsy (PWN) doesn't sleep more than a normal individual, but rather just no longer has control of when they sleep. You are only partially correct. Even though it appears that a PWN sleeps a lot, they actually sleep less. Yes, I said less. PWNs actually live with a constant sleep debt or sleep deprivation, which leads me to point #2.
    2. You are missing a symptom. You listed four, but there are actually five primary symptoms that most PWNs deal with. You left off a very important symptom, Disruptive Nighttime Sleep (DNS). Just as a PWN may fall asleep during the day, they may also be awake often at night. Combined with the excessive REM sleep and actually skipping more than one phase of sleep throughout the night along with the DNS, PWNs end up with LESS restorative, deep sleep and thus with less sleep overall. This not only contributes to the Excessive Daytime Sleepiness (EDS), but to higher very serious health risks and conditions.

  26. The only symptom I have is difficulty falling or staying asleep, constant dreaming anytime I sleep wake up with red heavy sunken eyes with hollow cheeks, but I don’t feel fatigued at all, sleep attack, cataplexy or hypnagogic hallucinations
    What’s wrong with me? Is this still narcolepsy or its early stage ? I will also add that I kinda in a sedentary lifestyle now where i use a lot of mobile phone any help or advice?

  27. I don’t have all the symptoms, but could I still have it? I do fall asleep out of nowhere. Like, I can start to fall asleep and be actually asleep in a minute. When I get tired out of nowhere, it’s impossible to stay awake. This happens at night when I am on my way to work 3rd shift with my dad. (We both work at Walmart overnight and the reason I work with him at night is because I’m a loser with no license or car, not even a permit). Anyway, I have hallucinations even when I’m not tired. I swear I see a customer walk into the isle I’m in during work, but I look and no one’s there. I once fell asleep holding canned vegetables when I was organizing them. I also fell asleep towards the end of the day during school and I tried to stay awake, but I couldn’t no matter what. I do this during my breaks at work too. I think I have narcolepsy, but I need to know for sure.

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