Narcolepsywas originally described towards the end of the 19th century and since then it has been possible to characterize more, having established its foundations, with a certain understanding of its biology. It is important to emphasize that currently, the treatments are better and wider, facilitating their management and thus improving the quality of life of patients.
Narcolepsy is characterized by the instability of sleep-wake transitions. Clinically, narcolepsy manifests with excessive daytime sleepiness that can be both personally and socially disabling. There may also be cataplexy, sleep paralysis, hypnagogic or hypnopompic hallucinations, but their presence is not necessary to make the diagnosis. In fact, a minority of patients with narcolepsy have all these symptoms.
Narcolepsy is classified as:
• Type 1 (with cataplexy)
• Type 2 (without cataplexy)
Cataplexy is transient muscle weakness by emotion is a specific characteristic of narcolepsy type 1. It often begins in the muscles of the face and may manifest itself with loosening of the jaw or a brief fall of the head. However, the episodes can be more dramatic and, if the trunk and limb muscles are also affected, a collapse can occur with a fall to the ground.
Narcolepsy has significant psychosocial consequences. As a result of their symptoms, people with narcolepsy may not be able to meet academic or work demands. On the other hand, your risk of a traffic accident is 3 to 4 times higher than in the general population, and more than a third of patients have suffered an accident due to drowsiness.
There is some evidence that shows that treatment eliminates this risk. Few systematic studies have examined mood disorders in narcolepsy, but studies tend to show a higher prevalence of psychiatric disorders than in the general population, most commonly depression and anxiety.
Narcolepsy should be included among the differential diagnoses of chronic excessive daytime sleepiness, but this disorder has many imitations.
Diagnosis is usually made late, with an average lapse between the onset of symptoms and diagnosis (8 to 22 years). However, the growing awareness of the disorder has improved the efficiency of the diagnostic process, and it is expected that this delay will decrease accordingly.
More commonly, symptoms arise in the second decade of life, but the age of onset varies significantly between the first and the fifth decade. Its incidence has a bimodal distribution, with the highest peak at approximately 15 years and a second smaller peak at the middle of the third decade. Some studies have suggested a slight masculine predominance.
Narcolepsy and differential diagnosis
• Sleep disorders
• Insufficient sleep syndrome
• Delayed sleep phase syndrome
• Idiopathic hypersomnia
• Disordered sleep breathing (obstructive or central).
• Sleep apnea
• Periodic disturbance of limb movement Kleine-Levin syndrome
As with many chronic disorders, the treatment of narcolepsy is symptomatic and non-curative, which can be done through pharmacological and non-pharmacological means. Here we will expose some non-pharmacological measures.
Planned naps of 15 to 20 minutes can help improve alertness. It is also important to schedule sleeping times, with good sleep hygiene, to ensure a sufficient night's sleep.
In one study, the combination of scheduled naps and regular nighttime sleep schedules reduced the level of daytime sleepiness and unintentional daytime sleep. Daytime naps were a great help for those with a higher degree of daytime sleepiness.
• The strategic use of caffeine can be useful and reduce dependence on pharmacological treatment.
• Routine screening for other sleep disorders, such as sleep apnea, should be done.
• When receiving treatment for other medical conditions, individuals with narcolepsy should avoid medications that can cause sedation, such as opiates or barbiturates.
• Alcohol must be diminished or avoided.
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