Narcolepsy among Adults: A Descriptive Study

Abstract

Narcolepsy is a chronic disorder of impaired expression of wakefulness and rapid-eye-movement (REM) sleep, reported more in adults as they have less sleeping hours because of busy work schedules whether in office or at home. There are studies indicating narcolepsy among old people as they suffer from different diseases due to their age but studies showing narcoleptic adults are lacking. The purpose of present study is to know about this under-recognized disease during adulthood. Pathophysiological studies have shown that the disease is caused by the early loss of neurons in the hypothalamus that produce hypocretin, a wakefulnessassociated neurotransmitter present in cerebrospinal fluid. Only cataplexy exhibits a high specificity for diagnosis of narcolepsy. While the natural history is poorly defined, narcolepsy appears to be lifelong but not progressive. Mild disease severity, misdiagnoses or long delays in cataplexy expression often cause long intervals between symptom onset, presentation and diagnosis. Only 15-30% of narcoleptic individuals are ever diagnosed or treated, and nearly half first present for diagnosis after the age of 40 years. Treatment includes counseling as to the chronic nature of narcolepsy, the potential for developing further symptoms reflective of REM sleep dyscontrol, and the hazards associated with driving and operating machinery. Non pharmacological management also includes maintenance of a strict wake-sleep schedule, good sleep hygiene, the benefits of afternoon naps and a programme of regular exercise. Thereafter, treatment is highly individualized, depending on the severity of daytime sleepiness, cataplexy and sleep disruption .It is important that general practitioners and other primary health-care workers identify abnormal daytime sleepiness early. Keyword: sleeping disorder, cataplexy, narcolepsy, non-pharmacological therapy.