Sleep – Wake Disorders
Sleep-Wake disorders are divided into two major categories: Dyssomnias and Parasomnias.
Dyssomnias involve difficulties in getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep, such as not feeling refreshed even though you have slept the whole night. Parasomnias are characterized by abnormal behavioral or psychological events that occur during sleep, such as nightmares and Sleepwalking.
In addition to daytime sleepiness, some people with narcolepsy experienced cataplexy, a sudden loss of muscle tone. Cataplexy occurs while the person is awake and can range from slight weakness in the facial muscles to complete physical collapse. Cataplexy lasts from several seconds to several minutes; it is usually preceded by strong emotion such as anger or happiness. People with Narcolepsy periodically progress right to this dream-sleep stage almost directly from the state of being awake. Narcolepsy includes rapid loss of muscle tone that can be quite mild or result in complete collapse. Often accompanied by Sleep paralysis and /or hypnagogic hallucination (illusion of being caught in a fire or flying through the air.
1. Episodes of cataplexy, occurring at least a few times per month.
a. Brief episodes of sudden bilateral loss of muscle tone with maintained consciousness.
b. Spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.
2. Three different stages:
Mild: Infrequent Cataplexy,need for naps only once or twice per day, and less disturbed nocturnal sleep.
Moderate: Cataplexy once daily or every few days, disturbed nocturnal Sleep, and need for multiple naps daily.
Severe: Drug resistant Cataplexy with multiple attacks daily, nearly constant sleepiness and disturbed nocturnal sleep.
Narcolepsy is associated with a cluster of genes on chromosome 6, and it may be an autosomal recessive trait. It appears that there is a significant loss of a certain type of nerve cell (hypocretin neurons) in those with narcolepsy. These neurons create peptides that appear to play an important role in wakefulness, although why these Individuals lack just these specific neurons is not yet understood.
The Suggested treatment for Narcolepsy is usually medical which includes stimulant drugs.
David H. Barlow, BOSTON UNIVERSITY
V. Mark Durand, UNIVERSITY OF SOUTH FLORIDA- ST. PETERSBERG
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